Eating disorders in adolescents: a background paper

Public interest and engagement in care for brain health in Slovenia: the role of education

Background and objective

Knowledge gap theory posits that individuals with better education have better opportunities to obtain, understand and utilise available information. In a health-related context, this insight could lead to a more effective disease prevention. The aim of our study was to test the hypothesis that knowledge gap underlies differences in behaviour aimed at maintaining brain health.

Methods

We conducted an online survey investigating Slovenian public view on brain, brain research, and science-based recommendations for brain health. The survey was filled out by a total of 2,568 respondents, of whom 2,450 completed it in full. They were divided into two subgroups based on their self-reported brain-related education, i.e., the lay subgroup (n = 1,012) and a topically educated group (n = 1,438), i.e., the educated subgroup. Among the latter, 728 participants reported to have a Bachelor's degree or higher education. We analysed the views of this sample subgroup on brain, neuroscience, and science-based brain health recommendations, and compared them with age- and education-matched lay subgroup (n = 565) from the same survey.

Results

Educated individuals showed greater awareness and adherence to science-based recommendations compared to the lay respondents, specifically in the perceived importance of following a healthy diet, exercising, ensuring time for rest, relaxation and maintenance of social contacts, acquiring new knowledge and skills and using supplements that are considered to improve mental abilities (all p < 0.005), but not in the perceived importance of getting enough sleep, avoiding drugs and alcohol or injuries and performing mentally-challenging activities or cognitive training (all p > 0.10). Educated individuals more frequently reported following a healthy diet, engaging in physical activity and socialising, acquiring new knowledge and skills, performing mental challenges and cognitive training, and using supplements (all p < 0.005), but not getting sufficient sleep, avoiding drugs, alcohol or injury, or ensuring time for rest and relaxation (all p > 0.08). A larger proportion of lay than educated participants (32 and 17%, respectively) identified lack of information as a reason for not engaging in healthy practices (p < 0.001). Educated participants outperformed lay individuals in identifying diseases amenable to lifestyle modification.

Conclusion

Understanding the differences in brain health perceptions between educated and lay individuals is crucial for developing effective public health strategies. Our results highlight a substantial knowledge gap in the Slovenian population and the need for targeted educational interventions that account for varying degrees of knowledge in different population segments which could lead to better adherence to healthy lifestyle practices.

Prevalence of problematic eating behavior and assessment of awareness on eating disorder among medical students

Background

There are few studies that highlight the problematic eating behavior of college students; however, similar data on the medical undergraduate population is sparse, especially in India. Awareness among medical students would be considered different compared to other students, owing to their training and education.

Aim

To know the prevalence of problematic eating behavior in medical undergraduate students and to measure the extent of awareness regarding problematic eating behavior present amongst the students.

Materials and Methods

The present study was a cross-sectional study conducted over 2 months that included students (1st -4th year and interns) aged 17-30 years, studying MBBS. Ethical approval to do the study was taken from the Institutional Ethics Committee. Purposive sampling was done. Those students who gave informed consent to be a part of this study and were not diagnosed with any severe mental and physical illness were included in this study. Socio-demographic data was collected in a semi-structured proforma. The questionnaire was given to the students to fill up. The questionnaire included EAT-26 (Eating Attitudes Test-26) score for screening the students for problematic eating behavior. For objectively assessing awareness amongst the students regarding the same, a few questions of knowledge, attitude, and practice (KAP) on problematic eating were included in the form. The result was analyzed using SPSS- 25 (Statistical Package for Social Sciences) and appropriate statistical tests.

Results

Among Medical undergraduates, 19.9% had EAT-26 score more than or equal to 20, suggesting some problematic eating behavior. A total of 36.7% of students were obese, while 5.6% were underweight. Gender and background do not play any role in the causation of Problematic Eating Behaviour (PEB). There was a significant difference in the EAT score with respect to the education of the head of the family (P < 0.01), positive history of mental illness in the family (P = 0.01), positive history of childhood obesity (P < 0.01), and positive history of bullying (P < 0.01). Awareness or knowledge about eating disorders is high among MBBS graduates, which could be a protective factor in general.

Conclusion

Obesity is a more concerning issue in the medical undergraduate population rather than underweight. Childhood obesity and bullying emerge as important factors affecting the eating attitudes and behavior among medical graduates.

An Update on Eating Disorders

Abstract:

It is no surprise that eating disorders (EDs) are increasing all over the planet. With the emergence of global westernization, development in technology, and societal changes, nearly all regions of the globe have been influenced by the concept of a perfect body image and height. EDs are a considerable public concern, a bewilderment for psychologists and a challenge for physicians. The primary EDs include anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). AN is an ED that is psychological and possibly life-threatening. Usually, people with AN experience an exceedingly low body weight due to their height and body shape. The highest rate of occurrence is between 14 and 17 years of age. BN is an extreme, lifethreatening, neurological ED in which you have binge eating cycles. You may not have any sense of balance in your diet throughout these binges. The weight-control engagement of patients with AN and BN results in various physiological shifts. EDs can control your lives and can be quite hard to cope with. Yet you will develop a better understanding of who you are by therapy, return to healthy eating and exercise, and undo any of the severe complications of AN. Investigation into EDs has yielded valuable new information over the past few decades, notably involving the psychological features and care of patients. The purpose of this study/review is to expand the knowledge of the people about these EDs, their global burden, diagnostic criteria, risk factors, medical complications, management, and the newly added avoidant/restrictive food intake disorder.

"In-between orthorexia" profile: the co-occurrence of pathological and healthy orthorexia among male and female non-clinical adolescents

BACKGROUND

The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO).

METHOD

A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals.

RESULTS

Cluster analysis based on ON and HO scores yielded 3 distinct groups: "Low orthorexia", "Moderate in-between orthorexia" and "High in-between orthorexia". While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes.

CONCLUSION

Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward.

The Impact of Inpatient Multimodal Treatment or Family-Based Treatment on Six-Month Weight Outcomes in Youth with Anorexia Nervosa: A Naturalistic, Cross-Continental Comparison

In the USA, family-based treatment (FBT) with inpatient medical stabilization as needed is the leading evidence-based treatment for youth with anorexia nervosa (AN). In continental Europe, typically inpatient multimodal treatment targeting weight recovery followed by outpatient care (IMT) is standard care, if prior outpatient treatment was not sufficient. Our aim was to compare weekly weight gain and hospital days over six months for adolescents receiving FBT (USA) versus IMT (Germany) using naturalistic treatment data. To yield similar subgroups of youth aged 12−18 years, inclusion criteria were a percent median BMI (%mBMI) between 70−85 and the restrictive AN subtype. Weight gain and hospital days were compared, adjusted further in a multiple linear regression analysis (MLRA) for baseline group differences. Samples differed on baseline %mBMI (FBT [n = 71], 90.5 ± 12.8; IMT [n = 29], 78.3 ± 9.1, p < 0.05). In subgroups with comparable baseline %mBMI, the weekly weight gain over 6 months was similar (FBT [n = 21]: 0.35 ± 0.18 kg/week; IMT [n = 20]: 0.30 ± 0.18, p = 0.390, p = 0.166 after MLRA), but achieved fewer hospital days in FBT (FBT [n = 7]: 4 ± 6 days, IMT [n = 20]: 121 ± 42 days, p < 0.0001 before and after MLRA). FBT may be effective for a subgroup of adolescents with AN currently receiving IMT, but head-to-head studies in the same healthcare system are needed.

