Abnormal eating attitudes in London schoolgirls--a prospective epidemiological study: factors associated with abnormal response on screening questionnaires

Prevalence and Risk Factors of Disordered Eating Attitudes and Behaviors Among High-school Girls in Al-Madinah City, Saudi Arabia

Objectives::

To determine the prevalence of disordered eating attitudes and behaviors among high-school girls in Al-Madinah City, Saudi Arabia.

Methods::

A cross-sectional descriptive study was conducted in Al-Madinah city in 2014-15. A multi- stage random sampling technique was adopted to include female students of government secondary schools. The Eating Attitudes Test (EAT-26) and socio-economical questionnaires were used in the study for assessing the prevalence of disordered eating. All data were entered and analyzed using SPSS version 20.

Results::

Overweight and obesity were reported among 11.2% and 5.6% of them, respectively, whereas 31.3% of the participants were underweight. The overall prevalence of disordered eating attitudes among female students was 42.5%. This rate was significantly higher among younger (≤16 years old) and those of the first scholastic level than others. The rate of disordered eating attitude was reported at a higher rate among obese students (59.1%) than underweight (41.5%) and normal students (42.4%). The commonest reported disordered eating behavior was self-reported binge eating behaviour (25.2%), followed by self-induced vomiting (8.7%) and the use of laxatives/ diuretics to control weight (6.1%).

Conclusion::

The findings show a high prevalence of disordered eating attitude among high school female students in Al-Madinah city. Younger girls and those of the first scholastic level showed higher disordered eating attitude.

Eating attitudes and its relationship with nutritional status: a micro level study on a group of adolescent girls in the city of Howrah, West Bengal

BACKGROUND

To assess the relationship between eating attitudes and nutritional status.

METHODS

This cross-sectional study was conducted among 400 adolescent girls (258 aged 14-17 years and 142 aged 18-21 years) from the city of Howrah, West Bengal. Eating attitude was measured using eating distress syndrome (EDS) questionnaire. Nutritional status was assessed using body mass index, waist-hip ratio (WHR) and body fat percentage (BF%).

RESULTS

Participants with disordered eating attitudes revealed significantly higher values for body mass index (BMI), WHR and BF% than those with normal eating attitudes (p≤0.01). Hierarchical linear regression analyses show that eating attitudes and socio-demographic characteristics (like mothers' education and occupation, age and birth order of the participants) significantly predict nutritional status.

CONCLUSION

The nutritional status of adolescents depends on their eating attitudes and socio-demographic characteristics.

Evaluation of Body Shape, Eating Disorders and Weight Management Related Parameters in Black Female Students of Rural and Urban Origins

This study examined body shape dissatisfaction, eating disorder and weight management-related parameters as well as assimilation of Western cultural norms regarding body shape in black female students of urban and rural origins. Subjects (n=180; 20 ± 4,4 years old) were weighed, their height was measured and they completed the Body Shape Questionnaire, EAT-26, Eating Inventory (restraint scale), Adolescent Self-Concept Scale and a questionnaire concerning weight management behaviours. Main findings include lower prevalences of overestimation of body weight and body shape dissatisfaction, similar prevalences for dieting and the use of Hazardous weight reduction methods, and higher prevalences for overweight, obesity, disordered eating attitudes and behaviours, and dietary restraint among subjects than among similar white groups. Furthermore, those with urban origins were more likely to be restrained eaters, to have attempted weight reduction, to aim for weight loss and to fear weight gain. These data indicate that there are signs of more realism concerning weight status among black female students. However, there are also signs of assimilation of Western cultural norms concerning body shape, eating attitudes and behaviours and weight management. This diversity in the black student population in South Africa needs to be recognized when planning interventions to address eating related problems.

Eating Disorders

More than 2 million female Americans have a clinically relevant eating disorder. Although the prevalence and seriousness of this problem has gained increasing attention in recent years, relatively little is known about eating disorder prevention. This article addresses a number of issues related to prevention efforts applied to eating disorders. An overview of putative risk factors that have been identified is presented. In particular, the article emphasizes the importance of understanding the psychological and physical developmental processes during adolescence and the sociocultural context in which eating disorders develop. A summary of empirical investigations of the efficacy of eating disorder prevention programs follows, including an illustration of one of the more promising strategies that has been reported to date. The role of counseling psychologists in further refining eating disorder prevention efforts is discussed.

Sexuality in eating disorders patients: etiological factors, sexual dysfunction and identity issues. A systematic review

The scientific community appears to be less interested in sexuality of eating disorders (EDs) as compared to other psychiatric or medical comorbidities. However, a clear association between sexual problems and ED psychopathology was reported from different perspectives. The overarching goal of this systematic review was to evaluate the general approach of the scientific literature toward the topic of sexuality and EDs. In particular, four different categories of research have been individuated, encompassing the role of puberty, and sexual abuse in the pathogenesis of the disorders, sexual dysfunctions, and the association between sexual orientation and EDs psychopathology. Timing of puberty with its hormonal consequences and the changes in the way persons perceive their own body represent a crucial period of life for the onset of the disorder. Sexual abuse, and especially childhood sexual abuse are well-recognized risk factors for the development of ED, determining a worse long-term outcome. Recent research overcome the approach that considers sexual activity of EDs patients, in terms of hypersexuality and dangerous sexual behaviors, considering the sexuality of EDs persons in terms of sexual desire, satisfaction, orgasm and pain. Results from this line of research are promising, and describe a clear relationship between sexual dysfunction and the core psychopathological features of EDs, such as body image disturbances. Finally, the analysis of the literature showed an association between sexual orientation and gender dysphoria with EDs psychopathology and pathological eating behaviors, confirming the validity of research developing new models of maintaining factors of EDs related to the topic of self-identity.

