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PubMed1991

Gender differences in eating behavior and body weight regulation.

Gender differences in food intake and selection first appear in adolescence. Men consume more calories than women, and the sexes have different eating styles, which indicate that women have been socialized to eat in a more feminine manner. Women experience more food-related conflict than men do, in that they like fattening foods but perceive that they should not eat them. Pressures to be thin are present in early adolescence, as noted by dieting behavior starting in very young girls. Women experience more dissatisfaction with their body weight and shape than men do. Sociocultural and psychological factors may be important in the etiology of eating disorders, which are much more prevalent in females than in males. Thus, further studies of gender differences in eating behavior will be important for understanding the etiology of eating and body-weight disorders and for designing gender-appropriate treatments.

Body Image↗

PubMed1992

Relation of level of exercise, age, and weight-cycling history to weight and eating concerns in male and female runners.

We examined the association between level of exercise and degree of weight preoccupation in a large sample of male and female runners, as well as risk factors posited to influence weight and eating concerns in the general population. Subjects were 2,459 males and 1,786 females who had completed a questionnaire on weight and eating concerns in a national running magazine. Eight percent of the males and 24% of the females had symptomatic scores on the Eating Attitudes Test (EAT). Exercise level, defined as weekly running mileage, was positively associated with excessive weight and eating concerns in males but not in females. Both sexes with a history of weight cycling were more likely to have symptomatic EAT scores than those with no such history. These results highlight the importance of studying these concerns in males as well as females and of examining the role of exercise level and weight-cycling history in the development of serious weight preoccupations.

Adolescent↗

PubMed2004

Eating-disordered behaviors, body fat, and psychopathology in overweight and normal-weight children.

This study examined eating-disordered pathology in relation to psychopathology and adiposity in 162 non-treatment-seeking overweight (OW) and normal weight (NW) children, ages 6-13 years. Participants experienced objective or subjective binge eating (S/OBE; loss-of-control eating), objective overeating (OO), or no episodes (NE). OW children experienced significantly higher eating-disordered cognitions and behaviors than NW children and more behavior problems than NW children: 9.3% endorsed S/OBEs, 20.4% reported OOs, and 70.4% reported NEs. OW children reported S/OBEs more frequently than did NW children (p =.01), but similar percentages endorsed OOs. S/OBE children experienced greater eating-disordered cognitions (ps from <.05 to <.01) and had higher body fat (p <.05) than OOs or NEs. OOs are common in childhood, but S/OBEs are more prevalent in OW children and associated with increased adiposity and eating-disordered cognitions.

Adipose Tissue↗

PubMed1997

Women with insulin-dependent diabetes mellitus (IDDM) complicated by eating disorders are at risk for exacerbated alterations in lipid metabolism.

OBJECTIVE: To examine lipid parameters that are affected in women with insulin-dependent diabetes mellitus (IDDM) who engaged in disordered eating behaviours. DESIGN: Randomized, unmatched. SETTING: Tertiary care. SUBJECTS: Ninety women (18-46 y) with IDDM. INTERVENTIONS: Classification of subjects based on severity of eating disorder: clinical (n = 14), subclinical (n = 13) and control (n = 63). Blood was analysed for glycosylated haemoglobin (HbA1c) and serum for triglycerides and cholesterol. Carotenoid and tocopherol concentrations were analysed by high performance liquid chromatography (HPLC). Dietary intake was assessed by the National Cancer Institute food frequency questionnaire. RESULTS: HbA1c was significantly increased im women demonstrating clinical and subclinical symptoms compared to control (10.4 +/- 2.6, 10.0 +/- 1.5 and 8.3 +/- 1.6%, respectively, P < 0.05). Triglycerides concentrations were significantly increased in women with subclinical eating disorders compared to controls. In women who intentionally omitted or reduced insulin, triglyceride cholesterol and HbA1c were significantly increased compared to controls. Women with IDDM and eating disorders who exhibited bulimic behaviours consumed significantly more energy, total fat and cholesterol compared to controls and women with eating disorders who were restrained eaters. CONCLUSION: While IDDM is known to perturb lipid metabolism, these data demonstrate that eating disorders, in combination with IDDM, results in additional alterations in lipid metabolism.

