Eating disorders in adolescents: a background paper

Anorexia nervosa in a Thai adolescent

In Thailand, anorexia nervosa (AN) has rarely been reported. We report a 13- year-old female adolescent with AN restrictive type, the first from Thailand to meet all Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revision (DSM IVTR) criteria for AN. The emergence of a patient with AN in Khon Kaen, a province from the region with the lowest gross domestic product, accentuates the existence of eating disorders in adolescents beyond Thailand capital. Future studies considering sociocultural issues on normal eating attitudes, eating behaviors and body image in Thailand should be conducted.

Respiratory acidosis in adolescents with anorexia nervosa hospitalized for medical stabilization: a retrospective study

OBJECTIVE

To examine the effect of malnutrition due to anorexia nervosa (AN) on venous blood gases of adolescents with AN hospitalized for medical stabilization.

METHOD

This retrospective study included 45 adolescents with recent onset (<1 year) AN diagnosed by DSM-IV criteria and excluded subjects with a history of lung disease.

RESULTS

Mean (± SD) age at hospitalization was 15.0 ± 2.0 years; time from onset of symptoms was 6.8 ± 3.0 months; body mass index (BMI) was 15.2 ± 1.5 kg/m(2) ; and minimal nocturnal heart rate (MNHR) was 39.8 ± 7.2 beats/min. On admission, pH was 7.32 ± 0.02, pCO(2) was 53.8 ± 4.6 mm Hg, and HCO(3) was 28.1 ± 2.1 mEq/l. Significant changes (p < .001) occurred during the relatively short hospitalization (9.7 ± 5.1 days): venous pH increased, pCO(2) decreased, HCO(3) decreased, MNHR increased, and heart rate orthostasis decreased. Mild respiratory acidosis (pH < 7.35 and pCO(2) > 45 mm Hg) was observed in 78% of the patients on admission and only in 35% at discharge (p = .0003). Positive correlations were found between % of weight loss and pCO(2) on admission and between BMI on admission and the delta pCO(2) during hospitalization.

DISCUSSION

Mild respiratory acidosis is common in adolescents with recently diagnosed AN, hospitalized for medical stabilization. Respiratory acidosis improves with bed rest and refeeding. The clinical significance of these findings should be further evaluated.

A study on consciousness of adolescent girls about their body image

Background:

Perceived body image is an important potential predictor of nutritional status. Body image misconception during adolescence is unexplored field in Indian girls.

Objectives:

To study the consciousness of adolescent girls about their body image.

Materials and Methods:

This multistage observational study was conducted on 586 adolescent girls of age 10–19 years in Lucknow district (151 from rural, 150 from slum, and 286 from urban area) of Uttar Pradesh, India. Information on desired and actual body size was collected with the help of predesigned questionnaire.

Results:

20.5% of studied girls show aspiration to become thin, who already perceived their body image as too thin. 73.4% adolescent girls were satisfied with their body image, while 26.6% were dissatisfied. The dissatisfaction was higher among girls of urban (30.2%) and slum (40.0%) areas in comparison to rural (22.5%) area. Percentage of satisfied girls was less in the 13–15 years (69.9%) age groups in comparison to 10–12 years (76.5%) and 16–19 years (76.4%). Among girls satisfied with their body image, 32.8% girls were found underweight, and 38.4% were stunted. Underweight girls (42.1%) and stunted girls (64.9%) were higher in number within satisfied girls of slum area. Among all of these adolescent girls, 32.8% of girls had overestimated their weight, while only 4.9% of girls had underestimated their weight.

Conclusions:

This study concludes that desire to become thin is higher in adolescent girls, even in those who already perceived their body image as too thin.

A risk model for preadolescent disordered eating

OBJECTIVE

This study tested this risk model for disordered eating in preadolescent girls: pubertal onset is associated with increases in negative urgency (the personality tendency to act rashly when distressed); negative urgency influences eating disorder symptoms by shaping psychosocial learning (expectancy formation), thus indirectly influencing symptom levels; and many influences on purging are mediated by binge eating.

METHOD

Nine hundred five fifth grade girls completed questionnaire measures of eating pathology, negative urgency, and dieting/thinness and eating expectancies.

RESULTS

Binge eating and purging behaviors were present in fifth grade girls. As anticipated, pubertal status was associated with higher levels of negative urgency, negative urgency was associated with each expectancy measure, quadratic dieting/thinness and eating expectancies were associated with binge eating, and binge eating was associated with purging.

DISCUSSION

It is important and feasible to develop risk models for preadolescent eating disordered behaviors. Our model that integrates puberty, personality, and psychosocial learning appears promising.

Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions

Restoring sleep is strongly associated with a better physical, cognitive, and psychological well-being. By contrast, poor or disordered sleep is related to impairment of cognitive and psychological functioning and worsened physical health. These associations are well documented not only in adults but also in children and adolescents. Importantly, adolescence is hallmarked by dramatic maturational changes in sleep and its neurobiological regulation, hormonal status, and many psychosocial and physical processes. Thus, the role of sleep in mental and physical health during adolescence and in adolescent patients is complex. However, it has so far received little attention. This review first presents contemporary views about the complex neurobiology of sleep and its functions with important implications for adolescence. Second, existing complex relationships between common adolescent somatic/organic, sleep-related, and psychiatric disorders and certain sleep alterations are discussed. It is concluded that poor or altered sleep in adolescent patients may trigger and maintain many psychiatric and physical disorders or combinations of these conditions, which presumably hinder recovery and may cross into later stages of life. Therefore, timely diagnosis and management of sleep problems appear critical for growth and development in adolescent patients.

