Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

A Cross-Sectional Analysis of College Students' Diet, Mental Health, and Hindrances to Healthy Lifestyles

Objective: To determine whether dietary intake and restrictions on diet are correlated with sleep, academic achievement, and/or mental health in a college population. Methods: We used Qualtrics to survey a large public university in the Northeast for Fall 2022, Spring 2023, and Fall 2023 academic semesters (n = 98;104;90) for campus demographics, diet quality, dietary restrictions, food insecurity, sleep quality and quantity, stress (PSS), anxiety (GAD-7), depression (PHQ-9), and academic success (GPA). We performed Spearman rho and Pearson r analyses (IBM SPSS, alpha = 0.05). Results: Diet quality correlated positively with GPA (Rho = 0.265, P < 0.05), dietary restrictions (Rho = 0.498, P < 0.05), and sleep hours (r = 0.284, P < 0.05), but negatively with anxiety (Rho = -0.300, P < 0.01), stress (r = -0.225, P < 0.05), and depression (r = -0.434, P < 0.05). Food insecurity correlated positively with anxiety (Rho = 0.488, P < 0.001), stress (r = 0.557, P < 0.001), and depression (r = 0.489, P < 0.001), but negatively with GPA (Rho = -0.390, P < 0.05). Sleep quality correlated negatively with stress (r = -0.269, P = 0.008), depression (r = -0.350, P < 0.001), and anxiety (Rho = -0.248, P = 0.014). Conclusions: Correlations among diet, food insecurity, dietary restrictions, sleep, and mental health metrics suggest that improvements in diet benefit students' lifestyles. However, more restrictive diets do not appear to be deleterious, implying a reduced need for dietary interventions in this population.

A cross-sectional study to estimate the prevalence of eating disorders and ascertain factors for eating disorder risk among senior college students in a metropolitan city

BACKGROUND

Eating disorders are more prevalent in Western countries and their prevalence is on the rise in India, mainly due to peer pressure and the influence of media. However, research on eating disorders is limited in India. The aim of this study is to estimate the prevalence of eating disorders among senior college students and to ascertain factors for eating disorder risk.

MATERIALS AND METHODS

A cross-sectional study was conducted among 807 students attending 2 of the arts and science colleges in a metropolitan city (Mumbai) over a period of 12 months from June 2019 to June 2020. A predesigned case record form was used to collect information on sociodemographic profiles and other factors related to eating disorder risk. Eating Attitude test (EAT-26) was used as a screening test to find the prevalence of those at risk for eating disorders. Munich-ED quest was used for the diagnosis of the eating disorder.

RESULTS

Data were analyzed using SPSS version 16.0. The Chi-square test was used to find the association of various factors with eating disorder risk. Our study found the overall proportion of eating disorder risk to be 42.25%. Among them, 19 (2.35%) individuals had night eating syndrome and 7 (0.86%) had binge eating syndrome as per DSM-5 criteria using Munich ED Quest. On logistic regression, we found fasting once or twice a week (OR: 2.916;95%CI: 1.524-5.574; P = 0.001), increase in duration of physical activities for more than 10 h a week (OR: 3.874; 95% CI: 2.200-6.821; P < 0.001), being commented for weight by friends/relatives (OR: 1.695; 95% CI: 1.244-2.309; P = 0.001), and thought of being overweight (OR: 1.763;95% CI: 1.178-2.639; P = 0.006) to be significantly associated with risk of eating disorders. The age group of 18-20 years (OR: 0.519;95%CI: 0.345-0.782; P = 0.002) was found to be at lower risk for eating disorders compared to the 22-24 year age group.

CONCLUSION

Screening of students with a simple tool like EAT-26 would prove beneficial in the early identification of those at risk of eating disorders.