Breasts, Butts, and Thighs—Oh My! Weight Spurt and Body Image Messages in Girls’ Puberty Books

Analyze popular girls’ puberty books to understand what messages they portray about weight spurt and body image. A critical ethnography was conducted of 13 best-selling books about girls’ puberty. This analysis specifically focused on messages about weight gain/spurt and body image presented in the books and whether these were aligned with larger cultural understandings of weight gain and body image. A data-driven thematic analysis was conducted on the portions of each book relevant to weight gain and body image. The cultural fat-phobic scripts were prevalent in the books, contrasting the well-intended developmental messages. Discussions of weight tended to be negatively framed and weight gain expectations were distressingly vague. The books discussed the necessity of and biological rationale for those changes while normalizing variation in timing. The books also focused on developing a positive body image during this time. Understanding this allows us to see the pervasive, conflicting messages about weight-spurts that girls are receiving from these resources, which can be used to tailor book choice and outreach programs.

Exocrine Pancreatic Function in Girls with Anorexia Nervosa

OBJECTIVES

To assess pancreatic exocrine function in patients with anorexia nervosa using a breath test with 13C-labeled mixed triglycerides (MTG-BT) and to determine the relationship between the test results and selected biochemical and hormonal parameters.

MATERIAL AND METHODS

Anthropometric measurements, biochemical and hormonal parameters (serum leptin, soluble leptin receptor (sLR), acylated and desacylated ghrelin, free leptin index (FLI)), and MTG-BT were performed in a group of 31 girls with the restrictive type of AN, as well as 38 healthy girls (C).

RESULTS

The average cumulative dose of 13C-triglycerides recovered with exhaled air (%CD) was similar in both study groups, while the average time from 13C-triglycerides administration to peak 13CO2 excretion in expired air (time to peak (TTP)) was significantly longer in patients with AN compared to C. In both groups, %CD correlated negatively with FLI. TTP correlated negatively with sLR and FLI in the AN and with serum insulin and HOMA-IR values in the C.

CONCLUSIONS

In girls with AN, the pancreatic efficiency of lipase secretion was found to be normal, while the kinetics of this enzyme secretion were disturbed. These changes may result from disorders in the functioning of the adipose-insular and islet-acinar axes.

Differences between Australian adolescents with eating disorder symptoms who are in treatment or not in treatment for an eating disorder

BACKGROUND

Mental health problems frequently occur during adolescence, however, few adolescents seek treatment for these problems, especially for eating disorders. The current study aimed to quantify how adolescents in a clinical sample (ie, those receiving treatment for an eating disorder), differ in terms of psychological factors (eating disorder symptoms and psychological distress), compared to adolescents with eating pathology in a community sample (ie, those not receiving treatment).

METHOD

Data were used from a community sample of adolescents with eating disorder pathology who have not sought treatment (n = 1011) and a clinical sample of adolescents presenting at eating disorder services for treatment (n = 153). Participants reported demographics and completed questionnaires assessing weight/shape concerns, disordered eating and psychological distress.

RESULTS

Adolescents with a lower BMI, more frequent purging and higher weight/shape concerns were more common in the clinical sample, while those engaging in more frequent driven exercise were less common in the clinical sample. The samples did not differ in severity of psychological distress.

CONCLUSIONS

The findings highlight the need for increasing mental health literacy about the role of BMI and driven exercise in eating disorder symptom presentation to increase early detection of these disorders among adolescents.

Gender Expression, Peer Victimization, and Disordered Weight-Control Behaviors Among U.S. High School Students

PURPOSE

The purpose of this study is to examine the association between gender expression, peer victimization, and disordered weight-control behaviors (DWCBs) in four population-based samples of U.S. high school students.

METHODS

Analyses include data from 5,488 U.S. high school students from the 2013 Youth Risk Behavior Surveys in four jurisdictions (Broward County, FL; Chicago, IL; Los Angeles, CA; San Diego, CA). Participants were 56% Hispanic/Latino, 21% black/African American, and 14% white. Two items asked about perceived gender expression; responses were classified into three groups: highly gender conforming (e.g., very masculine boys), moderately gender conforming, gender nonconforming (e.g., feminine boys). Sex-stratified multivariable logistic regression models were used to examine the association between gender expression, peer victimization, and DWCBs in previous month (fasting, using diet pills/liquids/powders, and purging [vomiting or using laxatives]), controlling for potential confounders.

RESULTS

Overall, 12% of respondents reported fasting, 6% reported diet pill use, and 5% reported purging, with significantly higher prevalence among gender nonconforming than among gender conforming male students (p < .001). In adjusted models, gender nonconforming male students had greater odds of fasting (odds ratio [95% confidence interval]: 3.0 [2.0-4.7]), diet pill use (6.1 [3.7-9.9]), and purging (7.2 [3.6-14.8]), relative to moderately conforming males. No significant associations were found among female students. Adding peer victimization to models modestly attenuated the association between gender nonconformity and DWCBs for male students.

CONCLUSIONS

In probability samples of U.S. high school students, we observed marked differences by gender expression in DWCBs among male students but not among female students. Gender expression-related stigma should be addressed within clinical and school-based interventions to prevent DWCBs.

Health in adulthood after severe anorexia nervosa in adolescence: a study of exposed and unexposed women

OBJECTIVE

To compare the global health status, frequency of somatic and psychological problems, and alcohol use in adulthood among women hospitalized in adolescence for severe anorexia nervosa (AN), with a matched control sample from the general population.

METHOD

Women (n = 86) who had been hospitalized for AN 9.31 ± 1.82 years previously were compared with 258 controls matched for gender, age, and socio-professional category. Data were retrieved from a French survey on health and social insurance coverage, and was mainly collected by self-report, except for the assessment of current eating disorders for those previously hospitalized for AN (assessed with the MINI).