Nocturnal enuresis in adolescents with anorexia nervosa: prevalence, potential causes, and pathophysiology

OBJECTIVE

The aim of this study was to determine the prevalence and potential causes of secondary nocturnal enuresis (NE) in adolescents with anorexia nervosa (AN).

METHOD

Adolescents with AN completed the Incontinence Symptom Index-Pediatric (ISI-P), a self-report urinary incontinence survey. Those who had NE associated with the onset of AN on the ISI-P completed a comprehensive clinical and laboratory evaluation, including urinary flow measurements.

RESULTS

The prevalence of NE in adolescents with AN was 17.0% (10 of 59). The overall frequency of day- and night-time urinary incontinence symptoms in adolescents with AN was 62.7%; urgency incontinence, 57.6%; stress incontinence, 32.2%; and insensate incontinence, 17.0%. Nine of the 10 adolescents with NE had secondary NE and confirmed that bedwetting ceased after weight restoration.

DISCUSSION

Decreased functional bladder capacity and detrusor instability may contribute to the NE observed in this population. The high prevalence of NE in adolescents with AN warrants further study to determine the potential causative pathways. Clinicians who work with adolescents with AN should assess for this problem.

Identification and management of eating disorders in children and adolescents

The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disorders may affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination.

The influence of a behavioral weight management program on disordered eating attitudes and behaviors in children with overweight

BACKGROUND

Behavioral interventions targeting children with overweight have been successful in facilitating weight loss; however, there is concern that these programs produce disordered eating attitudes among youth.

OBJECTIVE

The purpose of this research was to determine whether youth with overweight receiving one of two behavioral interventions were more likely to report an increase in disordered eating attitudes over time compared to a waitlist control and to determine psychosocial predictors of eating-disordered attitudes at 6-month follow-up.

DESIGN

Participants were randomized to one of two behavioral lifestyle interventions or a waitlist control. Data were collected at baseline, post-treatment, and 6-month follow-up.

PARTICIPANTS/SETTING

Participants were 68 youths with overweight, aged 8 to 13 years, and their parent(s) who lived in rural north central Florida. The project ran from January 2006 to January 2008.

INTERVENTION

Each treatment condition consisted of 12 group sessions over 16 weeks.

MAIN OUTCOME MEASURES

Parents completed a demographic form and the Child Feeding Questionnaire. Children completed the Children's Eating Attitudes Test, Schwartz Peer Victimization Scale, and Children's Body Image Scale.

STATISTICAL ANALYSES PERFORMED

Mixed 2×2 analyses of variance were used to examine the effect of treatment on eating attitudes. Hierarchical linear regression was used to assess whether baseline levels of psychosocial variables predicted disordered eating attitudes at follow-up, controlling for baseline eating attitudes and treatment condition.

RESULTS

Youth who participated in the behavioral interventions did not report significant increases in disordered eating attitudes over time compared to the waitlist control. Across all conditions, higher levels of body dissatisfaction, peer victimization, parent restrictive feeding practices, and concern for child weight at baseline predicted higher levels of disordered eating attitudes at follow-up.

CONCLUSIONS

These findings do not provide evidence that behavioral interventions lead to an increase in unhealthy eating attitudes and behaviors. Future research should examine the effects of incorporating eating disorder prevention in pediatric weight management programs.

Is there a role for primary care physicians' screening of excessive weight and eating concerns in adolescence?

OBJECTIVES

To determine the extent to which adolescents with excessive weight concerns and eating concerns are in contact with primary care physicians and could thus be identified in primary care.

STUDY DESIGN

A representative sample of 7548 (16 to 20 years old) students completed a self-administered questionnaire on health-related topics (2002 Swiss Multicenter Adolescent Health Survey). Adolescents with excessive weight and eating concerns were compared with control subjects for frequency of somatic complaints and primary care visits in the past year. Analyses were stratified by sex. Logistic regression was used to adjust for confounders.

RESULTS

Excessive weight and eating concerns were frequent in adolescents, particularly in girls (girls, 13.9%; boys, 1.6%). Adolescents with these concerns reported more frequent somatic complaints compared with their peers. Nearly 80% of them were in contact with a primary care physician at least once a year.

CONCLUSION

Primary care physicians are in contact with adolescents who have excessive weight and eating concerns. Identification of these concerns should be encouraged for appropriate management.

The experience of siblings of adolescents with eating disorders

PURPOSE

To qualitatively and quantitatively explore the experience and QOL of siblings of AEDs. To date, there is little research on the quality of life (QOL) and the effect an eating disorder (ED) has on the siblings of adolescents with an eating disorder (AEDs).

METHODS

Siblings were recruited between January 2008 and April 2008. Inclusion criteria included siblings aged 10-18 years old and living with a sibling with an ED. Exclusion criteria included having an ED, or major psychiatric disorder, or a communication problem that interfered with their participation. Siblings completed a general assessment questionnaire, the Pediatric Quality of Life inventory 4.0 Generic Core Scales and Eating Attitudes Test-26 (EAT-26). Focus group interviews were conducted until saturation was achieved and thematic analysis was employed.

