Preliminary identification of clinical cut-off of the vegetarian vegan eating disorder screener (V-EDS) in a community and self-reported clinical sample of vegetarians and vegans

BACKGROUND

The vegetarian vegan eating disorder screener (V-EDS) is an 18-item self-report screening tool designed to assess the unique elements of eating disorder symptomology in vegetarians and vegans. Previous results have suggested strong initial psychometric properties in non-clinical community samples of vegetarians and vegans. The present study sought to identify a preliminary threshold cut-off score to discriminate eating disorder pathology in a self-reported clinical and community sample.

METHODS

This study involved secondary analysis using data collected in McLean et al. (Development and preliminary validation of a novel eating disorder screening tool for vegetarians and vegans: the V-EDS, 2023), comprising 599 non-clinical participants and 51 self-reported clinical participants. Receiver operating characteristic (ROC) curve analysis was used to compute possible cut-off values for the V-EDS.

RESULTS

ROC analysis indicated good performance of the V-EDS (area under the curve = 0.87), with integration of the Youden index demonstrating a global score of ≥ 18 to be optimal in predicting clinical caseness with good sensitivity (0.804) and specificity (0.843).

CONCLUSIONS

The present study fills an important gap as the first to investigate an optimal V-EDS score to discriminate level of impairment from eating disorder pathology in a sample of vegetarian and vegan community and self-reported clinical participants. We extend the utility of the V-EDS in discovering good discrimination power in classifying clinical caseness with a cut-off score of 18 shown to optimise the trade-off between sensitivity and specificity. Future research should focus on expanding the psychometric properties of the V-EDS in larger and more diverse participant groups, including gender, age, cultural identity, and eating disorder history.

Development and preliminary validation of a novel eating disorder screening tool for vegetarians and vegans: the V-EDS

BACKGROUND

Eating disorders have one of the highest mortality of all mental illnesses but are associated with low rates of screening and early intervention. In addition, there remains considerable uncertainty regarding the use of current standardised screening tools in measuring eating pathology in vegetarians and vegans. With these groups presenting as potential at-risk groups for disordered eating development, the present study aimed to develop and preliminary validate a novel eating disorder screening tool, the Vegetarian Vegan Eating Disorder Screener (V-EDS).

METHODS

We utilised a mixed-methods approach, comprising four phases.

RESULTS

A conceptual framework was developed from 25 community, clinician, and lived experience interviews and used to derive a preliminary set of 163 items (Phase 1). Phase 2 piloted the items to establish face and content validity through cognitive debriefing interviews of 18 additional community, clinician, and lived experience participants, resulting in a reduced, revised questionnaire of 53 items. Phase 3 involved scale purification using Item Response Theory in analysis of 230 vegetarians and 230 vegans resulting in a further reduced 18-item questionnaire. Phase 4 validated the screening tool in a large community sample of 245 vegetarians and 405 vegans using traditional psychometric analysis, finding the V-EDS supports a unidimensional factor structure with excellent internal consistency (α = 0.95-0.96) and convergent validity (0.87-0.88), and moderate discriminate validity (0.45-0.55).

CONCLUSIONS

This study provided strong initial support for the psychometric validity and theoretical assumptions of the novel V-EDS screening tool. The V-EDS has the potential to increase early intervention rates for vegetarians and vegans experiencing eating disorder symptoms, further supporting advocacy and treatment approaches for these expanding dietary groups.

The 26-Item Eating Attitudes Test (EAT-26): Psychometric Properties and Factor Structure in Vegetarians and Vegans

The eating disorder screener, Eating Attitudes Test (EAT), has been used widely; however, its usability in specific dietary groups such as vegetarians and vegans remain unknown. Considering the rising popularity of vegetarianism and veganism, the current study aimed to assess the psychometric properties and theoretical assumptions of the 26-item EAT in separate groups of vegetarians (n = 278), vegans (n = 580), and omnivores (n = 413). Confirmatory factor analysis of four models from previous literature revealed inadequate fit of the data, with the exception of a 16-item four-factor model in vegetarians and vegans. Further assessment of the original three-factor model and 16-item four-factor model demonstrated poor psychometric properties. The primarily inadequate test-retest reliability discovered in this study, independent of whether a shortened version was used, raises concerns around the utility and stability of the EAT-26 in vegetarians and vegans. Future research should potentially investigate novel ways of measuring eating disorder pathology in these groups.

Disordered eating and the meat-avoidance spectrum: a systematic review and clinical implications

PURPOSE

Meat avoidance has long been thought to be related to eating psychopathology; however, research does not necessarily support this notion. Furthermore, commonly used eating disorder scales may be picking up on normal meat-avoiding behaviours in vegetarians and vegans. As such, we systematically reviewed the association between vegetarianism, veganism, and disordered eating, and reviewed the psychometric properties of eating disorder scales for use in these populations.

METHODS

We searched electronic databases MEDLINE, PsychINFO, and CINAHL for literature published until June 2021.

RESULTS

Forty-eight studies met eligibility criteria, with no consensus as to whether meat avoidance was associated with higher rates of disordered eating. Most studies reported a significant positive association with both vegetarianism and veganism, and orthorexia nervosa. Six studies provided evidence for the use of eating disorder measures in vegetarians and vegans, reporting poor psychometric fit among all scales.

CONCLUSION

This systematic review highlights the extent to which vegetarians and vegans have been highly understudied, with limited research suggesting higher levels of orthorexia nervosa behaviours in vegetarians and vegans. Furthermore, our results provide tentative evidence that the factorial validity of commonly used eating disorder scales, such as the EDE-Q, may be poor in vegans.