Adolescent↗

PubMed2002

Weight-teasing among adolescents: correlations with weight status and disordered eating behaviors.

OBJECTIVES: This study aimed to assess the prevalence of perceived weight-teasing and associations with unhealthy weight-control behaviors and binge eating in a population-based sample of youth. Particular focus was placed on overweight youth, who may be most vulnerable to weight-teasing. METHODS: The study population included 4746 adolescents from St Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of Project EAT, a population-based study of eating patterns and weight concerns among teens. RESULTS: There were statistically significant associations between perceived weight-teasing and weight status; both overweight and underweight youth reported higher levels of teasing than average weight youth. Very overweight youth (body mass index (BMI) > or = 95th percentile) were most likely to be teased about their weight; 63% of very overweight girls, and 58% of very overweight boys reported being teased by their peers, while weight-teasing by family members was reported by 47% of these girls and 34% of these boys. Youth who were teased about their weight, particularly overweight girls, reported that it bothered them. Perceived weight-teasing was significantly associated with disordered eating behaviors among overweight and non-overweight girls and boys. For example, among overweight youth, 29% of girls and 18% of boys who experienced frequent weight-teasing reported binge-eating as compared to 16% of girls and 7% of boys who were not teased. CONCLUSIONS: Many adolescents, in particular those who are overweight, report being teased about their weight and being bothered by the teasing. Weight-teasing is associated with disordered eating behaviors that may place overweight youth at increased risk for weight gain. Educational interventions and policies are needed to curtail weight-related mistreatment among youth.

Adolescent↗

PubMed2006

Eating patterns and dietary composition in relation to BMI in younger and older adults.

OBJECTIVE: To compare relative associations of eating patterns and dietary composition with body mass index (BMI) in younger (aged 20-59 years, n=1792) and older (aged 60-90 years, n=893) participants in the Continuing Survey of Food Intakes by Individuals, collected 1994-1996. METHODS: Data from two 24-h dietary recalls from individuals reporting physiologically plausible energy intake (within +/-22% of predicted energy requirements, based on previously published methods) were used. RESULTS: Mean reported energy intake was 96 and 95% of predicted energy requirements in younger and older subjects, respectively. Older subjects were less likely than younger subjects to skip a meal, but snacking was common in both age groups. Fiber density was significantly higher in the older group. A higher BMI in both age groups was associated with a higher total daily energy intake, and higher energy intakes at all eating occasions. In both age groups, eating frequency was positively associated with energy intake, and eating more than three times a day was associated with being overweight or obese. In the younger group but not the older group, a lower fiber density coupled with higher percentage of energy from fat was independently associated with having a higher BMI. CONCLUSIONS: While no one eating occasion contributes more than any other to excess adiposity, eating more often than three times a day may play a role in overweight and obesity in both younger and older persons. A reduced satiety response to dietary fiber in addition to lower energy expenditure may potentially further contribute to weight gain in older persons.

Adult↗

PubMed1997

Serum leptin concentrations in patients with anorexia nervosa, bulimia nervosa and non-specific eating disorders correlate with the body mass index but are independent of the respective disease.