RESULTS

Twenty siblings (14 females) of 17 AEDs (15 females) participated. All but one sibling scored within the normal range for the Eating Attitudes Test-26. Key themes identified included a desire to understand the ED, acute awareness of ED behaviors and thoughts, challenges in understanding noneating-related obsessive behaviors, increase in family conflict and arguments, compassion and concern for the AED, feelings of loss and sacrifice, overwhelming sense of responsibility for the AED, and a sense of pervasiveness of the ED in all aspects of their lives. The siblings' accounts of these themes were noted to be fraught with contradictions. Eighty percent reported that their QOL was negatively affected by the onset of their siblings' ED.

CONCLUSION

Clinical attention and further research into the experience of siblings of adolescents with ED is needed.

Peer status and victimization as possible reinforcements of adolescent girls' and boys' weight-related behaviors and cognitions

OBJECTIVE

Reciprocal longitudinal associations among weight-related behaviors and cognitions and peer relations constructs were examined among adolescent males and females.

METHODS

Participants included 576 adolescents aged 10-14 years, in grades 6-8. Measures assessed body dissatisfaction, negative weight-related cognitions, weight management behaviors, muscle-gaining behaviors, body mass index (BMI), likeability, popularity, and victimization at two time points, approximately 11 months apart. Multiple group path analyses were conducted to examine the reciprocal longitudinal associations between the peer relations constructs and weight-related behaviors and cognitions, controlling for participants' Time 1 BMI, pubertal development, and age.

RESULTS

Higher levels of body dissatisfaction were associated longitudinally with decreases in popularity. Higher popularity and lower likeability each were associated longitudinally with increases in negative body-related cognitions. Higher popularity was associated longitudinally with muscle-gaining behaviors for boys.

CONCLUSIONS

Findings suggest highly popular and disliked adolescents may be at greater risk of weight-related behaviors and cognitions than other adolescents.

Randomized controlled clinical trial of yoga in the treatment of eating disorders

PURPOSE

This was a pilot project designed to assess the effect of individualized yoga treatment on eating disorder outcomes among adolescents receiving outpatient care for diagnosed eating disorders (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified).

METHODS

A total of 50 girls and 4 boys aged 11-21 years were randomized to an 8-week trial of standard care vs. individualized yoga plus standard care. Of these, 27 were randomized to standard care and 26 to yoga plus standard care (attrition: n = 4). Standard care (every other week physician and/or dietician appointments) was required to meet ethical guidelines. The No Yoga group was offered yoga after study completion as an incentive to maintain participation. Outcomes evaluated at baseline, end of trial, and 1-month follow-up included Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State-Trait Anxiety Inventory, and Food Preoccupation questionnaire.

RESULTS

The Yoga group demonstrated greater decreases in eating disorder symptoms. Specifically, the EDE scores decreased over time in the Yoga group, whereas the No Yoga group showed some initial decline but then returned to baseline EDE levels at week 12. Food preoccupation was measured before and after each yoga session, and decreased significantly after all sessions. Both groups maintained current BMI levels and decreased in anxiety and depression over time.

CONCLUSIONS

Individualized yoga treatment decreased EDE scores at 12 weeks, and significantly reduced food preoccupation immediately after yoga sessions. Yoga treatment did not have a negative effect on BMI. Results suggest that individualized yoga therapy holds promise as adjunctive therapy to standard care.

Eating disorders in adolescents and their repercussions in oral health

OBJECTIVE

To examine the prevalence of oral alterations related to eating disorders and associated factors.

METHOD

A cross-sectional study including 650 adolescents aged from 12 to 16 was carried out through self-report questionnaires (EAT-26; BITE and self-rating hamilton depression questionnaire, SRHDQ) and dental examination.

RESULTS

Significant associations were observed in mucositis, cheilitis, hypertrophy of salivary glands, and dental erosions. The prevalence of adolescents at risk for eating disorders was of 33.1%, according to EAT-26 and 1.7% (high scores) and 36.5% (medium scores), in BITE, higher among 13-year-old females, with brothers, parents or responsible person who are illiterate, being the youngest child, living in a residence of at most two rooms and who showed depressive symptoms. All these factors showed significant relation to eating disorders.

DISCUSSION

Presence of oral alterations is associated to symptoms of eating disorders, helping precocious detection of sub clinical cases.

Eating disorders in the obstetric and gynecologic patient population

The eating disorders anorexia nervosa and bulimia nervosa and eating disorders not otherwise specified disproportionately affect women, have profound effects on the overall well-being of women and their children, and can have mortality rates as high as those found with major depression. These disorders may present to obstetrician-gynecologists (ob-gyns) clinically as menstrual dysfunction, low bone density, sexual dysfunction, miscarriage, preterm delivery, or low birth weight in offspring. Ninety percent of eating disorders develop before the age of 25 in otherwise healthy young women, a group that characteristically seeks the majority of their health care from ob-gyns. For all of these reasons, ob-gyns must have a greater awareness of these disorders and a lower index of suspicion for screening their patients than they currently do. Otherwise, they may miss life-threatening illness, treat characteristic amenorrhea inappropriately, or inadvertently intervene to help these women conceive, contributing to maternal and fetal risks. As providers of both primary and specialty care for women, ob-gyns have the opportunity to play a vital role in prevention and diagnosis of eating disorders and in the multidisciplinary management required to effectively manage these disorders.