Associations between dieting practices and eating disorder attitudes and behaviors: Results from the Canadian study of adolescent health behaviors

This study aimed to describe the frequency of dieting practices among adolescents and young adults in Canada, as well as determine the association between dieting and eating disorder attitudes and behaviors. Data from 2762 Canadian adolescents and young adults from the Canadian Study of Adolescent Health Behaviors were analyzed. Frequencies were used to determine the prevalence of 11 different diets among the sample, and chi-square tests were used to assess gender differences. Multiple modified Poisson and linear regression analyses were conducted to determine the associations between any dieting and eating disorder attitudes and behaviors. Among the sample, 15.7 % of girls and women, 10.4 % of boys and men, and 13.0 % of transgender/gender expansive (TGE) participants reported any dieting in the past 12 months, with the Ketogenic diet being most common among all genders. Results from regression analyses showed that engaging in any dieting in the past 12 months was associated with greater eating disorder psychopathology among girls, women, boys, and men, but not TGE participants. There were varying trends in association between specific types of dieting practices and eating disorder behaviors among girls, women, boys, and men. Dieting is relatively common among a national sample of Canadian adolescents and young adults, and engagement is associated with greater eating disorder psychopathology and behaviors. Healthcare and public health professionals should consider screening for eating disorders among adolescents and young adults who report engaging in dieting practices.

Ancient medicine for a modern disease: traditional Amazonian medicine to treat substance use disorders

Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.

Effects of intermittent fasting on cognitive health and Alzheimer's disease

OBJECTIVE

Caloric restriction by intermittent fasting produces several metabolic changes, such as increased insulin sensitivity and use of ketone bodies as energy sources. In humans, intermittent fasting has been studied in hypertension, diabetes, and related conditions, but, to date, not as a strategy to reduce the risk of emergent dementia. In this scoping review, the relevance of intermittent fasting as a potential preventive intervention for Alzheimer's dementia is explored.

BACKGROUND

The beneficial effects of calorie restriction have been documented in animals and humans. Decreased oxidative stress damage and attenuated inflammatory responses are associated with intermittent fasting. These changes have a favorable impact on the vascular endothelium and stress-induced cellular adaptation.

RESULTS

Physiological alterations associated with fasting have profound implications for pathological mechanisms associated with dementias, particularly Alzheimer's disease. Compared with ad libitum feeding, caloric restriction in animals was associated with a reduction in β-amyloid accumulation, which is the cardinal pathological marker of Alzheimer's disease. Animal studies have demonstrated synaptic adaptations in the hippocampus and enhanced cognitive function after fasting, consistent with these theoretical frameworks. Furthermore, vascular dysfunction plays a crucial role in Alzheimer's disease pathology, and intermittent fasting promotes vascular health.

CONCLUSIONS

These observations lead to a hypothesis that intermittent fasting over the years will potentially reverse or delay the pathological process in Alzheimer's disease.

Toward inclusivity: A systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades

OBJECTIVE

Sexual minority (SM) groups (e.g., those who identify as lesbian, gay, bisexual, questioning, queer, asexual, or those who feel their sexual orientation identity cannot be captured with existing terminology [LGBQA+] and those who report same-sex or same-gender attraction and/or behavior) are at elevated risk for eating disorder (ED) symptoms and behaviors. However, the ways in which this risk varies across SM is less clear, and findings are not fully convergent. Evolution in the definition and assessment of SM status may contribute to this divergence. The aim of this study was to systematically review how sexual orientation and SM status have been assessed in the ED literature and how this may relate to patterns of associations between SM status and ED symptoms.

METHODS

A systematic review of the literature focused on ED symptoms and behaviors and SM groups was conducted, yielding 182 studies.

RESULTS

Five categories were created reflecting SM status assessment: identity only (n = 105), attraction only (n = 8), behavior only (n = 4), combinations of identity, behavior, or attraction (n = 58), and articles with unclear or insufficient information about SM status assessment (n = 7). SM status operationalizations varied across studies, with more inclusive assessments in more recent work. Findings revealed persistent conflicting patterns of disordered eating symptomatology for some SM groups. In addition, decisions to selectively combine SM participants in some studies, most often to increase power, decreased the specificity of their results in relation to differential risk and protective factors within specific LGBQA+ groups.

DISCUSSION

Findings highlight the importance of inclusive assessments of sexual orientation in the ED literature and research focused on underrepresented groups with intersecting identities. Identifying modifiable targets for intervention is a critical next step.