The myth of Chinese Barbies: eating disorders in China including Hong Kong

Much of the literature on eating disorders deals with Western subjects. Although the majority of those seen in clinical settings are Caucasians, reports from Asia suggest that anorexia nervosa and bulimia nervosa do occur in the Chinese, sparking debate as to whether or not it is the result of Westernization. This project begins with a review of the current literature on eating disorders in Chinese populations and the role of culture as a mediating factor. A psychodynamic conceptualization and the potential role of traumatic experiences are explored in the emergence of pathological eating habits. Research suggests that applying Western models for Chinese subjects with eating disorders may not always be appropriate.

Comparative validity of the chinese versions of the bulimic inventory test edinburgh and eating attitudes test for DSM-IV eating disorders among high school dance and nondance students in Taiwan

OBJECTIVES

To compare the validity of the Eating Attitudes Test (EAT) and the Bulimic Investigatory Test Edinburgh (BITE) as screening tools for eating disorders (EDs), and to identify a new threshold for each questionnaire to detect ED cases among dance and nondance students.

METHOD

Dance students enrolled in high schools with gifted dance programs and nondance students randomly chosen from the same or nearby schools were invited to participate in a 2-phase ED survey. Participants completed the EAT and BITE questionnaires in the first phase. All participants who screened positive and 10% of the participants who screened negative were interviewed blindly using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Edition.

RESULTS

The BITE had better accuracy than the EAT in detecting ED in general among both dance and non-dance students. BITE scores of 19 and 16 were the optimal cutoff values for determining ED among dance and nondance students, respectively. The optimal cutoff value for the EAT to diagnose an ED was 19 for dance students and 12 for nondance students. Both questionnaires showed higher sensitivity and lower specificity in dance students than nondance students at the same cutoff points.

DISCUSSION

The BITE had better diagnostic performance than the EAT in this nonclinical population, although its ability to detect restrictive behaviors is likely as limited as that of the EAT. Plausible explanations for these results and limitations of this study are discussed in the text.

Puberty as a critical risk period for eating disorders: a review of human and animal studies

This article is part of a Special Issue "Puberty and Adolescence". Puberty is one of the most frequently discussed risk periods for the development of eating disorders. Prevailing theories propose environmentally mediated sources of risk arising from the psychosocial effects (e.g., increased body dissatisfaction, decreased self-esteem) of pubertal development in girls. However, recent research highlights the potential role of ovarian hormones in phenotypic and genetic risk for eating disorders during puberty. The goal of this paper is to review data from human and animal studies in support of puberty as a critical risk period for eating disorders and evaluate the evidence for hormonal contributions. Data are consistent in suggesting that both pubertal status and pubertal timing significantly impact risk for most eating disorders in girls, such that advanced pubertal development and early pubertal timing are associated with increased rates of eating disorders and their symptoms in both cross-sectional and longitudinal research. Findings in boys have been much less consistent and suggest a smaller role for puberty in risk for eating disorders in boys. Twin and animal studies indicate that at least part of the female-specific risk is due to genetic factors associated with estrogen activation at puberty. In conclusion, data thus far support a role for puberty in risk for eating disorders and highlight the need for additional human and animal studies of hormonal and genetic risk for eating disorders during puberty.

The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys

BACKGROUND

Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national BED data are presented here and compared with bulimia nervosa (BN) data in the World Health Organization (WHO) World Mental Health Surveys.

METHODS

Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high-income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist.

RESULTS

Country-specific lifetime prevalence estimates are consistently (median; interquartile range) higher for BED (1.4%; .8-1.9%) than BN (.8%; .4-1.0%). Median age of onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2-15.4) than BED (4.3 years; 1.0-11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid DSM-IV disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and to a somewhat lesser degree BED predicting subsequent onset of these conditions. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment.

CONCLUSIONS

Binge eating disorder represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.

Validation of Eating Disorder Examination Questionnaire (EDE-Q) –Spanish Version– for Screening Eating Disorders

This research examines the internal consistency, convergent validity, and sensitivity, specificity, and positive and negative predictive value of the Spanish version of the Eating Disorder Examination-Self-Report Questionnaire (S-EDE-Q), as a screening questionnaire for eating disorders (ED) in a community sample. Participants were 1543 male and female Spanish-speaking students (age range: 12-21 years), who volunteered to complete the S-EDE-Q and the EAT-40. The Spanish version of the Eating Disorders Examination (S-EDE) interview, 12th edition, was administered to 602 of the students. Acceptable internal consistency for the four subscales of the S-EDE-Q was obtained (α ≥ .74). Corrected pointbiserial correlation performed with the 22 items included in the S-EDE-Q subscales showed acceptable values for all the items. The EAT-40 Dieting subscale correlated highly and positively with the four S-EDE-Q subscales (r ≥ .70). Acceptable results in sensitivity, specificity, and positive and negative predictive value when compared with the EDE were found. Correlation between S-EDE and S-EDE-Q diagnoses was positive and significant. Overall, results support the psychometric adequacy of the S-EDE-Q as a screening questionnaire for ED in community samples.