Time since menarche, weight gain and body image awareness among adolescent girls: onset of eating disorders?

BACKGROUND

Eating, body weight and shape feelings and behaviours of female adolescents in relation to the time since their first menstrual period were studied.

METHOD

Three hundred sixty three female school students, aged 12-17 years participated in a cross-sectional computer survey.

RESULTS

There was a significant increase in body weight following menarche including a rapid rise from 7-12 months after menarche (47.4 kg, 95% CI 45.2-49.7, 56.9 kg 95% CI 54.0-59.8). Students did not immediately adjust their perception of body weight to incorporate this rapid rise. The discrepancy between actual and desired weight was greatest 7-12 and 13-24 months after menarche. Weight losing behaviours and associated feelings around body image increased significantly following menarche in adolescents of all body weights. Increases were related to body weight and time since menarche, but not to age. Binge eating commenced more than 6 months after menarche and purging behaviour after 12 months.

CONCLUSION

Both time since menarche and increase in body weight following menarche are associated with increasing concerns about eating, body image and weight losing behaviour. Some young women develop eating disorders. Menarche and subsequent weight gain appear as a risk factor for the onset of eating disorders.

Preventing obesity and eating disorders in adolescents: what can health care providers do?

This article describes five research-based recommendations for health care providers to help prevent both obesity and eating disorders among adolescents that they see within clinical, school, or other settings. The recommendations are based primarily upon findings from Project EAT, a large, population-based study of eating and weight-related issues in adolescents. Recommendations include the following: 1) discourage unhealthy dieting; instead encourage and support the use of eating and physical activity behaviors that can be maintained on an ongoing basis; 2) promote a positive body image; 3) encourage more frequent, and more enjoyable, family meals; 4) Encourage families to talk less about weight and do more at home to facilitate healthy eating and physical activity; and 5) assume that overweight teens have experienced weight mistreatment and address this issue with teens and their families. These recommendations stress the importance of helping adolescents and their families focus less on weight and more on sustained behavioral change.

Developmental pathways of eating problems in adolescents

OBJECTIVE

To examine the developmental eating trajectories of adolescents and identify psychological correlates and risk factors associated with those trajectories.

METHOD

Seven hundred thirty-nine adolescents completed self-reported measures of eating problems, internalizing and externalizing behaviors, alcohol and drug use, peer victimization, and depression.

RESULTS

Five eating trajectories were obtained. The proportions of males and females were the same in the increasing eating problems trajectory. For both genders, internalizing and externalizing problems were identified as associated risk factors of an eating pathology and reporting at least some eating problems was associated with an increased likelihood of psychological problems. Other risk factors found only in boys were frequency of drug use, victimization, and depressive symptoms.

CONCLUSION

Externalizing problems in girls and internalizing behaviors in boys with disordered eating should not be overlooked. Atypical eating behaviors in boys are of particular concern since it increases their risk of cooccurring psychopathology.

Variations in admission practices for adolescents with anorexia nervosa: a North American sample

PURPOSE

The purpose of this study was to assess the variability in admission practices and medical inpatient care for adolescent patients with anorexia nervosa (AN).

METHODS

Participants consisted of members of the 2001-2003 Eating Disorder Special Interest Group from the Society for Adolescent Medicine who completed a structured telephone interview about their admission practices and patterns of inpatient care for teens with AN. Questions focused on admission threshold for heart rate (HR), percentage of ideal body weight (% IBW), and refeeding protocols. Case vignettes were used.

RESULTS

Of 95 eligible practitioners, 51 (53%) agreed to participate. Participants represented 25 American states, one Canadian province, and 45 different adolescent programs. The majority of physicians reported they would hospitalize an AN patient with HR <40 beats/min. The most common response for when to hospitalize based on % IBW was 75% IBW. There were no differences in admission practices based on number of years in practice, gender of physician, or practice setting. Regional differences in admission practices were noted, with physicians in the western United States less likely to admit patients with HR >or=40 beats per minute (p = .018). Physicians described 28 different methods of advancing a diet during an admission. Only 37% of physicians were aware of a standardized refeeding protocol in their institution.

CONCLUSION

This study indicates variability in admission criteria and refeeding practices and shows evidence of geographic variations of admission standards. These data provide a baseline for outcome trials investigating medical admissions for adolescents with AN.

Clinical practice guidelines for treating restrictive eating disorder patients during medical hospitalization

PURPOSE OF REVIEW

Anorexia nervosa is a life-threatening complex psychiatric disorder that often requires patients to be medically hospitalized. In order to help provide consistent high-quality care to inpatients medically hospitalized for nutritional deficiency, a clinical practice guideline for these patients was created at Children's Hospital Boston. This paper reviews essential components of the clinical practice guideline for patients with restrictive eating disorders.

RECENT FINDINGS

There is considerable variability in admission practices, inpatient treatment and discharge criteria for patients with anorexia nervosa. Weight restoration is one critical factor in treatment, and research suggests that some medical complications are reversible with weight restoration. Weight gain during hospitalization is associated with better short-term outcomes, which indicate patients are continuing toward recovery. However, patients must be closely monitored during nutritional rehabilitation to avoid complications.