RESULTS

The women who had been hospitalized for AN reported significantly poorer current health status compared to controls (OR 2.9, 95% CI 1.5-5.79). According to the MINI, 13 women previously hospitalized with severe AN still presented an eating disorder (ED). Women with past AN reported more frequent acute throat infections (OR 4.9, 95% CI 1.81-13.51), gastralgia (OR 3.6, 95% CI 1.9-6.83), gastro-oesophageal reflux (OR 5.279, 95%CI 2.11-13.22), excess blood cholesterol or triglyceride levels (OR 2.55, 95% CI 1.03-6.33), anxiety (OR 8.7, 95% CI 3.48-21.8) and depression (OR 5.02 (2.8-9.01). These differences remained significant and of the same order of magnitude in sensitivity analyses among subjects with previous AN but without current ED, except for perceived health status and excess cholesterol and triglyceride levels.

DISCUSSION

Women who had been hospitalized for severe AN reported more symptoms 10 years after treatment, implies psychological and somatic follow-up in the long term.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Social Media Use and Body Image Disorders: Association between Frequency of Comparing One's Own Physical Appearance to That of People Being Followed on Social Media and Body Dissatisfaction and Drive for Thinness

(1) Summary: Many studies have evaluated the association between traditional media exposure and the presence of body dissatisfaction and body image disorders. The last decade has borne witness to the rise of social media, predominantly used by teenagers and young adults. This study’s main objective was to investigate the association between how often one compares their physical appearance to that of the people they follow on social media, and one’s body dissatisfaction and drive for thinness. (2) Method: A sample composed of 1331 subjects aged 15 to 35 (mean age = 24.2), including 1138 subjects recruited from the general population and 193 patients suffering from eating disorders, completed an online questionnaire assessing social media use (followed accounts, selfies posted, image comparison frequency). This questionnaire incorporated two items originating from the Eating Disorder Inventory Scale (Body Dissatisfaction: EDI-BD and Drive for Thinness: EDI-DT). (3) Results: We found an association between the frequency of comparing one’s own physical appearance to that of people followed on social media and body dissatisfaction and drive for thinness. Interestingly, the level of education was a confounding factor in this relationship, while BMI was not. (4) Discussion: The widespread use of social media in teenagers and young adults could increase body dissatisfaction as well as their drive for thinness, therefore rendering them more vulnerable to eating disorders. We should consequently take this social evolution into account, including it in general population prevention programs and in patients’ specific treatment plans.

Talking About Weight With Families-Helping Health Care Professionals Start the Conversation: A Nonrandomized Controlled Trial

Health care professionals (HCPs) and trainees feel ill-equipped to discuss weight-related issues with children and their families. A whiteboard video for HCPs and trainees outlining strategies to communicate about weight was developed and evaluated. Seventy HCPs, including 15 trainees, participated in the baseline assessment and 39 repeated measures 4 to 6 months later. HCP self-efficacy for initiating conversations with overweight and underweight patients, measured immediately following the video, significantly improved from pre-video values (Z = -5.6, P ≤ .001, and Z= -3.3, P = .001, respectively). Although improvements were not sustained 4 to 6 months later (overweight: P = .143, and underweight: P = .846), no significant decline was observed, suggesting retention of the skill. A majority of HCP respondents would recommend the video to a colleague and feel it will affect their practice. Thus, the present study suggests educational videos may be an effective tool for facilitating healthy weight-related conversations between HCPs and their pediatric patients.

Medical Assessment and Triage of Pediatric Patients with Anorexia Nervosa in Primary Care

OBJECTIVE

To examine the medical assessment and triage of pediatric patients with anorexia nervosa (AN) initially seen in primary care.

METHODS

A retrospective cohort study was conducted for all pediatric patients with AN who had eating/weight concerns and initially identified symptoms in primary care in a single health care system between January 1, 2010, and December 31, 2016. Information on presenting concern, medical assessment/laboratory tests, clinical diagnoses, treatment recommendations, and referrals were abstracted from the medical record.

RESULTS

Forty-one (mean age = 13.7 years; SD = 2.2) pediatric patients with AN had eating/weight concerns and initially identified symptoms in a primary care. Overall, only 5% (n = 2/41) of patients received an AN diagnosis during the index visit; a minority were assessed for electrolyte disturbance (n = 20), electrocardiogram abnormality (n = 18), hypothermia (n = 13), binge/purge behaviors (n = 13), orthostatic hypotension (n = 2), or dehydration (n = 1), and only 56% (n = 23) received triage consistent with practice recommendations. Although 61% (n = 25) met criteria for inpatient admission, inpatient hospitalization was recommended for only 2 patients. Patients who received triage consistent with practice recommendations received AN diagnosis and treatment significantly earlier than those who did not (p < 0.01 and p = 0.001, respectively).

CONCLUSION

Findings suggest that pediatric patients with AN may not be receiving medical assessment and triage per practice recommendations in the primary care setting. Understanding barriers to evidence-based care for pediatric eating disorders may inform provider education and system-wide changes to enhance outcomes in these patients.

Navigating the university transition among women who self-report an eating disorder: A qualitative study

OBJECTIVE

Although developmental milestones have been observed to alter eating disorder (ED) symptom burden, it remains unknown how the transition to university affects symptomatology. To address this gap, we designed a qualitative study to elucidate how students with an ED perceive their general university experience and to describe how the university environment shapes their ED.

METHOD

Undergraduate students who self-reported an ED were recruited through fliers, an undergraduate advocacy organization, and local treatment centers. We conducted audio-recorded semi-structured individual interviews. Two investigators separately coded verbatim transcripts using an editing approach, and final themes emerged from the pattern of descriptors.

RESULTS

Fifteen undergraduate students participated. Participants endorsed a variety of ED symptoms and sought various levels of treatment. Most participants transitioned to university with an already-established diagnosis. Participants described that ED symptoms tended to worsen in university for a variety of reasons including (a) minimization of ED severity, (b) loss of external accountability, (c) use of ED symptoms as a coping mechanism, and (d) glorification of ED behaviors in campus diet culture. Subsequently, the ED disrupted the university experience by (e) hindering participants' ability to focus on academic responsibilities and (f) leading to social isolation on campus.

DISCUSSION

We identified challenges unique to the university experience that can be addressed by ED treatment teams in order to provide anticipatory guidance and patient-centered care. Study limitations include lack of formal diagnostic ED assessment by research team and sampling of students from one university.

Fear of negative evaluation among eating disorders: Examining the association with weight/shape concerns in adolescence

OBJECTIVE

Fear of negative evaluation has been proposed as a transdiagnostic factor associated with the development of eating disorders and has been shown to relate to disorders of body image, especially those with weight/shape concerns such as eating disorders and muscle dysmorphia. The current study aimed to investigate whether fear of negative evaluation was a transdiagnostic factor of disorders diagnostically characterized by weight/shape concerns. The study examined whether fear of negative evaluation was associated with higher odds for meeting criteria for an eating disorder and/or muscle dysmorphia, especially those disorders diagnostically characterized by weight/shape concerns.