Relationships between psychological stress, coping and disordered eating: A review

Abstract Objective: Psychological stress and inadequate coping skills have been hypothesized to play important roles in the etiology of disordered eating. This paper reviews the empirical evidence which has emerged regarding the proposed relationships among stress. coping skills and various forms of disordered eating.

METHOD

A search of psychological and medical databases was conducted to identify studies examining life events, and other types of psychological stress and coping strategies, in relation to the onset of disordered eating.

RESULTS

Despite methodological limitations such as the use of non-representative samples and retrospective methodologies, evidence of relationships between stress. coping and disordered eating was obtained in the majority of studies reviewed.

DISCUSSION

The implications of these findings am discussed and suggestions for future research, including the utilization of longitudinal. prospective studies, am presented.

Analysis of eating disorders among 12-17 year-old adolescents in the island of Gran Canaria

A clinical pathology characterized by disturbances in eating behaviour has been often associated to socio-cultural factors that influence the psychopathology of these disorders. The alarming increase in the number of teenagers with eating disorders underscores the need to promote research on the underlying causes, and to identify high-risk subpopulations in need of effective targeted treatment. The objective of this study was to assess the prevalence of eating disorders among an adolescent population of both sexes on the island of Gran Canaria. The sample was composed of adolescent boys and girls aged 12 to 17 years old (N=1364) who resided in different municipalities of Gran Canaria. The EAT-40 questionnaire was administered (cut-off point at 30), and body mass index measurements were assessed. The mean BMI for the 1364 subjects was 21.8 Kg/m²; 15% were underweight, and of these at least 1% obtained BMI values below 15 Kg/m². Thus, 13.4% of adolescents were potentially at risk of eating disorders according to the EAT-40 questionnaire. Moreover, the BMI was not significantly correlated to the EAT-40 and was not considered a sufficient parameter to establish the incidence of eating disorders.

Weight perception and weight control practice in a multiethnic sample of US adolescents

OBJECTIVES

Obesity is disproportionately prevalent among many racial/ethnic minority groups. The main objectives of this study are (1) to examine the extent of body weight misperception for a representative sample of US adolescents; (2) to explore the gender and racial/ethnic differences associated with an adolescents' weight goals and weight loss attempts and; (3) to examine the influence of an array of sociodemographic factors (eg socioeconomic status) on body weight misperception in adolescents.

METHODS

A sample of 2,195 adolescents (aged 10 to 18 years) enrolled in the National Health and Nutrition Examination Survey (2005-2006) was examined. Adolescents' weight and height were measured by lab exams. Perception of weight status, weight goals, and weight loss attempts were obtained by questionnaire. Participants' self-perceptions of their current weight status were compared to classification of their body mass index (BMI) in order to determine concordance. We used multinomial logistic regression models to assess the predictive effects of various sociodemographic factors on weight misperception.

RESULTS

Twenty-five percent of girls and 33.2% of boys misperceived their weight status by medical standards. Significant sex and racial/ethnic differences existed in weight perception, attempts to lose weight, and weight goals. Multivariate analysis revealed that age, gender, marital status of parent/guardian were independently associated with the misperception of weight status, controlling for body mass index.

CONCLUSIONS

Differences in weight perception, weight goals, and weight loss attempts among ethnic and racial groups call for targeted obesity control efforts.

Combining education and video-based contact to reduce stigma of mental illness: "The Same or Not the Same" anti-stigma program for secondary schools in Hong Kong

This study examined the effects of three versions of school-based stigma reduction programs against mental illness - education, education followed by video-based contact (education-video), and video-based contact followed by education (video-education). The participants, 255 students from three secondary schools in Hong Kong, completed measures of stigmatizing attitudes (Public Stigma Scale), social distance (Social Distance Scale), and knowledge about schizophrenia (Knowledge Test) at pre-test, post-test, and 1-month follow-up. Results suggested that adding video-based contact to education could significantly improve program effectiveness only when video-based contact was presented after but not prior to education. In comparison with the education condition, the education-video condition showed larger improvements in stigmatizing attitudes at post-test, in social distance at both post-test and follow-up, and in knowledge at follow-up. However, such differences were not observed when the education condition was compared with the video-education condition. Implications of these findings for future research are discussed.

Eating behavior and body image among psychology students

OBJECTIVE: To characterize eating habits and possible risk factors associated with eating disorders among psychology students, a segment at risk for eating disorders. METHOD: This is a cross-sectional study. The questionnaires Bulimic Investigatory Test Edinburgh (BITE), Eating Attitudes Test (EAT-26), Body Shape Questionnaire (BSQ) and a variety that considers related issues were applied. Statistical Package for the Social Sciences (SPSS) 11.0 was utilized in analysis. The study population was composed of 175 female students, with a mean age of 21.2 (DP ± 3.6 years). RESULTS: A positive result was detected on the EAT-26 for 6.9% of the cases (CI95%: 3.6-11.7%). The prevalence of increased symptoms and intense gravity, according to the BITE questionnaire was 5% (CI95%: 2.4-9.5%) and 2.5% (CI95%: 0.7-6.3%), respectively. According to the findings, 26.29% of the students presented abnormal eating behavior. The population with moderate/severe BSQ scores presented dissatisfaction with corporal weight. CONCLUSION: The results indicate that attention must be given to eating behavior risks within this group. A differentiated gaze is justified with respect to these future professionals, whose practice is jeopardized in cases in which they are themselves the bearers of installed symptoms or precursory behavior.