OBJECTIVE: Leptin, the product of the ob gene, is a recently discovered hormone secreted by adipocytes. Serum leptin concentrations increase in correlation with the percentage of body fat, but little else is known about the physiological actions of leptin in humans. The aim of this study was to determine the role of leptin in severe eating disorders, and whether its levels are correlated with the specific disease or exclusively with body weight. TESTS: Serum concentrations of human leptin were analysed by specific radioimmunoassay and compared with the individual body mass indexes (BMI). The correlations between serum leptin concentrations and BMI, age and height were analysed. PATIENTS: A total of 65 women were studied: 25 patients with anorexia nervosa, 20 women with bulimia nervosa, 6 women with a diagnosis of nonspecific eating disorder, and 14 normal-weight women who acted as controls. At the time of the study, the patients were non-cured, under treatment, and at different stages of therapeutic evolution. MEASUREMENTS: Plasma leptin levels were measured by specific radioimmunoassay. RESULTS: The mean serum leptin in the normal-weight women was 10.5 +/- 1.1 micrograms/l, compared with 7.6 +/- 1.1 micrograms/l in the anorexia nervosa patients (P < 0.05). This reduction in leptin levels was paralleled by the differences in BMI (21.4 +/- 0.4 vs 18.8 +/- 0.2) P < 0.05. These differences between the controls and anorexia nervosa patients were not observed in patients with bulimia nervosa who had a mean serum leptin level of 9.9 +/- 1.4 micrograms/l and BMI of 21.3 +/- 0.6, neither significantly different from controls. On the contrary, patients with non-specific eating disorders showed a large reduction in BMI (17.9 +/- 1.2, P < 0.05 vs control), and a parallel reduction in serum leptin levels, 4.5 +/- 1.0 (P < 0.05 vs controls). When individual values of leptin were plotted against BMI a wide range was observed in all groups; in the control subjects from 5.6 to 17.7 micrograms/l, in anorexia nervosa patients from 2.1 to 28.1 micrograms/l, in patients with bulimia nervosa between 2.6 and 25.9 micrograms/l, and in women with non-specific eating disorder from 2.0 to 8.9. No correlation was observed with the specific disease but in each group a significant correlation was observed only with BMI. CONCLUSIONS: Serum leptin levels in three groups of patients affected by severe eating disorders are not related to the specific pathology but are correlated with the individual BMI. The analysis of leptin values may be a useful index of assessing the adipose tissue stores in the clinical setting, but will be of no help for diagnosis nor prognosis of severe eating disorders.

Adult↗

PubMed2003

Lived experiences of eating problems for patients with head and neck cancer during radiotherapy.

Only a small proportion of cancer patients undergo radical radiotherapy to the head and neck, but their needs are particularly complex. Although extensive research describes the side-effects of radiotherapy to the head and neck, few studies focus on patients' subjective experiences of eating problems and the impact these have on the patients' daily life. In this study a phenomenological approach was used, as the purpose was to acquire deeper understanding of head and neck cancer patients' lived experiences of eating problems, their consequences in daily life and patients' strategies of coping with these problems. Eight patients from two radiation therapy departments in mid-Sweden were interviewed in an open dialogue. Data analysis was based on Colaizzi's method. Eating problems experienced were captured in two interrelated main themes: "Ability to chew and swallow" and "Will and desire to eat". The eating problems were found to cause a number of severe consequences in daily life. These are incorporated into one main theme: "The way of life is disturbed". Ways to cope with this disturbance were captured in one main theme: "Trying to see the end - To survive". This study identifies the need to view eating problems as a complex phenomenon in a specific context including the individual patient's life situation. The findings create the opportunity to develop nursing interventions based on patients' own needs. To facilitate this, a specialist nurse should be responsible for reviewing patients regularly throughout radiation therapy. Intervention studies are needed to provide optimal clinical guidelines.

Adaptation, Physiological↗

PubMed2000

Prevalence of cutaneous manifestations in 200 patients with eating disorders.

BACKGROUND: Eating disorders are increasing and show a variety of symptoms. They mainly include anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not specified (EDNOS). They predominate in females and represent an important danger, especially in teenagers. In serious cases, they may be life-threatening. Objective To determine the prevalence of cutaneous findings in patients with eating disorders and to compare the results with those found in the literature. METHODS: An observational, transverse, and prospective study was performed. Two hundred patients of recent admission to ALUBA (association that fights against BN and AN), a psychiatric unit for eating disorders, were included: 122 BN; 62 AN; 16 EDNOS. RESULTS: Patients with eating disorders show dermatologic manifestations (alopecia, xerosis, hypertrichosis, caries, nail fragility) that are secondary to starvation. Russell's sign, seen as calluses on the dorsal aspect of the hands, is a consequence of self-induced vomiting and the local trauma of the superior incisors. This sign represents a compensatory behavior to overeating and predominates in the BN group. CONCLUSION: The recognition of dermatologic signs could be of immense value and could lead to the early diagnosis and treatment of these eating disorders.