METHOD

Data were used from a subgroup of the first wave of the EveryBODY study, a longitudinal investigation of eating disorders and body image concerns among Australian adolescents (N = 4,030). Participants completed measures on demographics, weight/shape concerns, disordered eating, psychological distress, muscularity concerns, and fear of negative evaluation.

RESULTS

Findings revealed that fear of negative evaluation was associated with higher odds of meeting criteria for any eating disorder but significantly more so for those characterized by weight/shape concerns diagnostically, as well as binge-eating disorder. Similar results were found for muscle dysmorphia.

DISCUSSION

The findings suggest that fear of negative evaluation constitutes a transdiagnostic feature for developing and/or maintaining an eating disorder.

Resting Energy Expenditure, Body Composition and Phase Angle in Anorectic, Ballet Dancers and Constitutionally Lean Males

BACKGROUND

The prevalence of anorexia nervosa among males is increasing but few data are available in the literature. This cross sectional study aims to evaluate resting energy expenditure (REE) and phase angle as a marker of qualitative changes of fat free mass (FFM) in three leanness groups as compared with control subjects.

METHODS

17 anorectic (AN) males, 15 constitutionally lean (CL) individuals, 12 ballet dancers (DC), and 18 control (CTR) subjects were evaluated. REE was measured by indirect calorimetry (V max29- Sensormedics), and body composition was evaluated by bioimpedance analysis (BIA) at 50 kHz (DS Medica). Phase angle (a bioimpedance variable related to nutritional status) was used to evaluate differences in FFM characteristics between these three types of leanness.

RESULTS

REE, adjusted for FFM and fat mass (FM), were significantly higher in CL and lower in AN individuals (1783 ± 47 vs. 1291 ± 58 kcal, p < 0.05) compared to the other groups. Body composition was similar in AN and CL whereas dancers had the highest FFM (58.9 ± 4.8 kg, p < 0.05); anorectic males showed the lowest phase angle (5.8 ± 1.2 degrees vs. other groups, p < 0.05) and dancers the highest phase angle (7.9 ± 0.7 degree vs. other group, p < 0.05).

CONCLUSIONS

Our findings confirm that phase angle could be a useful marker of qualitative changes, above all in the field of sport activities. On the other hand, there is the need to further evaluate the relationship between resting energy expenditure, body composition and endocrine status in different conditions of physical activity and dietary intake.

Identifying and Intervening with Students Exhibiting Signs of Gaming Addiction and other Addictive Behaviors: Implications for Professional School Counselors

This article discusses strategies professional school counselors can use to recognize and intervene with students who are presenting with signs of addictive behaviors. First, the authors present a definition of addictive behaviors. The authors then define and discuss the most common addictive behaviors impacting adolescents, with a special emphasis on gaming addiction. Finally, the article offers screening and intervention strategies that professional school counselors can use in the school setting.

Feelings and perceptions of women recovering from anorexia nervosa regarding their eating behavior

Abstract: According to the phenomenological approach, observing a phenomenon through the perspective of those who lived it may be necessary to acquire fully comprehension of it. Therefore, to fully understand the eating behavior during anorexia nervosa and during its recovery, this study investigated individual perceptions and feelings of three women recovering from anorexia nervosa. This study is characterized as a qualitative research with phenomenological approach. The data were collected through interviews and analyzed following steps proposed by phenomenology researchers. During the anorexia nervosa experience, food restriction and irregular meal patterns were observed. Controlling food intake was associated with happiness. Guilt, anguish, sadness, fear and anger were associated with eating, and food was considered a villain. An obsessive thinking about food and a paradox between liking to eat and not wanting to eat were also observed. During recovery, it is important to have a more flexible eating behavior without negative feelings regarding food; however, feelings of guilty and fear were still detected. Perceptions about contact with nutritionists revealed the use of ineffective strategies. Although similarities were found in all reports, every woman had their own particular and singular experience. Rescuing their memories and experiences through their speech was important to fully understand and comprehend these personal experiences, and this complete understanding may enable health professionals to act more efficiently in the treatment of this complex phenomenon.

A retrospective analysis of biochemical and haematological parameters in patients with eating disorders

BACKGROUND

The objective of the study was to determine whether levels of biochemical and haematological parameters in patients with eating disorders (EDs) varied from the general population. Whilst dietary restrictions can lead to nutritional deficiencies, specific abnormalities may be relevant to the diagnosis, pathogenesis and treatment of EDs.

METHODS

With ethics approval and informed consent, a retrospective chart audit was conducted of 113 patients with EDs at a general practice in Brisbane, Australia. This was analysed first as a total group (TG) and then in 4 ED subgroups: Anorexia nervosa (AN), Bulimia nervosa (BN), ED Not Otherwise Specified (EDNOS), and AN/BN. Eighteen parameters were assessed at or near first presentation: cholesterol, folate, vitamin B12, magnesium, manganese, zinc, calcium, potassium, urate, sodium, albumin, phosphate, ferritin, vitamin D, white cell count, neutrophils, red cell count and platelets. Results were analysed using IBM SPSS 21 and Microsoft Excel 2013 by two-tailed, one-sample t-tests (TG and 4 subgroups) and chi-square tests (TG only) and compared to the population mean standards. Results for the TG and each subgroup individually were then compared with the known reference interval (RI).

RESULTS

For the total sample, t-tests showed significant differences for all parameters (p < 0.05) except cholesterol. Most parameters gave results below population levels, but folate, phosphate, albumin, calcium and vitamin B12 were above. More patients than expected were below the RI for most parameters in the TG and subgroups.

CONCLUSIONS

At diagnosis, in patients with EDs, there are often significant differences in multiple haematological and biochemical parameters. Early identification of these abnormalities may provide additional avenues of ED treatment through supplementation and dietary guidance, and may be used to reinforce negative impacts on health caused by the ED to the patient, their family and their treatment team (general practitioner, dietitian and mental health professionals). Study data would support routine measurement of a full blood count and electrolytes, phosphate, magnesium, liver function tests, ferritin, vitamin B12, red cell folate, vitamin D, manganese and zinc for all patients at first presentation with an ED.

Prospective associations between problematic eating attitudes in midchildhood and the future onset of adolescent obesity and high blood pressure

BACKGROUND

Clinically diagnosed eating disorders may have adverse cardiometabolic consequences, including overweight or obesity and high blood pressure. However, the link between problematic eating attitudes in early adolescence, which can lead to disordered eating behaviors, and future cardiometabolic health is, to our knowledge, unknown.

OBJECTIVE

We assessed whether variations in midchildhood eating attitudes influence the future development of overweight or obesity and high blood pressure.