Disordered eating in Jewish adolescent girls

OBJECTIVES

To examine the presence and nature of disordered eating attitudes and behaviours among Jewish Canadian adolescents, as compared with non-Jewish Canadian adolescents in an urban community. A secondary goal was to examine whether rates of eating-disordered behaviour differed among the adolescents based on the degree of Jewish religious observance.

METHOD

High school students (n = 868) from the Toronto area completed a demographic and religious practice questionnaire together with the Eating Attitudes Test (EAT), a self-report test that discriminated adolescents with syndromal eating disorders from normal adolescents.

RESULTS

Jewish females aged 13 to 20 years, but not males, reported significantly more disordered eating behaviours and attitudes, compared with their non-Jewish female counterparts. Twenty-five percent of Jewish females, as compared with 18% of non-Jewish females, scored above the clinical cut-off for the EAT. No differences in vulnerability to disordered eating were found within the group of Jewish females or males related to their degree of religious observance.

CONCLUSIONS

Adolescent Jewish females, but not males, appear to be at greater risk for abnormal attitudes and behaviours related to eating, compared with their non-Jewish female peers. While the reasons for this finding are unclear, this study is a step toward improving understanding of the relations between sex, culture, religion, and the development of eating disorders. Culturally sensitive and sex-specific prevention strategies and treatment interventions are indicated.

[Validation of the Eating Attitudes Test (EAT) as a screening tool in the general population]

BACKGROUND AND OBJECTIVE

To validate the best alternative cut-off point of a Spanish version of the Eating Attitudes Test (EAT-40) for the screening of eating disorders cases in the general population.

SUBJECTS AND METHOD

The translated questionnaire was administered to a representative sample of 2,734 female students who ranged in age from 13 to 22 years. Participants who scored above 21 points were interviewed, as were a random sample of participants who scored 21 or below. Internal and external validity parameters were estimated for different alternative cut-off scores below the usual EAT score of 30.

RESULTS

The best diagnostic prediction was obtained with a cut-off score of 21 points (sensitivity: 73.3%; specificity: 85.1%). A positive predictive value of 20% and a negative predictive value of 98.4% were obtained.

CONCLUSIONS

The best diagnostic prediction in a non-clinical setting is obtained with a cut-off score of 21, below that recommended by the authors of the questionnaire.

Prognosis of adolescent partial syndromes of eating disorder

BACKGROUND

Partial syndromes of eating disorder are common in adolescents but the health significance of these syndromes remains uncertain.

AIMS

To document the health and social adjustment in young adulthood of females assessed as having a partial syndrome of eating disorder in adolescence.

METHOD

A community sample of 1943 participants was tracked over 10 years in an eight-wave cohort study. A partial syndrome was defined as the fulfilment of at least two DSM-IV criteria for either anorexia or bulimia nervosa at one assessment or more between the ages of 15 years and 17 years.

RESULTS

Partial syndromes were found in 9.4% of 15- to 17-year-old female participants and 1.4% of males. There were few instances of progression of partial syndromes to fully fledged anorexia and bulimia nervosa. However, among those with partial syndromes depressive and anxiety symptoms were two to three times higher in young adulthood, substance misuse was common, and a majority of those with a partial syndrome of anorexia nervosa were still underweight in their mid-20s.

CONCLUSIONS

Given the level of subsequent psychopathology and social role impairment, there may be justification for initiating trials of preventive and early clinical intervention strategies for adolescent partial syndromes.

Comportamento alimentar e imagem corporal entre estudantes de educação física

OBJETIVO: Caracterizar práticas alimentares e possíveis fatores de risco associados a transtornos do comportamento alimentar entre estudantes de Educação Física em uma universidade pública do município do Rio de Janeiro. MÉTODO: Estudo seccional, elegendo-se como população-alvo um segmento de risco para o surgimento de transtornos alimentares. Foram aplicados os questionários Bulimic Investigatory Test Edinburgh (BITE), Eating Attitudes Test (EAT-26), Body Shape Questionnaire (BSQ) e uma variável que considera os dois instrumentos associados. RESULTADOS: Detectou-se resultado positivo em 6,9% (IC95%: 3,6-11,7%) no EAT-26. No BITE, para sintomas elevados e gravidade intensa, foram encontradas prevalências de 5% (IC95%: 2,4-9,5%) e 2,5% (IC95%: 0,7-6,3%), respectivamente. Constatou-se que 26,29% das estudantes apresentavam comportamento alimentar anormal. CONCLUSÃO: Os resultados deste estudo indicam que se deve atentar para comportamentos alimentares de risco nesse grupo, justificando-se um olhar diferenciado em relação a esses futuros educadores.

Menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group

OBJECTIVE

To examine chronology and experience of menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group.

METHOD

We interviewed 150 females, namely 50 patients with anorexia or bulimia nervosa (ED), 50 patients with polysubstance dependence (PSD-CO), and 50 healthy controls (HE-CO) (defined by DSM-IV) on chronology and their experience of menarche, puberty, and first sexual activities adjusted for childhood sexual abuse.