SUMMARY

The clinical practice guideline for patients with restrictive eating disorders outlines the care patients receive during the course of their hospitalization. The clinical practice guideline has been effective in helping patients to meet weight-gain goals. Clinical practice guideline outcome data could be used to compare protocols on a national level and help establish best practices for the inpatient medical treatment for these patients.

Avoiding Conflict

Music therapy is an integral part of the inpatient treatment programme for young women with disordered eating at the Royal Children's Hospital in Melbourne. As part of ongoing clinical audit activities, an investigation was undertaken to analyse retrospectively the lyrics of young women who had participated in the music therapy programme. The purpose was to monitor and improve local clinical practice and clarify the specific contribution of music therapy to the diagnosis of anorexia nervosa. Results highlighted the role of mothers in the experiences of the young participants, with references to this relationship exceeding those to any other relationships. These findings are discussed in conjunction with an abandoned study where parental consent was not forthcoming for participation in a group music therapy research project. This article promotes a continuing awareness of the importance of the mother-daughter relationship in the treatment of eating disorders.

An evaluation of eating disorders among a group of Turkish university students

The prevalence of eating disorders has been increasing in the last 20 years, not only in developed countries, but also in less developed countries such as Turkey. This study was conducted among 610 university students, 338 males and 272 females who are between 17 and 23 years old, in Ankara, the capital of Turkey, to determine eating disorders among the young. The data regarding the eating disorders and self-evaluation were assessed according to the EAT-40 test and the Body Cathexis Scale. The scores received from the eating attitudes test were low among the underweight (18.9+/-9.7) and higher among the overweight (21.6+/-15.9). Eating disorders risks are more prevalent among females compared to males (P<0.001). 17.2% of the underweight and 21.2% of the overweight are at higher risk of eating disorders. There was a positive correlation between the eating attitudes test scores and young people's body weight, BMI, mid-upper arm and waist circumferences, while a negative correlation was determined between the body cathexis scores and these variables. The authors believe that educating young people about healthy nutrition and monitoring them through longitudinal research studies will be helpful to prevent eating disorders, which are significant in terms of public health.

Surgery and parental separation as potential risk factors for abnormal eating attitudes-longitudinal study

Due to the susceptibility of eating disorders (ED) to stressful life events, we wanted to examine longitudinally whether two childhood adversities: (1) surgery and (2) parental separation, will affect abnormal eating attitudes in adolescents. Consecutively for 4 years, the eating attitude test (EAT-26) and the eating disorder inventory-2 (EDI-2) questionnaires were administered to students from grades 7th through 10th and 8th through 11th. Multilevel analysis revealed that parental separation and oral or cosmetic dermatologic surgeries were significantly correlated with EAT-26 and EDI-2 scores throughout the 4 years of the study. Post-hoc interpretation suggests a connection between (A) chirurgic intervention in the oral cavity and problematic eating attitudes, and (B) cosmetic dermatologic surgery and greater awareness to body appearance-a feature which might characterize adolescents who are prone to develop ED.

Gender, school and academic year differences among Spanish university students at high-risk for developing an eating disorder: an epidemiologic study

BACKGROUND

The aim of this study was to assess the magnitude of the university population at high-risk of developing an eating disorder and the prevalence of unhealthy eating attitudes and behaviours amongst groups at risk; gender, school or academic year differences were also explored.

METHODS

A cross-sectional study based on self-report was used to screen university students at high-risk for an eating disorder. The sample size was of 2551 university students enrolled in 13 schools between the ages of 18 and 26 years. The instruments included: a social-demographic questionnaire, the Eating Disorders Inventory (EDI), the Body Shape Questionnaire (BSQ), the Symptom Check List 90-R (SCL-90-R), and the Self-Esteem Scale (RSE). The sample design is a non-proportional stratified sample by academic year and school. The prevalence rate was estimated controlling academic year and school. Logistic regression analysis was used to investigate adjusted associations between gender, school and academic year.

RESULTS

Female students presented unhealthy weight-control behaviours as dieting, laxatives use or self-induced vomiting to lose weight than males. A total of 6% of the females had a BMI of 17.5 or less or 2.5% had amenorrhea for 3 or more months. In contrast, a higher proportion of males (11.6%) reported binge eating behaviour. The prevalence rate of students at high-risk for an eating disorder was 14.9% (11.6-18) for males and 20.8% (18.7-22.8) for females, according to an overall cut-off point on the EDI questionnaire. Prevalence rates presented statistically significant differences by gender (p < 0.001) but not by school or academic year.

CONCLUSION

The prevalence of eating disorder risk in university students is high and is associated with unhealthy weight-control practices, similar results have been found in previous studies using cut-off points in questionnaires. These results may be taken into account to encourage early detection and a greater awareness for seeking treatment in order to improve the diagnosis, among students on university campuses.

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Anorexia nervosa (AN) initiates an adaptive response at the level of the hypothalamus, which results in a complex interplay involving most elements of the neuroendocrine axis. Consequences of onset of disease in adolescence include amenorrhoea, pubertal arrest with potential loss of target height, and osteoporosis with reduced capacity for future attainment of peak bone mass. With recovery, delay in restoration of menses is common. Hormonal therapies for restoration of bone mineral density (BMD) in adolescents have shown limited efficacy. This review will discuss the reproductive endocrine effects of AN in adolescence, and discuss new investigative tools for monitoring restoration of reproductive function and BMD in this population.