DESIGN

Of 17,046 children who participated in the Promotion of Breastfeeding Intervention Trial (PROBIT), we included 13,557 participants (79.5% response rate) who completed the Children's Eating Attitudes Test (ChEAT) at age 11.5 y and in whom we measured adiposity and blood pressure at ages 6.5, 11.5, and 16 y. We assessed whether ChEAT scores ≥85th percentile (indicative of problematic eating attitudes) compared with scores <85th percentile at age 11.5 y were associated with new-onset overweight, obesity, high systolic blood pressure, or high diastolic blood pressure between midchildhood and early adolescence.

RESULTS

After controlling for baseline sociodemographic confounders, we observed positive associations of problematic eating attitudes at age 11.5 y with new-onset obesity (OR: 2.18; 95% CI: 1.58, 3.02), new-onset high systolic blood pressure (OR: 1.34; 95% CI: 1.05, 1.70), and new-onset high diastolic blood pressure (OR: 1.25; 95% CI: 0.99, 1.58) at age 16 y. After further controlling for body mass index at age 6.5 y, problematic eating attitudes remained positively associated with new-onset obesity (OR: 1.80; 95% CI: 1.28, 2.53); however, associations with new-onset high blood pressure were attenuated (OR: 1.14; 95% CI: 0.89, 1.45 and OR: 1.09; 95% CI: 0.86, 1.39 for new-onset systolic and diastolic blood pressure, respectively).

CONCLUSIONS

Problematic eating attitudes in midchildhood seem to be related to the development of obesity in adolescence, a relatively novel observation with potentially important public health implications for obesity control. PROBIT was registered at clinicaltrials.gov as NCT01561612 and isrctn.com as ISRCTN37687716.

The understanding of risk factors for eating disorders in male adolescents

OBJECTIVE

The study aimed to describe the medical, psychiatric, and cultural features of adolescent males with an eating disorder (ED).

MATERIALS AND METHODS

This retrospective evaluation took place at Hacettepe University, İhsan Doğramacı Children's Hospital, Ankara, Turkey, and covered a 4-year period between 2010 and 2013. Sixty adolescents were diagnosed with an ED during this period, 47 (78.3%) were females and 13 were males (21.7%) male. All 13 male patients who met full criteria for an ED according to the DSM criteria were included. Medical and psychiatric records of male patients treated for an ED were re-evaluated.

RESULTS

The most striking finding of the study was that the female to male ratio became 3.6:1, with the increasing number of male adolescents with an ED. In our study, medical findings and complications of males with ED were similar to those seen in females. However, the most predominant gender difference was the co occurrence of a comorbid physical or mental illness.

CONCLUSION

It is imperative to raise awareness of EDs in males. Although the medical findings of the study suggest that male and female adolescents with EDs are clinically similar to each other, the understanding of certain gender-specific risk factors shown in our study, such as a medical illness and/or obesity and co-morbid psychiatric diagnosis, are essential in raising suspicion. Further studies that especially evaluate cultural and social factors that affect parenting styles for boys are important in addessing possible risk factors for the development of EDs in males within different societies.

Preventing Obesity and Eating Disorders in Adolescents

Obesity and eating disorders (EDs) are both prevalent in adolescents. There are concerns that obesity prevention efforts may lead to the development of an ED. Most adolescents who develop an ED did not have obesity previously, but some teenagers, in an attempt to lose weight, may develop an ED. This clinical report addresses the interaction between obesity prevention and EDs in teenagers, provides the pediatrician with evidence-informed tools to identify behaviors that predispose to both obesity and EDs, and provides guidance about obesity and ED prevention messages. The focus should be on a healthy lifestyle rather than on weight. Evidence suggests that obesity prevention and treatment, if conducted correctly, do not predispose to EDs.

The effects of parental mental health and social-emotional coping on adolescent eating disorder attitudes and behaviors

This study examined whether social-emotional coping skills moderate the association between parental mental health symptoms and adolescent disordered eating attitudes and behaviors in a clinical sample of adolescents with internalizing and/or externalizing symptoms. Fifty-nine adolescent-parent dyads (N = 118 total participants) recruited from a metropolitan area in the Northeastern United States completed assessments at baseline and 12-month follow-up. Generally, higher parental depression and anxiety were only found to be associated with greater disordered eating attitudes and behaviors among adolescents who reported poorer (versus stronger) emotional awareness/expression skills and less (versus greater) ability to regulate emotions. Results may suggest that adolescents who lack the ability to effectively recognize, express, and manage negative emotions that arise in the context of a challenging home environment may be at greater risk for engaging in maladaptive coping behaviors, such as disordered eating. Thus, bolstering adolescent social-emotional coping skills may help protect against adolescent disordered eating.

Inhibition of growth and induction of apoptosis in A549 cells by compounds from oxheart cabbage extract

BACKGROUND

Oxheart cabbage (Brassica oleracea var. capitata) is a member of the Brassica genus. Although some studies on the anticancer effects of extracts from oxheart cabbage have been reported, comprehensive information on the bioactive fractions and components from oxheart cabbage extracts is still lacking. The aim of this study was to isolate and identify the bioactive fractions and components from oxheart cabbage seeds using activity-guided isolation methods.

RESULTS

The cytotoxicity and apoptotic effects of fraction II, fraction III, iberverin, sulforaphane and iberin from oxheart cabbage seed extract were investigated. The results showed that all five components had inhibitory effects on the in vitro growth of A549 cells which were dose-dependent. These compounds also changed the morphology of A549 cells, and their inhibitory activity on A549 cells was as follows: sulforaphane > iberin > iberverin > fraction III > fraction II. The IC50 values were 3.53 ± 0.63, 4.93 ± 1.02, 7.07 ± 0.51, 15.56 ± 0.24 and 27.32 ± 0.63 µg mL(-1) respectively. Fraction II, fraction III, iberverin, sulforaphane and iberin induced cell apoptosis by increasing early apoptosis and late apoptosis/necrosis, and activation of caspase-3, -8 and -9.

CONCLUSION

These results indicated that the decrease in A549 cell viability by active compounds from oxheart cabbage seed extract was due to the induction of apoptosis. © 2015 Society of Chemical Industry.

Eating Disorders in the Adolescent Population:

Although eating disorders often begin during adolescence, characteristics of this population can complicate early detection by clinicians. The purpose of this article is to selectively review the literature on the diagnostic criteria for eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder) as described in Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and International Classification of Diseases (10th ed.). The prevalence and course of eating disorders, theories regarding their etiology, and issues of comorbidity and differential diagnosis are also discussed.

Eating Disorders in Adolescent Athletes

Adolescent athletes are especially vulnerable to developing disordered eating behaviors. Risk factors include participation in sports where weight and lean body type are important, high-intensity training, pressure from coaches, and training and dieting beginning at an early age. Medical complications associated with these unhealthy dietary and weight-control practices and eating disorders can be potentially dangerous. Prevention strategies include minimizing the importance of weight, increased sensitivity on the part of those working with athletes for issues around weight and dieting, and appropriate education on proper weight-control methods and nutrition. The long-term prognosis is not known.