LEVEL OF EVIDENCE

Level I, systematic review.

The impacts of COVID-19 on eating disorders and disordered eating: A mixed studies systematic review and implications

Purpose

The unique constraints to everyday life brought about by the COVID-19 pandemic have been suggested to negatively impact those with pre-existing mental health issues such as eating disorders. While individuals with eating disorders or disordered eating behaviors likely represent a vulnerable group to the COVID-19 pandemic, the impact of the pandemic is yet to be fully established.

Methods

We systematically examined the impact of the COVID-19 pandemic on eating disorders and disordered eating behaviors. We searched electronic databases MEDLINE, PsycINFO, CINAHL, and EMBASE for literature published until October 2021. Eligible studies were required to report on individuals with or without a diagnosed eating disorder or disordered eating behaviors who were exposed to the COVID-19 pandemic.

Findings

Seventy-two studies met eligibility criteria with the majority reporting an increase in eating disorder or disordered eating behaviors associated with the COVID-19 pandemic. Specifically, it appears children and adolescents and individuals with a diagnosed eating disorder may present vulnerable groups to the impacts of the COVID-19 pandemic.

Discussion

This mixed systematic review provides a timely insight into COVID-19 eating disorder literature and will assist in understanding possible future long-term impacts of the pandemic on eating disorder behaviors. It appears that the role of stress in the development and maintenance of eating disorders may have been intensified to cope with the uncertainty of the COVID-19 pandemic. Future research is needed among understudied and minority groups and to examine the long-term implications of the COVID-19 pandemic on eating disorders and disordered eating behaviors.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284749, PROSPERO [CRD42021284749].

Characteristics and clinical implications of the relationship between veganism and pathological eating behaviours

OBJECTIVE

Veganism may serve as a socially acceptable means to restrict food intake and disguise pathological eating behaviours. Studies that include vegan participants typically group them with other meat avoiders (e.g., vegetarians), potentially masking risk factors unique to veganism.

METHOD

We addressed this issue by recruiting two Amazon Mechanical Turk samples of 110 vegan and 118 omnivore participants, with comparable gender composition. We aimed to examine whether vegans showed higher disordered eating than omnivores, and if motives for pursuing a vegan diet impacted disordered eating. We assessed disordered eating using the Eating Attitudes Test, the Eating Disorder Examination-Questionnaire, and the Eating Pathology Symptom Inventory.

RESULTS

Vegans displayed more pathological eating behaviours than omnivores, which was significantly predicted by cognitive restraint. However, body dissatisfaction levels were higher in omnivores than vegans. Diet motives did not influence vegans' disordered eating.

CONCLUSION

We propose vegans have high levels of cognitive restraint, possibly due to their intention to avoid animal products. In turn, cognitive restraint subscales in eating disorder measures might be over-pathologising rates of eating disorders in vegans. Future research should monitor the progression of people's eating-related attitudes and behaviours before and after they transition to veganism to establish whether veganism increases the risk of disordered eating, or vice versa.

LEVEL OF EVIDENCE

IV, cross-sectional study.

An Australian perspective on "clean" dietary labels: Commentary on Negowetti et al. (2021)

"Clean eating" is an increasingly popular diet trend in Western countries with links to disordered eating behaviors. However, the definition of "clean" is a highly contentious issue. Negowetti, Ambwani, Karr, Rodgers, and Austin explore this important issue from a U.S. perspective conducting a scoping review of the public health implications of the use of "clean" labels on food, including legal and policy implications. The review showed that the U.S. Food and Drug Administration (FDA) has taken little action to address regulation of the use of "clean" dietary labels. Our own brief investigations suggest that the landscape in Australia under the Food Standards Australia New Zealand authority is similar. We discuss recommendations made by Negowetti et al. to address this issue in the United States, such as the FDA providing industry guidance on the term "clean," and the issuing of warning letters to companies who contravene this guidance. However, we predict that educating consumers to be more critical of unsubstantiated food labels in public health campaigns will be the most efficient way to change consumer behavior and address the "clean eating" diet trend. We also encourage eating disorder researchers and clinicians to be an influential part of this discussion.

Early defibrillation and the chain of survival in 'in-hospital' adult cardiac arrest; minutes count

OBJECTIVE

To report the outcomes from and the impact of the chain of survival in 'in-hospital' cardiac arrest where the presenting rhythm was VF/VT, the arrest was witnessed, defibrillation was conducted rapidly and no other resuscitation interventions were required.

OUTCOME MEASURES

Any return of spontaneous circulation and discharge from hospital.

METHODS

A 2-year prospective resuscitation audit using the Utstein style was conducted within a major London NHS Hospital Group.

RESULTS

There were 124 patients who had primary VF/VT arrest. Eight were excluded from the study and 14 had non-witnessed cardiac arrest. Twenty one patients had witnessed VF/VT arrest but with delayed defibrillation, 81 patients had witnessed VF/VT arrest with rapid defibrillation, 69 patients had witnessed VF/VT arrest with rapid defibrillation, CPR and other additional interventions. There were 15 patients that had witnessed cardiac arrest with a presenting rhythm of VF/VT, who received rapid defibrillation and had no ventilation or chest compression prior to or following defibrillation. All 15 patients achieved a return of spontaneous circulation, and 12 were discharged alive.

CONCLUSIONS

Rapid defibrillation prior to any other resuscitation intervention is associated with increased survival from witnessed VF/VT arrest in in-hospital cardiac arrest victims, and that the time to first shock is critical in enhancing the prospects of long-term survival in these patients.