RESULTS

ED women were similar to HE-CO in age at menarche and most sexual milestones, but differed significantly from PSD-CO women, who were "early starters." Regarding their experience of menarche, pubertal body changes, and first sexual activities, however, ED women rated these variables significantly more negatively than did either of the comparison groups. These significant differences remained after adjusting for sexual abuse.

CONCLUSION

These findings suggest a negative body attitude in ED patients already at pubertal age, namely years before onset of the disorder. Prospective data are needed.

Cultural expectations of thinness in women: a partial replication and update of magazine content

OBJECTIVE

To determine if magazine articles in mainstream women's magazines, continue to emphasize weight reduction.

METHOD

Articles devoted to diet, exercise, and cosmetic surgery were tabulated from January 1989 to April 2007 in eight popular women's magazines.

RESULTS

The number of cosmetic surgery articles has substantially increased since 1989, while exercise articles continue to decline. Diet for weight loss articles have progressively decreased since 1989, with a marginal increase between 2003-2007.

CONCLUSION

The upward trend in cosmetic surgery articles indicates that cosmetic surgery is now viewed as an alternate means to diet and exercise that women may choose to alter their physical appearance. One of the implications of moving to cosmetic surgery as a means to conform is that when it comes to female beautification, there are few extremes.

Two-phase survey of eating disorders in gifted dance and non-dance high-school students in Taiwan

BACKGROUND

Despite a growing body of literature reporting eating disorders (EDs) in non-Western countries in recent years, most of these studies are limited to questionnaire-based surveys or case-series studies. This study aimed to investigate the prevalence and correlates of EDs in Taiwanese high-school students.

METHODS

The study subjects consisted of all the female high-school students enrolled in the gifted dance class in 2003 in Taiwan (n=655) and non-dance female students randomly chosen from the same school (n=1251). All the participants were asked to complete self-report questionnaires, including the 26-item Eating Attitudes Test (EAT-26) and the Bulimic Investigatory Test Edinburgh (BITE). All the screen positives and an approximate 10% random sample of the screen negatives were then interviewed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Version (SCID-I/P).

RESULTS

The prevalence of individual EDs was much higher in the dance [0.7% for anorexia nervosa (AN), 2.5% for bulimia nervosa (BN) and 4.8% for EDs, not otherwise specified (EDNOS)] than in the non-dance (0.1, 1.0 and 0.7% respectively) students. Multivariate logistic regression analyses revealed that being in the dance class, higher concern about body shape and lower family support were correlates of EDs for all students, whereas lower parental education level was associated with EDs only for non-dance students.

CONCLUSION

EDs were more prevalent in the weight-concerned subpopulation. Although AN is still rare, BN has emerged as a comparable prevalent disorder in Taiwan, as in Western countries.

Factors associated with abnormal eating attitudes among female college students in Japan

OBJECTIVES

To determine the prevalence rates of abnormal eating attitudes and associated risk factors among female Japanese college students.

SUBJECTS AND METHODS

The study population was 7812 female college students in Tokyo. They were asked to fill out the Japanese version of EAT-26 and lifestyle questionnaires.

RESULTS

5.1% of the subjects had a total EAT-26 score above the cutoff point (>20). Multiple regression analysis found the most important factors associated with abnormal eating attitudes were distorted body image, fewer sleeping hours, irregular meal habits, cigarette smoking and more exercise.

DISCUSSION

The prevalence of abnormal eating attitudes among female college students in this study was lower than that of Japanese female high school students and lower than that reported for college students of both western and non-western countries. Our results suggest that body image dissatisfaction may be the most important factor associated with abnormal eating behavior.

Can collaboration between education and health professionals improve the identification and referral of young people with eating disorders in schools? A pilot study

In this pilot study, a number of different methods of identifying young people with eating disorders in schools were compared. Pupils aged 16-18 years from 3 schools in the South West of the UK participated (389 boys and 374 girls in total). A self-report questionnaire (EDE-Q) was found to be the most effective method of case identification. However, very few of these cases accepted the offer of help and it was strongly suspected that other cases went undetected despite teacher, parent and school nurse guidance. Implications for future early intervention studies are discussed.

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.

The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26

In a cross-sectional study conducted four years ago to assess the validity of the Brazilian version of the Eating Attitudes Test-26 (EAT-26) for the identification of abnormal eating behaviors in a population of young females in Southern Brazil, 56 women presented abnormal eating behavior as indicated by the EAT-26 and the Edinburgh Bulimic Investigation Test. They were each matched for age and neighborhood to two normal controls (N = 112) and were re-assessed four years later with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI). The EAT results were then compared to diagnoses originating from the CIDI. To evaluate the temporal stability of the two screening questionnaires, a test-retest design was applied to estimate kappa coefficients for individual items. Given the prevalence of eating disorders of 6.2%, the CIDI psychiatry interview was applied to 161 women. Of these, 0.6% exhibited anorexia nervosa and 5.6%, bulimia nervosa (10 positive cases). The validity coefficients of the EAT were: 40% sensitivity, 84% specificity, and 14% positive predictive value. Cronbach's coefficient was 0.75. For each EAT item, the kappa index was not higher than 0.344 and the correlation coefficient was lower than 0.488. We conclude that the EAT-26 exhibited low validity coefficients for sensitivity and positive predictive value, and showed a poor temporal stability. It is reasonable to assume that these results were not influenced by the low prevalence of eating disorders in the community. Thus, the results cast doubts on the ability of the EAT-26 test to identify cases of abnormal eating behaviors in this population.