National athletic trainers' association position statement: preventing, detecting, and managing disordered eating in athletes

OBJECTIVE

To present recommendations for the prevention, detection, and comprehensive management of disordered eating (DE) in athletes.

BACKGROUND

Athletes with DE rarely self-report their symptoms. They tend to deny the condition and are often resistant to referral and treatment. Thus, screenings and interventions must be handled skillfully by knowledgeable professionals to obtain desired outcomes. Certified athletic trainers have the capacity and responsibility to play active roles as integral members of the health care team. Their frequent daily interactions with athletes help to facilitate the level of medical surveillance necessary for early detection, timely referrals, treatment follow-through, and compliance.

RECOMMENDATIONS

These recommendations are intended to provide certified athletic trainers and others participating in the health maintenance and performance enhancement of athletes with specific knowledge and problem-solving skills to better prevent, detect, and manage DE. The individual biological, psychological, sociocultural, and familial factors for each athlete with DE result in widely different responses to intervention strategies, challenging the best that athletics programs have to offer in terms of resources and expertise. The complexity, time intensiveness, and expense of managing DE necessitate an interdisciplinary approach representing medicine, nutrition, mental health, athletic training, and athletics administration in order to facilitate early detection and treatment, make it easier for symptomatic athletes to ask for help, enhance the potential for full recovery, and satisfy medicolegal requirements. Of equal importance is establishing educational initiatives for preventing DE.

Experiences of women with bulimia nervosa in a mindfulness-based eating disorder treatment group

The experience of 6 college-age women with bulimia nervosa was examined after they participated in an 8-week mindfulness-based eating disorder treatment group. This phenomenological study used individual interview and pre- and post-treatment self-portraits. Participants described their experience of transformation from emotional and behavioral extremes, disembodiment, and self-loathing to the cultivation of an inner connection with themselves resulting in greater self-awareness, acceptance, and compassion. They reported less emotional distress and improved abilities to manage stress. This treatment may help the 40% of women who do not improve with current therapies and might be useful to prevent symptoms in younger women.

Healthy Buddies: a novel, peer-led health promotion program for the prevention of obesity and eating disorders in children in elementary school

OBJECTIVE

We designed and tested a novel health promotion program for elementary schools that was based on peer teaching from older to younger schoolchildren ("Healthy Buddies").

SUBJECTS AND METHODS

This prospective pilot study compared the effect of our program (2-3 hours/week, 21 weeks) in 2 Canadian elementary schools (intervention: n = 232 children, the whole school implementing the program; control: n = 151). Older students (4th through 7th grade) were given direct instruction from 1 intervention teacher and were paired with younger students (kindergarten through 3rd grade) for the whole school year. Students in 4th through 7th grade then acted as teachers for their younger "buddies." All lessons included 3 components of healthy living: nutrition, physical activity, and healthy body image. The students first learned how to be positive buddies and learned the 3 components of a healthy life. Thereafter, they learned how to overcome challenges to living a healthy life. Outcome measures (intervention and control schools at the beginning and end of the school year) included validated questionnaires that assessed healthy-living knowledge, behavior and attitude, a 9-minute fitness run, self-competence, body satisfaction, disordered eating symptoms, and anthropometry (BMI, blood pressure, and heart rate).

RESULTS

Compared with control students, both older and younger intervention students showed an increase in healthy-living knowledge, behavior, and attitude scores and a smaller increase in systolic blood pressure. BMI and weight increased less in the intervention students in 4th through 7th grade and height more in the intervention students in kindergarten through 3rd grade.

CONCLUSIONS

Our student-led curriculum improved knowledge not only in older schoolchildren but also in their younger buddies. It also decreased weight velocity in the older students. Student-led teaching may be an efficient, easy-to-implement way of promoting a healthy lifestyle from kindergarten to 7th grade.

Dieting among Thai adolescents: having friends who diet and pressure to diet

The purpose of this study was to assess dieting behavior, the number of friends who diet, and number of friends who pressure to go on a diet among a sample of 2,519 Thai adolescents. More than half of the girls (52.2%) and over one-fourth of boys (28.0%) reported going on a diet in the past 30 days. Dieting among friends was very common with only 14.2% of girls and 34.3% of boys saying none of their friends dieted. Results also showed significant associations between 1) number of friends who diet and 2) number of friends who pressure to diet with dieting behavior, body mass index (BMI), weight satisfaction, perceived body fatness, effort to look like people in the media, and frequency of thinking about wanting to be thinner in girls. In addition, several of these associations for boys were significant. The role of BMI in these relationships was also explored.

Disordered Eating: Young Women's Search for Control and Connection

PROBLEM

Approximately 5% of American women suffer from eating disorders and scores more exhibit signs of disordered eating. The purpose of this study was to gain an understanding of disordered eating in adolescence.

METHODS

Grounded theory method was employed. In-depth interviews were conducted with 15 college women to explore their experiences with disordered eating.

FINDINGS

Choosing disordered eating behaviors as a method of control occurred when the young women lacked connected and close relationships with others. Conversely, when meaningful relationships were present in their lives, the dysfunction abated.