Eating Disorders in the Adolescent Population:

Adolescents become vulnerable to developing eating disorders as they mature. Very little is known about the prevalence, etiology, assessment, treatment, and outcome of eating disorders among adolescents. In general, research on eating disorders continues to be plagued with design flaws. Future studies need to be prospective research based on larger, more diverse samples of adolescents that represent all developmental stages of adolescence. Consistent diagnostic criteria and definitions of treatment interventions and outcomes also need to be employed. In addition, research should address the identification of protective and risk factors that predict who will actually develop an eating disorder.

Treatment of Adolescents with Anorexia Nervosa

Research on the treatment of adolescents with anorexia nervosa is limited but shows that effective strategies employ a multidisciplinary team approach. Most patients receive medical attention when there is an acute medical or psychiatric emergency after losing a significant amount of weight and there is a need for nutritional and metabolic stabilization. Medical and nutritional stabilization are the first courses of treatment, followed by psychological stabilization. Initial treatment settings are dependent on the severity of symptoms and can range from inpatient to partial hospitalization or from day treatment to outpatient clinics. Physical activity and weight gain must be gradually accomplished. Effective treatment includes a variety of psychotherapeutic approaches (individuals and family therapy). Psychopharmacotherapy is generally unreliable in the treatment of anorexia nervosa and should be targeted to specific symptoms or complications. Prevention programs have been shown to have limited success.

What Triggers Abnormal Eating in Bulimic and Nonbulimic Women?; The Role of Dissociative Experiences, Negative Affect, and Psychopathology

Dissociative experiences and abnormal eating were examined in 92 non-eating-disordered women and 61 age-matched bulimic women. In the nonclinical sample of women, dissociative experiences were associated with abnormal eating attitudes and behavior, even after controlling for other forms of psychopathology; furthermore, dissociation mediated the relationships between abnormal eating and sexual abuse, abnormal eating and emotional distress, and abnormal eating and impulsivity Analyses using both bulimic women and occasional binge eaters among the controls showed that a combination of reported negative affect and dissociative experiences preceding a binge was associated with the highest levels of abnormal eating. Finally, in both bulimic women and occasional binge eaters, feelings of panic appeared to decrease as a binge episode progressed, whereas, in bulimic women only, dissociative experiences appeared to increase during binge eating. The implications for the role of dissociation in combination with emotional distress in triggering and reinforcing abnormal eating in women are discussed.

Impact of short-term refeeding on appetite and meal experiences in new onset adolescent eating disorders

Restrictive eating disorders (ED) are increasing and represent a serious risk to the health of adolescent females. Restrictive ED in youth are often treated through aggressive short-term refeeding. Although evidence supports that this intervention is the "gold standard" for improving ED outcomes in youth, little research has specifically probed appetite and meal-related responses to this type of intensive, short-term refeeding in newly diagnosed individuals. Information about appetite and meal-related dysfunction could provide valuable insights regarding treatment-interfering features of ED in both acute inpatient and longer-term outpatient treatment. The purpose of this study was to evaluate the hunger, fullness, olfactory, and gustatory responses of adolescents with newly-diagnosed restrictive ED and to probe how and when these responses are altered by refeeding. Using a quasi-experimental ecologically valid methodology, this study described and compared profiles of hunger, fullness, olfactory, and gustatory responses in adolescent females (n = 15) with newly diagnosed restrictive ED at hospital admission (i.e., severe malnutrition) and after medical refeeding, in comparison to healthy controls (n = 15). Results showed that newly diagnosed (i.e., malnourished) adolescents with ED showed significantly different meal-related experiences than controls. Refeeding improved some of these differences, but not all. Following refeeding, females with ED continued to show lower hunger, greater fullness, and lower pleasantness of smell ratings compared to controls. Unpleasantness of taste ratings maladaptively increased, such that females who were re-fed reported more aversive scents than pre-treatment. Profiles of meal-related responses were also identified and compared between groups. The applicability of these findings are discussed within the context of critical periods of change during refeeding treatment and potentially promising intervention targets that might enhance treatment outcomes for adolescents with newly onset, restrictive ED.

Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations. Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review. Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047; p = 0.039). No statistical significance was found between electrolytes and calories provided during refeeding. Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

An Adolescent Boy with Comorbid Anorexia Nervosa and Hashimoto Thyroiditis

Low triiodothyronine syndrome is a physiological adaptation encountered in anorexia nervosa (AN) and generally improves with sufficient weight gain. However, when a primary thyroid pathology accompanies AN, both the evaluation of thyroid hormone levels and the management of the co-morbid disease become more challenging. Hashimoto thyroiditis could complicate the management of AN by causing hyper- or hypothyroidism. AN could also negatively affect the treatment of Hashimoto thyroiditis by altering body weight and metabolic rate, as well as by causing drug non-compliance. We present the case of a 15-year-old boy with comorbid AN restrictive sub-type and Hashimoto thyroiditis. In this case report, we aimed to draw attention to the challenges that could be encountered in the diagnosis, treatment, and follow-up of patients with AN when accompanied by Hashimoto thyroiditis.

A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions?

Despite significant advances in the development of prevention and treatment interventions for eating disorders and disordered eating over the last decade, there still remains a pressing need to develop more effective interventions. In line with the 2008 Medical Research Council (MRC) evaluation framework from the United Kingdom for the development and evaluation of complex interventions to improve health, the development of sound theory is a necessary precursor to the development of effective interventions. The aim of the current review was to identify the existing models for disordered eating and to identify those models which have helped inform the development of interventions for disordered eating. In addition, we examine the variables that most commonly appear across these models, in terms of future implications for the development of interventions for disordered eating. While an extensive range of theoretical models for the development of disordered eating were identified (N=54), only ten (18.5%) had progressed beyond mere description and to the development of interventions that have been evaluated. It is recommended that future work examines whether interventions in eating disorders increase in efficacy when developed in line with theoretical considerations, that initiation of new models gives way to further development of existing models, and that there be greater utilisation of intervention studies to inform the development of theory.

Therapeutic engagement: Perspectives from adolescents with eating disorders

This study aimed to identify factors that adolescents with eating disorders (ED) consider important for therapeutic engagement, and to examine similarities and differences in the number of identified factors considered important for therapeutic engagement based on diagnostic status and readiness and motivation to change dietary restriction behaviors. Treatment seeking adolescent females (n=34, Mage=16.33, SD=1.34) with an ED were prompted to generate responses to 4 constructs related to therapeutic engagement: (1) Trust, (2) Agreement on therapeutic goals, (3) Confidence in Ability to Change and (4) Feelings of Inclusion in therapeutic decisions. A coding scheme for each construct was developed using a random sample of responses, and each category within a construct was rated as present or absent for each participant. Frequencies and percentages of participants who reported each category within each construct are reported. Additionally, findings indicate that the top two out of three categories reported within each construct were the same between participants with AN versus EDNOS, and between participants high and low in readiness and motivation to change dietary restriction behaviors. This study is a first step in identifying aspects of therapeutic engagement that are important to adolescents with ED, which may differ from adults.

Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives

BACKGROUND

Admission to hospital is the treatment of choice for anorexia nervosa in adolescent patients who are medically unstable; however, stays are often prolonged and frequently disrupt normal adolescent development, family functioning, school and work productivity. We sought to determine the costs of inpatient treatment in this population from a hospital and caregiver perspective, and to identify determinants of such costs.

METHODS

We used micro-costing methods for this cohort study involving all adolescent patients (age 12-18 yr) admitted for treatment of anorexia nervosa at a tertiary care child and adolescent eating disorder program in Toronto, between Sept. 1, 2011, and Mar. 31, 2013. We used hospital administrative data and Canadian census data to calculate hospital and caregiver costs.

RESULTS

We included 73 adolescents in our cohort for cost-analysis. We determined a mean total hospital cost in 2013 Canadian dollars of $51 349 (standard deviation [SD] $26 598) and a mean total societal cost of $54 932 (SD $27 864) per admission, based on a mean length of stay of 37.9 days (SD 19.7 d). We found patient body mass index (BMI) to be the only significant negative predictor of hospital cost (p < 0.001). For every unit increase in BMI, we saw a 15.7% decrease in hospital cost. In addition, we found higher BMI (p < 0.001) and younger age (p < 0.05) to be significant negative predictors of caregiver costs.

INTERPRETATION

The economic burden of inpatient treatment for adolescents with anorexia nervosa on hospitals and caregivers is substantial, especially among younger patients and those with lower BMI. Recognizing the symptoms of eating disorders early may preclude the need for admission to hospital altogether or result in admissions at higher BMIs, thereby potentially reducing these costs.

More than half of high school students report disordered eating: a cross sectional study among Norwegian boys and girls

Disordered eating and eating disorders are of great concern due to their associations with physical and mental health risks. Even if adolescence has been identified as the most vulnerable time for developing disordered eating, few studies have used a broad spectrum of criteria to investigate the prevalence of disordered eating among high school students of both genders, in different programs of study, nor assessed correlates of disordered eating among this important target group. The purposes of this study were therefore to investigate the prevalence and correlates of disordered eating among both male and female high school students in sport-, general and vocational programs. A comprehensive questionnaire was completed by 2,451 students (98.7%), aged 15–17 years. The total prevalence of disordered eating was 54.9%, with 64.3% among girls and 45.0% among boys (p<0.001). The highest prevalence of disordered eating was found among vocational students (60.7%), followed by students in general programs (49.8%) and sport students (38.3%) (p<0.001). Female gender, school program (vocational and general), overweight/obesity and weight regulation were positively associated with disordered eating. The high prevalence indicates the importance of tailored prevention efforts directed at high school students, particularly in vocational programs. Furthermore, a smaller girls–boys ratio than expected indicates that the efforts to identify and manage disordered eating among high school students should include both genders.

Implementing highly specialized and evidence-based pediatric eating disorder treatment: protocol for a mixed methods evaluation

Background

Eating disorders, which include anorexia nervosa and bulimia nervosa, are common in adolescent females and can have serious emotional and physical consequences, including death. Despite our knowledge about the severity of these illnesses, previous research indicates that adolescent patients are not receiving the best available treatment with fidelity. The main goal of this project is to reduce the knowledge gap between what research indicates is the best known treatment and what is actually delivered in clinical practice. Informed by the National Implementation Research Network model and the Consolidated Framework for Implementation Research meta-theory, our primary study aim is to increase the capacity of Ontario-based therapists to provide family-based treatment, by providing training and ongoing supervision.

Methods/design

We will use a multi-site case study with a mixed method pre/post design to examine several implementation outcomes across four eating disorder treatment programs. We will provide a training workshop on family-based treatment as well as ongoing monthly supervision. In addition, we will assemble implementation teams at each site and coach them by phone on a monthly basis regarding any process issues. Our main outcomes include fidelity to the treatment model using quantitative evaluation of audio-recorded therapy sessions, as well as qualitative analysis of the perceptions of the implementation process using audio-recorded focus groups with all clinicians and administrators involved in the study.

Discussion

To our knowledge, this is the first study to evaluate an implementation strategy for an evidence-based treatment for eating disorders. Challenges to date include obtaining ethics approval at all sites, and recruitment. This research will help to inform future studies on how to best implement evidence-based treatments in this field.

Associations of elevated liver enzymes among hospitalized adolescents with anorexia nervosa

OBJECTIVES

To analyze the prevalence, predictors, and evolution of increased liver enzymes in a large sample of adolescents hospitalized with anorexia nervosa (AN).

STUDY DESIGN

Electronic medical records of all subjects 10-22 years of age with AN, first admitted to a tertiary children's hospital from January 2007 to December 2012, were reviewed retrospectively. Demographic factors, anthropometric factors, initial prescribed calories, and alanine aminotransferase levels were recorded. Multivariate analysis was performed to assess the effect of sex, degree of malnutrition, and initial calories prescribed on having alanine aminotransferase ≥40 IU/L.

RESULTS

A total of 356 subjects met eligibility criteria (age 16.1 ± 2.4; 89.0% female; admission body mass index [BMI] 15.9 ± 1.9; admission percentage median BMI 78.2 ± 8.5), with elevated liver enzymes present in 37.0% on admission and in 41.1% at any point during the hospitalization. Lower percentage median BMI (aOR 0.96; 95% CI 0.93-0.98) and male sex (aOR 0.45; 95% CI 0.22-0.94) were significantly associated with odds of elevated liver enzymes on admission. Higher initial prescribed calories were associated with odds of elevated liver enzymes after admission (aOR 1.81; 95% CI 1.04-3.18).

CONCLUSIONS

In this study of AN and elevated liver enzymes, the degree of malnutrition and male sex predicted elevated liver enzymes on admission but initial prescribed calories also may be associated with elevated liver enzymes after admission in a small proportion of patients. Future research should better characterize the evolution of elevated liver enzymes in patients hospitalized with AN undergoing refeeding.

Renal complications in anorexia nervosa

PURPOSE

Anorexia nervosa is a malady with possible long-lasting physiological consequences. Among these, little is known about the renal effects, which remain rarely investigated.

METHODS

A literature review was conducted using electronic databases and manual search of relevant articles, discussing the renal impacts of anorexia nervosa.