PUBLIC SIGNIFICANCE

Sexual minority (SM) groups have been identified as presenting elevated risk for eating disorder symptoms and behaviors. Our findings suggest that the level of risk is variable across SM groups and points to the need for multi-dimensional assessments of SM status, and increased focus on the function of disordered eating behaviors and different profiles that might emerge related to efforts to modify physical appearance or to regulate emotion.

Intermittent fasting: Describing engagement and associations with eating disorder behaviors and psychopathology among Canadian adolescents and young adults

Intermittent fasting has grown in popularity over the past several years. However, intermittent fasting has also been shown to relate to eating disorder behaviors and psychopathology, yet little research has explored this relationship in epidemiological samples. Therefore, the aims of this study were to determine prevalence and characteristics of engagement in intermittent fasting, and associations with eating disorder behaviors and psychopathology. Data from the Canadian Study of Adolescent Health Behaviors, a national study of Canadian adolescents and young adults (N = 2762) were analyzed. Multiple modified Poisson regression analyses were conducted to determine the association between intermittent fasting (past 12 months and 30 days) and eating disorder behaviors and psychopathology (measured using the Eating Disorder Examination Questionnaire). Overall, 47.7 % of women, 38.4 % of men, and 52.0 % of transgender/gender non-conforming (TGNC) participants reported engaging in intermittent fasting in the past 12 months. Intermittent fasting in the past 12 months and 30 days was significantly associated with eating disorder psychopathology among women, men, and TGNC participants. Varying patterns of association between intermittent fasting and eating disorder behaviors were found across genders, with the most consistent relationships between intermittent fasting and ED behaviors in women. Findings underscore the common nature of intermittent fasting among a large, community sample of adolescents and young adults across Canada, as well as associated eating disorder behaviors and psychopathology. Continued research is needed to further understand the effects of intermittent fasting, as clinical and public health efforts are needed to protect the health of adolescent and young adults.

Characterizing cheat meals among a national sample of Canadian adolescents and young adults

BACKGROUND

"Cheat meals", described as brief eating episodes that depart from established dietary practices to consume prohibited foods, represent a novel and increasingly common eating behavior with particular salience in adolescence and young adulthood. However, knowledge gaps remain regarding the frequency and characterization of foods and calories consumed during cheat meals, and their associations with eating disorder behaviors and psychopathology. Thus, the aims of this study were to delineate engagement in cheat meals among a large, national sample of Canadian adolescents and young adults.

METHODS

Participants (N = 2,717) were from the Canadian Study of Adolescent Health Behaviors. Frequencies of engagement in cheat meals, and associated foods and calories consumed, in the past 12 months and 30 days were determined. The associations between engagement in cheat meals and eating disorder behaviors and psychopathology were determined using modified Poisson regression analyses.

RESULTS

Engagement in cheat meals in the past 12 months was highest among men (60.9%) compared to women (53.7%) and transgender/gender non-conforming (TGNC; 52.5%) participants. Cheat meals consisting between 1,000 and 1,499 cal were those most frequently reported among all participants. Mean number of cheat meals in the past 12 months was equivalent to > 1 per week, which was similar to engagement in the past 30 days. Finally, engagement in cheat meals in the past 12 months and 30 days was associated with patterns of eating disorder behaviors and psychopathology among all participants, including binge-eating-related behaviors.

CONCLUSIONS

This study further characterized and extended knowledge of cheat meal engagement across genders, aligning with prior research by demonstrating that engagement is associated with greater eating disorder psychopathology. Findings from this study add to the growing characterization of the novel behavioral phenomenon of cheat meals. Specifically, over half of adolescents and young adults across all 13 provinces and territories in Canada reported engaging in > 1 cal dense cheat meal per week, over the past 12 months. Despite the normalization and promotion of cheat meal engagement among the general public and unique fitness communities, engagement in this behavior is linked to greater eating disorder behaviors and psychopathology, including binge-eating episodes. Our findings emphasize the need for further research, public awareness, and clinical interventions aimed at addressing this potentially harmful eating behavior.