CONCLUSIONS

Psychosocial and dietary assessments are necessary to identify youngsters without connected relationships and/or predispositions to disordered eating.

Constitutional thinness and lean anorexia nervosa display opposite concentrations of peptide YY, glucagon-like peptide 1, ghrelin, and leptin

BACKGROUND

Food intake is controlled by the arcuate nucleus through integration of peripheral hormonal signals such as leptin, ghrelin, peptide YY (PYY), and glucagon-like peptide 1 (GLP-1). The most common condition resulting in underweight young women in the developed world is restrictive anorexia nervosa (AN). However, constitutional thinness (CT) is also known to exist in the same low-weight range. Women with CT have normal menstrual periods and do not have the psychological or hormonal features of AN. Little is currently known about regulation of food intake in subjects with CT.

OBJECTIVE

We tested the hypothesis that concentrations of leptin, ghrelin, PYY, and GLP-1 in persons with AN are significantly different from those in persons with CT.

DESIGN

Concentrations of PYY, GLP-1, ghrelin, and leptin were measured in 3 groups of young women: normal weight (n = 7), CT (n = 10), and AN (n = 12). Samples were collected every 4 h for 24 h.

RESULTS

PYY concentrations were significantly higher in CT subjects than in AN or control subjects. GLP-1 concentrations were significantly higher in AN than in CT subjects, whereas ghrelin was significantly higher in AN subjects than in control and CT subjects. CT subjects had the lowest ghrelin concentrations. Leptin concentrations were significantly lower in AN subjects. PYY and leptin circadian variations were not significantly different between CT and control subjects, whereas these profiles were blunted in AN subjects.

CONCLUSIONS

Orexigenic and anorexigenic hormones in CT contrast with an adaptative profile characterizing AN. The hormones appear to be valuable biomarkers for distinguishing these 2 categories of severely underweight subjects.

A program for parents of teens with anorexia nervosa and eating disorder not otherwise specified

Objective. This study investigates the effects of a multidisciplinary education and support program for parents of adolescents with anorexia nervosa. Methods. This was a case-control study with 29 prospective cases and 53 retrospective controls. Parents of 10-17-year-old patients hospitalized due to medical complications of their eating disorders were invited to participate. These parents were offered a multidisciplinary education and support program. At the termination of the hospitalization, parents completed a survey examining their: knowledge about the treatment course of eating disorders, inclusion in their child's care and preparedness to care for their child at home. Results. Using two-tailed t-tests, results indicate that study parents felt: more knowledgeable about the treatment course for eating disorders (p<0.001), less excluded from their child's care (p=0.001), more prepared to take their child home (p<0.001), and that they had a better idea of what to feed their child at home (p<0.001). Conclusion. These results suggest that providing multidisciplinary education and support to parents of hospitalized adolescents with eating disorders helps to improve their feelings of inclusion in and knowledge about the treatment course, and increases their perceived ability to care for and re-nourish their child upon discharge.

Limiting the effects of the media on body image: does the length of a media literacy intervention make a difference?

This study examined whether or not the length of a media literacy intervention had an impact on awareness of sociocultural ideals, internalization of sociocultural ideals, and body dissatisfaction. Fifty-four traditional-aged undergraduate females were assigned to a control condition (25.9%), a video only condition (22.4%), a short-term single session intervention condition (22.4%), or a long-term multi-session intervention condition (29.3%). The long-term intervention did decrease body dissatisfaction and both the short- and long-term intervention conditions decreased internalization of sociocultural ideals. It appears that longer term media literacy interventions have more potential to reduce body dissatisfaction than shorter term media literacy interventions and both short- and long-term media literacy interventions reduce internalization of socio cultural ideals.

Partial eating disorders among adolescents: a review

PURPOSE

Many adolescents do not fulfill all the DSM-IV criteria's for anorexia nervosa and bulimia, but do nevertheless suffer from partial eating disorders (EDs). This review focuses on the definition, epidemiology and clinical aspects of these disorders.

METHODS

Search on Medline & PsycINFO, review of websites, screening of bibliographies of articles and book chapters.

RESULTS

There is still no consensus on the definition of these disorders, which cover a wide range of severity. Affected adolescents often suffer from physical and psychological problems owing to co-morbidity or as a consequence of their eating patterns: chronic constipation, dyspeptic symptoms, nausea, abdominal pain, fatigue, headaches, hypotension, menstrual dysfunction as well as dysthymia, depressive and anxiety disorders, or substance misuse and abuse. In comparison with those who are unaffected, adolescents with partial ED are at higher risk of evolving into full ED. However, most of them evolve into spontaneous remission. Adolescents with partial ED engaged, over a period of several months, in potentially unhealthy weight-control practices, suffering from intense fear of gaining weight and a disturbed body weight/image should be offered therapeutic support.

CONCLUSION

Future research should focus on the exact delineation of various subtypes of clinical presentations in partial ED and on evidence-based treatment and follow-up of these various situations.