Eating disorder and depressive symptoms in urban high school girls from different ethnic backgrounds

This study examined ethnic group differences in the rates of eating disorder symptoms (EDS) and depressive disorder symptoms (DDS) with respect to ethnic identity, relative body weight, and abnormal eating behaviors among adolescent girls. A district-wide sample of high school girls (N = 1445) from different ethnic backgrounds was surveyed. EDS were assessed with the Eating Attitudes Test-26, abnormal eating behaviors with the Eating Behaviors Survey, and DDS with the Short Mood and Feelings Questionnaire. Two dimensions of ethnic identity, ethnic identity achievement and other group orientation, were assessed with Multi-Group Ethnic Identity Measure. Hispanic and non-Hispanic white girls had the highest and African-American (AA) and Caribbean girls the lowest rates of EDS. Asian girls reported the highest and AA girls the lowest rates of DDS. Early dieting was associated with EDS and DDS in Caribbean, non-Hispanic white, and mixed background girls. Relative body weight was related to EDS in all ethnic groups except in non-Hispanic white and mixed background girls. The authors did not find an effect of ethnic identity achievement on psychopathology, but there was an effect of other group orientation on both EDS and DDS. Clinicians should inquire about EDS and DDS in girls of all ethnic groups. Prevention efforts to delay unsupervised dieting may protect adolescent girls from the development of EDS and DDS.

Psychosocial correlates, outcome, and stability of abnormal adolescent eating behavior in community samples of young people

OBJECTIVE

The current study investigated psychosocial correlates of abnormal adolescent eating behavior at three times during adolescence and young adulthood and its association with psychiatric diagnosis in young adulthood in a community sample.

METHOD

Sixty-four (10.5%) high-risk subjects (mean age 15 years) with abnormal eating behavior were identified at Time 1, another 252 (16.9%) were identified at Time 2 (mean age 16.2 years), and 164 (16.9%) were identified at Time 3 (mean age 19.7 years) and compared with three control groups matched for age and gender. Dependent measures included emotional and behavioral problems, life events, coping capacities, self-related cognition, social network, and family functions. Outcome was measured additionally by structured psychiatric interviews, and stability of abnormal eating behavior was studied in a longitudinal sample of 330 subjects.

RESULTS

Few subjects showed more than one of five criteria of abnormal eating behavior. High-risk subjects shared a very similar pattern at all three times. They were characterized by higher scores for emotional and behavioral problems, more life events including more negative impact, less active coping, lower self-esteem, and less family cohesion. Among 10 major psychiatric disorders, only clinical eating disorders at Time 3 shared a significant association with abnormal eating disorder at the same time whereas high-risk status at Times 1 and 2 did not predict any psychiatric disorder at Time 3. Stability of abnormal eating behavior across time was very low. Stability of abnormal eating behavior across time was very low.

DISCUSSION

Abnormal eating behavior in adolescence and young adulthood is clearly associated with various indicators of psychosocial maladaption. In adolescence, it does not significantly predict any psychiatric disorder including eating disorder in young adulthood and it is predominantly a transient feature.

Eating Disorders Examination versus Eating Disorders Examination-Questionnaire in adolescents with full and partial-syndrome bulimia nervosa and anorexia nervosa

OBJECTIVE

The current study compared the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in adolescents with eating disorders.

METHOD

Adolescents (N = 70) with bulimia nervosa (BN; n = 21), partial-syndrome BN (PBN; n = 25), and anorexia nervosa (AN; n = 24) were assessed with the EDE and EDE-Q.

RESULTS

Moderate to high correlations were found on all four subscales within and between diagnostic groups. The discrepancy between the EDE and EDE-Q was significantly greater in BN relative to PBN and AN for the Eating Concern subscale. Objective binge episode (OBE) frequency in BN and subjective binge episode (SBE) frequency in BN and PBN were higher with the EDE compared with the EDE-Q. Self-induced vomiting was highly correlated between the two measures.

DISCUSSION

Adolescents with BN, PBN, and AN exhibited strong correspondence between the EDE interview and questionnaire formats. However, this consistency was not as pronounced for BN as it was for PBN and AN. The current study lends preliminary credibility to the use of the EDE-Q in adolescent eating disorder samples.

Population at risk for eating disorders in a Spanish region

OBJECTIVE

To estimate the prevalence of adolescent population at risk for eating disorders (EDs), to examine gender differences and their association with non-psychotic mental disorders.

METHODS

Cross-sectional study using an anonymous, self-reported questionnaire in the classroom and measurement of weight and height in a representative sample of 4334 teenagers of both sexes. A definition of population at risk for EDs has been established, that differentiates those with dieting criteria and those with binge-purge eating behaviour criteria. This definition includes a combination of weight, behaviour, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, and Eating Disorder Inventory (EDI) results. The General Health Questionnaire-28 (GHQ-28) was used to assess non-psychotic mental disorders.