Adolescent↗

PubMed2002

Psychological characteristics of eating disorders as evidenced by the combined administration of questionnaires and two projective methods: the Tree Drawing Test (Baum Test) and the Sentence Completion Test.

The objective of this study is to examine psychological/psychopathological characteristics of eating disorders and their subtypes through a combined administration of questionnaires and projective tests. Three questionnaires (Eating Disorder Inventory - 2, Social Adaptation Scale, Southern California University Eating Disorder Inventory - Revised) and two projective tests (the Tree Drawing Test [TDT, Baum Test], and the Sentence Completion Test [SCT]) were administered to 126 female patients between the ages of 15 and 30 years, with eating disorders according to DSM-IV criteria at our outpatient clinic, and to 54 sex- and age-matched control subjects. The purging subtypes of eating disorders (anorexia nervosa - binge-eating/purging type [ANBP] and bulimia nervosa - purging type [BNP]) were clearly differentiated from the controls, both by the questionnaires and the projective tests. Compared with the controls, ANBP/BNP showed more problematic profiles across the three questionnaires, drew smaller and poorer trees in TDT to a more left location on the drawing paper, and gave fewer positive, and more negative responses in SCT. In contrast, few significant differences were found between anorexia nervosa- restricting type (ANR) and the controls, and between ANBP and BNP. As a trend, however, ANR was consistently located between the controls and ANBP/BNP across the whole questionnaires and projective tests.

Adolescent↗

PubMed2000

Detection, evaluation, and treatment of eating disorders the role of the primary care physician.

OBJECTIVE: To describe how primary care clinicians can detect an eating disorder and identify and manage the associated medical complications. DESIGN: A review of literature from 1994 to 1999 identified by a MEDLINE search on epidemiology, diagnosis, and therapy of eating disorders, including anorexia nervosa and bulimia nervosa. MEASUREMENTS AND MAIN RESULTS: Detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in activities valuing thinness, family history of an eating disorder, amenorrhea, lanugo hair) and bulimia nervosa (e.g., unsuccessful attempts at weight loss, history of childhood sexual abuse, family history of depression, erosion of tooth enamel from vomiting, partoid gland swelling, and gastroesophageal reflux). Providers must also remain alert for disordered eating in female athletes (the female athlete triad) and disordered eating in diabetics. Treatment requires a multidisciplinary team including a primary care practitioner, nutritionist, and mental health professional. The role of the primary care practitioner is to help determine the need for hospitalization and to manage medical complications (e.g., arrhythmias, refeeding syndrome, osteoporosis, and electrolyte abnormalities such as hypokalemia). CONCLUSION: Primary care providers have an important role in detecting and managing eating disorders.

Anorexia Nervosa↗

PubMed2003

Four simple questions can help screen for eating disorders.

Current screening instruments for eating disorders are cumbersome to administer and have not been validated in primary care populations. We compared the performance characteristics of 2 screening tools, the SCOFF clinical prediction guide, and a new set of questions, the Eating disorder Screen for Primary care (ESP), using the Questionnaire for Eating Disorders Diagnosis as the independent standard, in 104 consecutive patients from a primary care practice and 129 university students. Twelve percent of the combined population had an eating disorder. One or no abnormal responses to the ESP ruled out an eating disorder (likelihood ratio [LR] 0.0), whereas 3 or more abnormal responses ruled one in (LR 11). The SCOFF questions were less sensitive than predicted (1 or no abnormal responses, LR 0.25), but were as effective at ruling in an eating disorder (3 or more abnormal responses, LR 11).

Feeding and Eating Disorders↗

PubMed2001

Changes in eating disorder symptoms with pediatric obesity treatment.