A community-based training program for eating disorders and its contribution to a provincial network of specialized services

The Ontario Community Outreach Program for Eating Disorders is a pilot training project within the eating disorder programs at the University Health Network--Toronto General Hospital (TGH) and the Hospital for Sick Children. This system provides ongoing training, consultation, and research evaluation in areas ranging from prevention through to tertiary care, in the hopes of increasing the capacity of practitioners to respond to the healthcare pressures of those experiencing eating disorders. A total of 3,315 health care practitioners and educators in Ontario participated in community-based training workshops. A pre-post analysis of participants' self-report evaluations was conducted using chi-square analyses. The findings revealed that there was a statistically significant increase in participants' (a) knowledge of eating disorders and of body image issues and (b) level of comfort to either treat clients with eating disorders or teach a curriculum on body image. The contribution of the training program to the development of a provincial network of specialized eating disorder services, designed to promote the public's access to timely and appropriate care for the full spectrum of eating disorders, are discussed.

Disorders of Fuel Metabolism: Medical Complications Associated with Starvation, Eating Disorders, Dietary Fads, and Supplements

Disorders of fuel metabolism as they relate to abnormal fuel intake,abnormal fuel expenditure, and dietary supplements are the focus of this article. The emergency physician should be aware of the medical complications that can occur as a result of starvation states,eating disorders, fad diets, hypermetabolic states, and ergogenic aids. Knowledge and understanding of the complications associated with these disorders will facilitate the diagnosis and management of patients who present to the emergency department with any of the disorders reviewed.

[Validation of the SCOFF questionnaire for screening the eating behaviour disorders of adolescents in school]

OBJECTIVE

To determine the internal consistency and criteria validity of the SCOFF questionnaire for screening adolescent eating behaviour disorders.

DESIGN

Validation study with stochastic sampling.

SETTING

Three schools at Bucaramanga, Colombia.

PARTICIPANTS

241 students selected at random from 1595 possible ones.

MAIN INTERVENTIONS

SCOFF questionnaire and semi-structured CIDI interview, administered independently.

MAIN MEASUREMENTS

Social and personal details, Cronbach's alpha, sensitivity analysis, specificity, forecast values, Cohen mean kappa test, and ROC curve.

RESULTS

Sensitivity found was 81.9% (95% CI, 70.7-89.7) and specificity, 78.7% (95% CI, 71.7-84.6). The area under the ROC curve was 0.8596 (95% CI, 0.8108-0.9084); the Cronbach's alpha test, 0.436, and the Cohen mean kappa, 0.554 (95% CI, 0.425-0.683).

CONCLUSIONS

The SCOFF questionnaire is an acceptable alternative for screening groups of adolescents because of its simplicity and speed of administration.

"Everybody's Different": a primary prevention program among fifth grade school children

The aim of the present study was to assess the efficacy and effectiveness of the primary prevention program "Everybody's Different" among fifth grade school children. Pre and post measurements were made in both the intervention and control groups regarding body image, weight concern, emotional well-being, attitudes and behaviors associated with disordered eating, self-esteem, anxiety, and depression. The study did not result in any significant improvements regarding self-esteem, eating attitudes, or body image. The prevention program does not seem to be effective for children in grade five in its present form. Further research on and development of primary prevention programs is needed.

Ghrelin, peptide YY, glucose-dependent insulinotropic polypeptide, and hunger responses to a mixed meal in anorexic, obese, and control female adolescents

To determine whether peptide YY (PYY), ghrelin, glucose-dependent insulinotropic polypeptide (GIP), and satiety responses to food intake are impaired in anorexia or obesity, we studied 30 female adolescents with anorexia nervosa [body mass index (BMI) 16.3 kg/m2], obesity (BMI 34.3 kg/m2), or normal weight (BMI 20.2 kg/m2). PYY, ghrelin, GIP, insulin, and glucose concentrations and four markers of satiety were measured for 240 min after a mixed meal. The area under the curve for glucose was similar in obese (OB) and normal-weight control (C) subjects but was 15% lower in anorexic (AN) subjects. The area under the curve for insulin was 47% lower in AN and 87% higher in OB subjects, compared with C subjects. After the meal, PYY increased significantly in C (+41%, P < 0.05) but not in AN or OB adolescents. Ghrelin concentrations were highest in AN subjects and lowest in the OB group, compared with C subjects and fell significantly by 25% in all three groups. GIP concentrations were lower in AN subjects throughout the test and increased in all three groups after the mixed meal. AN adolescents reported being less hungry than OB and C adolescents. There was a negative correlation between fasting ghrelin (but not PYY or GIP) and BMI and insulin (r2= 0.33) and a positive correlation between the decrease in hunger 15 min after the meal and PYY concentrations at 15 min (r2= 0.20). In conclusion, the blunted PYY response to a meal in OB adolescents suggests that PYY plays a role in the pathophysiology of obesity. Ghrelin is unlikely to play a causal role in anorexia nervosa or obesity. The lower GIP observed in AN subjects despite a similar caloric intake may appropriately prevent an excessive insulin response in these patients.

Understanding women's journey of recovering from anorexia nervosa

Previous studies of recovery from anorexia nervosa (AN) have concentrated on discrete behavioral responses of individual women. Little is understood about the subjective process of women's recovery in the context of family, community, or society. In this feminist grounded theory study, the authors explored the perceptions of 12 women who considered themselves recovered or recovering from AN. They discovered a substantive theory of self-development that explains, within the current social context, women's journey from the perilous self-soothing of devastating weight loss to the informed self-care of healthy eating and problem-solving practices. The findings provide an urgently needed explanatory framework to inform women, clinicians, and health policy makers in their prevention and recovery efforts.