Weight gain attempts and substance use behaviors among adults across five countries

Weight gain attempts are common among adolescents, yet a paucity of research has explored these behaviors among adults, particularly in relation to substance use behaviors. To address this gap in the literature, pooled data from the 2018 and 2019 International Food Policy Study (N = 42,108) were analyzed. The association of weight gain attempts in the past 12 months with four important and relatively common substance use behaviors (alcohol use, binge-drinking, cigarette smoking, marijuana use) was examined using multiple modified Poisson regression analyses that adjusted for theoretically relevant covariates. Among men and women, weight gain attempts were associated with a higher likelihood of cigarette smoking in the past 30 days, marijuana use in the past 12 months, and binge-drinking one or more times per month in the past 12 months among men only. Among women, weight gain attempts were associated with a lower likelihood of alcohol use one or more times per month in the past 12 months. Our findings contribute to the literature demonstrating that substance use behaviors are more prevalent among adults who report weight gain attempts in a large international sample.

Changes in the prevalence and sociodemographic correlates of eating disorder symptoms from 2013 to 2020 among a large national sample of U.S. young adults: A repeated cross-sectional study

OBJECTIVE

The present study aimed to: (1) identify recent temporal changes in the prevalence of different cognitive and behavioral eating disorder (ED) symptoms, current probable EDs, lifetime ED diagnoses, and mental healthcare use among college students across the United States; (2) determine whether established disparities in ED prevalence and receiving mental healthcare have widened or narrowed over time for marginalized groups within this population.

METHOD

Participants included a large national sample of U.S. college students (N = 286,720) who completed the repeated cross-sectional Healthy Minds Study from 2013 to 2020. Descriptive statistics and polynomial regressions quantified time-trends in participants' ED symptoms and past 12-month mental healthcare. Moderated regressions examined temporal changes in ED symptoms and mental healthcare based on sociodemographic characteristics.

RESULTS

Individuals' engagement in different cognitive and behavioral ED symptoms, and likelihoods of exhibiting current probable EDs, reporting lifetime ED diagnoses, and (for individuals with current probable EDs) receiving therapy or counseling in the past 12-months exhibited nonlinear increases from 2013 to 2020. Further, the prevalence of current and lifetime ED symptoms and (for symptomatic individuals) past 12-month mental healthcare differed over time for individuals with different BMIs and gender, sexual, and racial/ethnic identities (but not ages). In particular, individuals with higher BMIs and those who identified as male, bisexual, and gay, lesbian, or queer exhibited increasing ED pathology over time.

DISCUSSION

These findings provide important information on groups of U.S. college students that have experienced increasing burden of ED symptoms and may help guide ED prevention, treatment, and research priorities.

PUBLIC SIGNIFICANCE

Recent temporal changes in the prevalence of eating disorder (ED) symptoms and mental healthcare were examined in a national sample of U.S. young adults. Non-linear increases in ED symptoms and mental healthcare were identified among U.S. young adults overall from 2013 to 2020. U.S. young adults with higher BMIs, males, bisexual, and gay, lesbian, or queer individuals exhibited increasing ED burden over time.

Using Illicit Drugs to Lose Weight among Recovering Female Drug Users in China: An Exploratory Qualitative Study

The population of female drug users has been growing in China, and these women have been found to care deeply about their weight. Against this backdrop, this study examines the relationship between Chinese women's illicit drug use and their intentions to lose weight, keep fit, and maintain a slim body shape. The participants of this study were 29 women who all had experience with illicit drug use for weight control. These women were drawn from a female compulsory drug treatment center located in eastern China. Semi-structured interviews with these 29 participants were conducted between 2013 and 2016. Expectations of losing weight and pursuing their ideal slim body shape were found to be an important reason for the study participants' initiation of drug use, its maintenance, and failures to achieve abstinence. These Chinese female drug users were generally satisfied with weight loss outcomes subsequent to drug consumption. A fuller appreciation of Chinese women's weight-loss-related illicit drug use patterns is much needed to help devise strategies and policies to deal with this growing problem. These include changing the dominant aesthetic cultural preference for thinness, paying particular attention to the functional use of illicit drugs in drug treatment programs, and having special interventions for women who interact with drug users within their social networks.