RESULTS

The prevalence of population at risk for EDs was 2.2% (95% CI: 1.6-2.8) for men and 15.3% (95% CI: 13.8-16.9) for women. The prevalence rate of combining both ED risk and mental disorder was 0.8% (95% CI: 0.4-1.2) for men and 9.9% (95% CI: 8.6-11.2) for women. Non-psychotic mental disorders were more prevalent in the population at risk for EDs than in the rest of the population.

CONCLUSIONS

A considerable proportion of adolescent females have eating problems and non-psychotic mental disorders. Their male counterparts also suffer from these disorders, however, a different pattern is followed.

Nonresponse bias in a general population survey of eating-disordered behavior

OBJECTIVE

To investigate nonresponse bias in a two-phase epidemiologic study of eating-disordered behavior.

METHOD

Self-report questionnaires were delivered to a community sample of women aged 18-45 drawn from the electoral roll. Follow-up interviews were completed with a subgroup of respondents. Eating disorder psychopathology, general physical and mental health, and sociodemographic characteristics were compared among early (n = 259) and late (n = 71) respondents at the first phase of the study and among individuals with whom interviews were completed (n = 208) and individuals declining to be interviewed (n = 63) at the second phase.

RESULTS

With respect to levels of eating disorder psychopathology, and on all other measures, individuals who responded at the first phase of the study only after repeated reminders did not differ from those who responded to the initial mailout, and individuals who declined to be interviewed did not differ from individuals with whom interviews were completed.

CONCLUSIONS

Nonresponse bias among individuals declining to be interviewed is unlikely to pose a problem in two-phase epidemiologic studies of eating disorders. Further research is needed to examine the characteristics of nonrespondents at the first phase of such studies.

Disordered eating attitudes: an emerging health problem among Mediterranean adolescents

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.

Review of the prevalence and incidence of eating disorders

OBJECTIVE

To review the literature on the incidence and prevalence of eating disorders.

METHODS

We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found. Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases.

RESULTS

An average prevalence rate for anorexia nervosa of 0.3% was found for young females. The prevalence rates for bulimia nervosa were 1% and 0.1% for young women and young men, respectively. The estimated prevalence of binge eating disorder is at least 1%. The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year. The incidence of anorexia nervosa increased over the past century, until the 1970s.

DISCUSSION

Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care.

Comportamento alimentar e imagem corporal em atletas

O ambiente esportivo pode ser um meio ampliador de pressões socioculturais motivadas pelo ideal de corpo magro. A presente investigação teve o objetivo de verificar a presença de comportamentos sugestivos de transtornos do comportamento alimentar (TCAs), de alterações na imagem corporal e de disfunções menstruais em atletas da EEFD-UFRJ. Foram avaliadas 12 atletas do sexo feminino (20 ± 2,0 anos) com 4,6 ± 2,3 anos de treinamento (13,8 ± 2,9h/semana) e seus resultados foram comparados com os de 32 jovens não-atletas (15,0 ± 1,4 ano). A avaliação de atitudes e comportamentos relacionados com a alimentação e o controle de peso foi realizada pelo Eating Attitudes Test (EAT-26), a existência de comportamentos sugestivos de bulimia nervosa pelo Bulimic Investigatory Test Edimburgh (BITE) e o grau de insatisfação com a imagem corporal pelo Body Shape Questionnaire (BSQ). Esses são instrumentos de auto-aplicação e foram usados na versão em português. As atletas apresentavam massa corporal total de 59 ± 7,3kg, estatura de 1,65 ± 0,03m, percentual de gordura corporal (%G) 23,1 ± 4,1% e índice de massa corporal (IMC) de 21,6 ± 2,3kg/m². O BSQ apontou que 33% das atletas apresentam leve distorção da imagem corporal mesmo estando com valores para gordura corporal dentro de padrões esperados para a idade e sexo. O BITE apontou 16,6% das atletas com padrão alimentar não-usual na escala de sintomas, sem que estas apresentassem expressão na escala de gravidade. As atletas com padrão alimentar não-usual estão incluídas no total sugestivo de distorção de imagem corporal. O EAT-26 exibiu resultado negativo para todas as atletas. Os resultados encontrados na análise sugerem a presença de sintomas que não caracterizam, precisamente, a bulimia nervosa ou a anorexia nervosa, mas ressaltam a necessidade de avaliação e vigilância mais criteriosas da existência de TCA e seus precursores no ambiente esportivo, como forma de prevenção.

Weight concern, dieting and eating behaviors. A survey of Israeli high school girls

The main goal of the present study was to explore some of the risk-factor variables for eating disorders among Israeli junior high and high school adolescent girls (12-18 years old) from different residential areas in the northern district of Israel. Additionally, this study examined and identified which group was most prone to develop disordered eating behaviors and attitudes.

METHOD

A representative sample of 1,316 Jewish adolescent females from five Israeli school sub-groups and from five different residential areas was selected proportionally to various school sub-groups and residential areas. The Eating Disorder Inventory-2 (EDI-2) was the assessment tool used, yielding scores on 11 sub-scales.

RESULTS

In regard to age, the 16.6-18 year-olds were found to have significantly higher total EDI-2 scores, as compared to the other age groups. Girls aged 16.6 and up were found to have the highest score in six sub-scales out of eleven. As for different types of schools in different residential settings, the secular boarding school sub-group had the significantly highest scores, while the kibbutz sub-group had the lowest scores for the total EDI-2, as well as for most subscales. The majority of scores for the other school sub-groups fell midway between the two extreme groups.