OBJECTIVE: To evaluate the effects of behavioral, family-based treatment on disordered eating and child behavior problems for obese 8- to 12-year-old children. STUDY DESIGN: We examined disordered eating in children and parents using the Kids' Eating Disorder Survey (KEDS) and the Binge Eating Scale, respectively; and psychologic problems in children and their parents using the Child Behavior Checklist and Symptom Checklist-90, respectively, in 47 families who participated in a family-based obesity treatment program. RESULTS: Obese children showed significant decreases (-12.5 +/- 13.5) in percent overweight, internalizing problems (-7.0 +/- 7.3), and total behavior problems (-4.8 +/- 6.6) and increases in behavioral competence (3.7 +/- 5.0) over 2 years of measurement; and their parents showed significant decreases in weight (-5.0 +/- 8.3 kg) and reductions in parental distress (-2.3 +/- 7.6) and in disturbed eating and weight-related cognition (-3.2 +/- 5.3). No significant changes were observed in total KEDS (-0.2 +/- 1.9), weight dissatisfaction (-0.3 +/- 1.7), or purging/restricting (0.2 +/- 0.6) scores. Decreases in total KEDS were related to decreases in total behavior problems and externalizing behavior problems. CONCLUSIONS: These results document improvements in child behavior problems and competence and no change in symptoms of disordered eating in a standardized behavioral weight control program.

Body Mass Index↗

PubMed1991

The efficiency of chewing during eating and ruminating in goats and sheep.

The total amounts of time spent eating and ruminating per 24 h by goats and sheep were determined. The efficiencies of chewing during eating (mean value of C.EAT) and chewing during ruminating (mean value of C.RUM) on the breakdown of feed particles to below the critical size required to leave the rumen (less than 1.0 mm) were investigated. All studies were done with the animals fed on a chaffed lucerne (Medicago sativa) hay diet. Goats spent more time eating (+3.1 h; P less than 0.01), and less time ruminating (-2.2 h; P less than 0.05) per 24 h, than sheep, when fed hourly at ad lib. intake. The efficiency of chewing during eating (mean value of C.EAT) in breaking down feed particles to less than 1.0 mm was greater in goats (85%; P less than 0.01) than sheep (48%). The process of rumination in sheep served to reduce the feed particles which were greater than 1.0 mm in the rumen to less than 1.0 mm. Sheep tended to be more efficient in this process than goats (59 v. 48%), with the difference not attaining significance (P greater than 0.1). The greater frequency of chews (number of total jaw movements/min) during eating in goats (P less than 0.01), or during ruminating in sheep (P less than 0.001), was the major component explaining differences in efficiency between the two species in both the eating and rumination processes. When corrected for the number of chews/min, the differences in mean value of C.RUM and mean value of C.EAT were not significant between goats and sheep.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Nutritional Physiological Phenomena↗

PubMed2001

Affluent adolescent girls of Delhi: eating and weight concerns.

Despite a dramatic increase in research on eating-related pathologies, gaps remain in our understanding of the factors responsible for the development and maintenance of dysfunctional attitudes and behaviour related to weight and eating among adolescents. A study was therefore conducted to compare eating and weight concerns among underweight, normal-weight and obese affluent adolescent girls in New Delhi. The sample comprised fifty underweight, fifty normal-weight and thirty obese girls, 16-18 years of age. Information was collected about their body image perception, weight concerns and eating attitudes by a well-structured questionnaire. Dietary intake was determined by 24 h recall and a food-frequency questionnaire. Body size was adjudged by measurements of weight, height, waist, hip and mid upper arm circumferences, and the BMI and waist : hip ratio were determined. Of the subjects, 99.2 % had a gynoid pattern of fat distribution. Concerns about excess weight were prevalent among the adolescent girls, even among those who were normal-weight and underweight. The level of satisfaction with body size decreased with increase in weight. Dieting behaviour was reported in a higher number of obese (76.6 %) compared with normal-weight (38 %) and underweight (14 %) girls. Of the obese girls, 43.3 % were found to be at a significantly (P=0.00109) greater risk of developing anorexia in the future. Characteristic dietary features of adolescence, such as missing meals, snacking and eating out, were observed. While the diets of most of the subjects were adequate in Ca, thiamin, riboflavin and vitamin C, they were found to be deficient in energy, protein, Fe, niacin, vitamin A and fibre. Thus, it is important to recognize that weight concerns and dissatisfaction with body size may pose a threat to a healthy nutritional state, and may develop into precursors of a later eating disturbance.