RESULTS

Renal failure has been described in malnourished patients, but the optimal non-invasive tool to assess the glomerular function rate in this population needs to be further evaluated. Significant disruptions in osmolar regulation, even in the absence of potomania, arise from multiple factors: hypothalamic dysfunction, intrinsic renal insufficiency, and use of psychotropic medications. Urinary urgency and nocturnal enuresis are frequent symptoms, rarely reported by patients. Among hydroelectrolytic disorders, hypokalemia is the most frequent, especially in settings of vomiting or medication misuse. Hyponatremia, hypomagnesemia, and hypophosphatemia may also be encountered. Urinary lithiases are relatively frequent as a consequence of dehydration, laxative use, or both.

CONCLUSION

Investigation and follow-up of the renal function are essential in patients with an eating disorder, especially when the illness has been present for a long time.

Developmental trends of eating disorder symptoms and comorbid internalizing symptoms in children and adolescents

OBJECTIVE

To determine when gender differences in disordered eating symptoms emerge, when correlations between disordered eating and internalizing symptoms develop, and whether the relationship between internalizing and disordered eating symptoms varies based on age and/or gender.

METHOD

We used questionnaire data from a community sample (N = 424) of third, sixth, and ninth grade girls and boys.

RESULTS

Gender differences in eating pathology emerge between 12 and 15 years. The relationship between anxiety symptoms and eating pathology among both genders is weak and remains constant between the third and ninth grades. The relationship between depressive symptoms and eating pathology increases between the third and sixth grades for boys, and the sixth and ninth grades for girls.

CONCLUSION

Before age 12, prevention programs for eating disorders should be given to both genders, whereas after age 12, they should target girls. Further, providers should offer intervention for comorbid depressive symptoms by third grade for boys and sixth grade for girls.

Shifting paradigms: continuous nasogastric feeding with high caloric intakes in anorexia nervosa

PURPOSE

The initial goal of admission for a patient with anorexia nervosa is physiologic stabilization through nutritional rehabilitation balanced against the risk of refeeding syndrome. Recent alternative approaches emphasize meal composition, limiting carbohydrates, to reduce risk. The Montreal Children's Hospital has instituted a standardized high-calorie continuous nasogastric (NG) refeeding protocol for the initial management of inpatient adolescents with restrictive eating disorders. This study aims to confirm that this protocol results in a shorter admission duration and faster rate of weight gain without increased incidence of complications.

METHODS

Retrospective chart review of patients with restrictive eating disorders admitted to the Montreal Children's Hospital during December 2003 to December 2011. Those treated with higher calorie NG refeeding protocol (N = 31) were compared with those managed with a standard bolus meal treatment (N = 134).

RESULTS

Length of stay was significantly reduced in the NG-fed cohort (NG cohort 33.8 days; bolus-fed cohort 50.9 days; p = .0002). Mean rate of weight gain in the NG group was significantly improved for both the first and second week when compared with the bolus-fed cohort (1.22 kg/week (1), p = .01; 1.06 kg/week (.9), p = .04). No significant difference was found in the rate of complications or electrolyte abnormalities with 90% of the NG-fed cohort receiving prophylactic phosphate supplementation from admission.

CONCLUSIONS

This study provides further evidence to support the treatment of undernourished inpatients with restrictive type eating disorders with a higher initial caloric intake to achieve rapid and safe nutritional rehabilitation.

Effectiveness of a multimodal inpatient treatment for adolescents with anorexia nervosa in comparison with adults: an analysis of a specialized inpatient setting : treatment of adolescent and adult anorexics

OBJECTIVE

There is evidence for an increased prevalence and an earlier onset of anorexia nervosa (AN) in adolescents. Early specialized treatment may improve prognosis and decrease the risk of a chronic course. The current study evaluates the effectiveness of a multimodal inpatient treatment for adolescent AN patients treated in a highly specialized eating disorder unit for adults.

METHOD

177 adolescents and 1,064 adult patients were included. The evaluation focused on eating behavior, depressive symptoms and general psychopathology.

RESULTS

All measured variables decreased significantly in both groups during inpatient treatment. No differences were found concerning weight gain, improvement of global eating disorder symptomatology as well as depressive symptoms. However, adults showed a higher psychological distress and in this regard also a greater improvement.

CONCLUSION

Results indicate that treating adolescent AN patients in a highly specialized eating disorder unit for adults can be an effective treatment setting for these patients.

Associated Factors of Unhealthy Eating Patterns among Spanish University Students by Gender

This study has examined bio-socio-demographic and psychopathological factors probably associated with unhealthy eating patterns among university students and to estimate a multifactorial model following the associated factors by gender. Adjusted odds ratios were calculated to describe associations on basis of Eating Disorder Inventory (EDI) stratified by gender in a representative sample of Spanish university students (n = 2551). The high EDI scorers for both sexes presented higher prevalence of dieting, body dissatisfaction, levels of psychopathology and lower self-esteem than the low EDI scorers. The results suggest that older students and higher self-esteem scores present lower scores in the EDI. In the female population, depression, paranoid dimension, dieting and body dissatisfaction were associated with population with unhealthy eating patterns. In the male sample, dieting, body dissatisfaction and interpersonal sensibility were also associated with unhealthy eating patterns. The results corroborate that abnormal eating patterns tend to affect specific vulnerable groups. We do not know the precise mechanisms through which these risk behaviors and attitudes, such as dieting or body dissatisfaction, may facilitate the later development of an eating disorder.

Weighing in on the issue: a longitudinal analysis of the influence of selected individual factors and the sports context on the developmental trajectories of eating pathology among adolescents

Eating disorders, and related issues (e.g., body dissatisfaction, weight control behaviors), represent pressing and prevalent health problems that affect American adolescents with alarming frequency and potentially chronic consequences. However, more longitudinal research is needed to elucidate the developmental processes that increase or maintain risk for, and that protect against, eating- and weight-related problems among adolescents. Accordingly, the current study used longitudinal data from 1,050 male and female (68.0 %) adolescents (Grades 9-11)-the majority of whom were European Americans (72.2 %)-who participated in the 4-H Study of Positive Youth Development to (a) describe trajectories of adolescents' eating pathology and body dissatisfaction, (b) identify individual and contextual correlates of these pathways, (c) examine whether trajectories of eating pathology and body dissatisfaction related to adolescents' depressive symptoms, and (d) elucidate whether sports participation moderated associations between specific trajectories of eating pathology and body dissatisfaction and adolescents' depressive symptoms. Results suggest that the diverse pathways of eating pathology and body dissatisfaction that exist across middle adolescence, in combination with adolescents' sports participation, have important implications for the positive and problematic development of our youth. In addition, the findings underscore the need to evaluate the interindividual differences that exist in regard to how sports participation may relate positively and negatively to developmental outcomes.