DISCUSSION

The results are discussed in terms of cultural, religious, ethnic, and socioeconomic influences.

CONCLUSION

The results highlight the need to conduct a systematic methodological study comparing various psychological and socioeconomic factors, including maladaptive eating behavior in different types of religious residential schools.

Significant linkage on chromosome 10p in families with bulimia nervosa

Bulimia nervosa (BN) is strongly familial, and additive genetic effects appear to contribute substantially to the observed familiality. In turn, behavioral components of BN, such as self-induced vomiting, are reliably measured and heritable. To identify regions of the genome harboring genetic variants conferring susceptibility to BN, we conducted a linkage analysis of multiplex families with eating disorders that were identified through a proband with BN. Linkage analysis of the entire sample of 308 families yielded a double peak, with the highest nonparametric multipoint maximum LOD score (MLS), of 2.92, on chromosome 10. Given the high heritability of self-induced vomiting and the reliability with which it can be measured, we performed linkage analysis in a subset (n=133) of families in which at least two affected relatives reported a symptom pattern that included self-induced vomiting. The highest MLS (3.39) observed was on chromosome 10, between markers D10S1430 and D10S1423. These results provide evidence of the presence of a susceptibility locus for BN on chromosome 10p. Using simulations, we demonstrate that both of these scores, 2.92 and 3.39, meet the widely accepted criterion for genomewide significance. Another region on 14q meets the criterion for genomewide suggestive linkage, with MLSs of 1.97 (full sample) and 1.75 (subset) at 62 centimorgans from p-ter.

The influence of definitions on the prevalence of eating problems in an adolescent population

OBJECTIVE

The definitions of eating problems vary widely as they integrate cognitive, behavioural and physiological components to different degrees. The aim of this study was to show how much these differences affect the prevalence of eating problems in an adolescent population.

METHOD

All of the 9131 adolescents in a Norwegian county participated in a health study, 8042 (88.1%) of whom gave valid responses to a questionnaire covering various aspects of eating problems, and had their weight and height measured.

RESULTS

The prevalence of eating problems ranged from 0.3 to 47.0% depending on the definitions used. The various definitions also gave different gender ratios, although the prevalences increased with age in females only.

CONCLUSIONS

The various definitions of eating problems had a low degree of correlation and led to quite variable prevalences. All of them showed that the prevalence of eating problems was higher in females, but their prevalence in males was also considerable.

Discriminant validity of the Eating Attitudes Test according to American Psychiatric Association and World Health Organization criteria of eating disorders

The purpose of this study was to assess the sensitivity, the specificity, and the positive predictive value of the Eating Attitudes Test in a sample of Spanish nonclinical 18-yr.-olds. 304 subjects answered the Eating Attitudes Test-40, 290 of whom were interviewed individually with the Spanish version of the Schedules for Clinical Assessment in Neuropsychiatry. Eating disorders were diagnosed using ICD-10 and DSM-III-R criteria. The prevalence of eating disorders was higher for ICD-10 (5.2%) than for DSM-III-R (2.6%) and only affected the rate of diagnosis in women. According to ICD-10 criteria, the cut-off of 25 was more sensitive (87.5%) than the cut-off of 30 (75%) and varied little in specificity (93.9% vs 97.1%). The positive predictive value of the Eating Attitudes Test cut-off of 30 for eating disorders (ICD-10) was 36%. Our results support the test as useful for identifying eating disturbances in 18-yr.-olds and suggest assessment of a cut-off lower than 30 may be appropriate in the general population if confirmed in further research with a representative sample of adults.

Menstrual functioning and psychopathology in a county-wide population of high school girls

OBJECTIVE

To examine the association between menstrual functioning and depressive disorder symptoms (DDS), obsessive-compulsive disorder symptoms (OCDS), and eating disorder symptoms (EDS) in high school girls.

METHOD

Survey data from a county-wide high school population (completion rate 91%) were used. Associations between menstrual indices and scores above clinical cutoff on the Beck Depression Inventory, Leyton Obsessive-Compulsive Inventory-Child Version, and Eating Attitudes Test were examined by using logistic regression ( = 2,547 girls).

RESULTS

Controlling for chronological age and other risk factors, late menarche was associated with DDS (odds ratio [OR] = 2.26, 95% confidence interval [CI] = 1.16-4.18). Gynecological year 1 (GY1) was associated with DDS (OR = 3.13, CI = 1.23-7.33), EDS (OR = 3.11, CI = 1.00-8.09), and OCDS, both number (OR = 5.75, CI = 1.79-15.74) and interference (OR = 12.55, CI = 3.20-41.4). Secondary amenorrhea was associated with DDS (OR = 1.94, CI = 11.30-2.84) and EDS (OR = 2.32, CI = 1.51-3.49); polymenorrhea with EDS (OR = 1.92, CI = 1.27-2.86); and irregular cycles with EDS (OR = 1.70, CI = 1.11-2.54) and DDS (OR = 1.76, CI = 11.21-2.53).

CONCLUSIONS

In high school girls, late menarche, GY1, and menstrual cycle abnormalities are associated differentially with DDS, OCDS, and EDS.