Adolescent↗

PubMed2006

Breakfast eating and overweight in a pre-school population: is there a link?

OBJECTIVES: To analyse the socio-economic factors related to breakfast eating, the association between breakfast eating and overweight, and to gain a more thorough understanding of the relationship between these two elements in a population-based cohort of 4.5-year-old children. We hypothesised that a relationship could be observed between breakfast skipping and overweight independently of socio-economic factors such as ethnicity, maternal education, single parenting and family income. DESIGN: A population-based study whereby standardised nutritional interviews were conducted with each child's parent. The children's height and weight were taken by a trained nutritionist and parents were asked about their child's breakfast eating. SETTING: The analyses were performed using data from the Québec Longitudinal Study of Child Development (1998-2002), conducted by Santé Québec (Canada). SUBJECTS: Subjects were 1549 children between the ages of 44 and 56 months, with a mean age of 49 months. RESULTS: Almost a tenth (9.8%) of the children did not eat breakfast every day. A greater proportion of children with immigrant mothers (19.4% vs. 8.3% from non-immigrant mothers), with mothers with no high school diploma (17.5% vs. <10% for higher educated mothers) and from low-income families (15% for income of $39,999 or less vs. 5-10% for better income) did not eat breakfast every day. Not eating breakfast every day nearly doubled the odds (odds ratio=1.9, 95% confidence interval 1.2-3.2) of being overweight at 4.5 years when mother's immigrant status, household income and number of overweight/obese parents were part of the analysis. CONCLUSION: Although our results require replication before public policy changes can be advocated, encouraging breakfast consumption among pre-school children is probably warranted and targeting families of low socio-economic status could potentially help in the prevention of childhood obesity.

Adult↗

PubMed2000

Perception of parental acceptance in women with binge eating disorder.

The authors contribute to the validating literature for binge eating disorder (BED) by examining perceptions of parents and satisfaction with life among obese women with and without BED. Participants were female patients, recruited through a private medical clinic, who were assigned to groups on the basis of body mass index (BMI) and scores on the Questionnaire on Eating and Weight Patterns (QEWP; R. L. Spitzer et al., 1992). Groups consisted of (a) obese women with BED (n = 32), (b) obese women who had no eating disorders (n = 51), and (c) nonobese women with no eating disorders (n = 30). All participants completed the Parental Acceptance/Rejection Questionnaire (PARQ; R. P. Rohner, 1986), the Satisfaction with Life Scale (SWLS; J. Fischer & K. Corcoran, 1994), and the Beck Depression Inventory (BDI; A. T. Beck & R. A. Steer, 1987). Obese women with BED perceived their fathers as more rejecting than did women in the other groups. Moreover, obese women with BED perceived their fathers as significantly more rejecting than their mothers. The BED group indicated lower satisfaction with life and higher levels of depression than the groups without eating disorders. These findings further validate the diagnostic category of BED. Obese women with BED appear to be a distinct subgroup of the obese population. The results indicate a need for further assessment of the father-daughter relationship in connection to BED and other eating disorders.

Compulsive Behavior↗

PubMed1998

Eating disorders among Indian and Australian university students.

In a study of eating disorders, 297 Australian and 249 Indian university students completed the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982) and the Goldfarb Fear of Fat Scale (GFFS; Goldfarb, Dykens, & Gerrard, 1985). Contrary to predictions, the Indian participants scored significantly higher than the Australian participants on both measures. The Indian women scored significantly higher than the Australian women on the EAT-26 but not on the GFFS. The Australian men showed significantly fewer symptoms than all other groups. The Indian men did not differ from the Australian or Indian women on either the EAT-26 or GFFS. The urban Indians did not differ from their rural counterparts on the GFFS, but the rural Indians had significantly higher EAT-26 scores than the urban Indians.

Adolescent↗