Greater dietary variety is associated with lower food anxiety at discharge from intensive eating disorder treatment

OBJECTIVE

Food anxiety and limited dietary variety often persist after intensive treatment for eating disorders (EDs) and may contribute to relapse. Prior studies demonstrate decreased meal-related anxiety with residential or inpatient treatment, but less is known about changes in dietary variety and anxiety associated with specific foods. The current study assessed change in food anxiety and dietary variety in inpatients with EDs (anorexia nervosa and bulimia nervosa) in relation to discharge outcomes from meal-based behavioral treatment.

METHOD

Patients (N = 128) admitted to a specialized, hospital-based behavioral treatment program completed measures of food anxiety, dietary variety, and ED symptoms at admission and discharge. Demographic and clinical data were abstracted from electronic medical records. A novel network community analysis identified three food anxiety groups: fruit-veg, animal-based, and carb-based foods.

RESULTS

High-energy density combination foods were most anxiety-provoking and most avoided. Food anxiety decreased, and dietary variety increased from admission to discharge. Reduction in food anxiety was associated with lower ED symptom scores and higher normative eating self-efficacy at discharge. For animal-based foods, increased dietary variety was associated with lower food anxiety at discharge. Neither variety nor anxiety was associated with weight restoration.

DISCUSSION

Findings highlight the importance of broadening dietary variety and targeting food anxiety during the nutritional rehabilitation and weight restoration phase of ED treatment. Increasing dietary variety may contribute to reduced food anxiety, which, in turn, may increase normative eating self-efficacy. These results may help inform nutritional guidelines for meal-based treatment programs.

PUBLIC SIGNIFICANCE

Consuming a greater variety of foods during meal-based intensive treatment may help alleviate food anxiety in patients with eating disorders.

Behavior and adoptability of hoarded cats admitted to an animal shelter

Objectives

The aim of this study was to analyze the behavioral characteristics and success of adoption for previously hoarded cats.

Methods

Shelter records and post-adoption surveys were analyzed for hoarded cats ⩾6 months old at intake. A non-standard scoring system was used. Intake scores were allocated contemporaneously and socialization scores were applied retrospectively for three time points (TPs): 5–10 days post-intake (shelter TP), ⩽1 week post-adoption (home TP1) and >1 week post-adoption (home TP2). Adoption returns were compared between hoarded and non-hoarded cats.

Results

The study included 195 hoarded cats, of which 174 were adopted. Of 164 cats with intake scores, 86 (52%) were scored as ‘friendly’ at intake. Forty-five cats had socialization scores for all of the TPs, and of these, the percentages of ‘supersocial’ or ‘social’ decreased from 87% at the shelter TP to 47% at home TP1, then increased to 84% at home TP2. Most cats that scored as ‘tense’ at intake had supersocial or social scores at home TP2. Nine of the 88 cats with survey results had out-of-box (OOB) elimination in either the shelter or home but only 1/88 in both. Adopters expressed positive feelings for 42/43 cats for which feelings-based language was used in their survey responses. Notable behaviors, such as neediness, were recorded for 48/88 cats. Relationships with other household pets were typically positive. Eighteen of 174 hoarded (10%) and 188/2662 non-hoarded (7.1%) cats were returned post-adoption. Of these, six hoarded and 87 non-hoarded returns included behavioral reasons. There were no significant differences between hoarded and non-hoarded cats for total or behavioral returns.

Conclusions and relevance

Hoarded cats had high adoption rates, high adopter satisfaction and the potential for good emotional well-being in adoptive homes. Behavior at intake and OOB elimination in the shelter may not reflect post-adoption behavior. Behavior-based outcome decisions for these vulnerable animals should be deferred to allow time for habituation.

Changes in patient quality of life during oral immunotherapy for food allergy

BACKGROUND

Quality of life (QOL) is impaired in patients with food allergy and improves following oral immunotherapy (OIT). However, the treatment itself is prolonged and demanding. We examined changes in patient QOL during OIT for food allergy.

METHODS

The FAQLQ-PF was administered to children aged 4-12 years undergoing OIT for milk, peanut, or egg allergy, at the beginning and after 4 months of treatment. Patients were categorized as improved, unchanged, or diminished FAQLQ-PF (>0.5 point decrease, a change of ≤0.5 points, or >0.5 increase, respectively) and compared. Food-allergic patients not undergoing OIT served as controls.

RESULTS

The Food Anxiety, Social and Dietary Limitation, and total FAQLQ-PF scores improved significantly during the study period (P=.001, P=.018, and P=.01, respectively) in treated but not in control patients, while the Emotional Impact did not. The change in the FAQLQ-PF was independent of the maximal tolerated dose at baseline or following four months of treatment, the pace of dose increase, or the number or severity of reactions experienced. The total FAQLQ-PF score was inversely associated with the score at baseline on multivariate analysis (regression coefficient=-0.56, P<.001). That was driven primarily by improvement in QOL scores in patients with high score (worse QOL) at baseline. Some patients with low FAQLQ-PF score (better QOL) at baseline deteriorated.

CONCLUSIONS

QOL of patients with food allergy improves in some but deteriorates in others during OIT. Patients with impaired QOL at baseline improve significantly despite the treatment burden. Some patients with better QOL at baseline might deteriorate during OIT.

Food Anxiety Is Associated with Poor Health Status Among Recently Hospital-Discharged Older Adults

Older adults returning home from the hospital may encounter health issues that cause anxiety about their ability to obtain enough food. Home-delivered meal (HDM) programs support nutritional needs and improve food security of those who cannot provide for themselves. A study conducted in six states examined feelings of anxiety about getting enough food in older adults (aged 60 years and older), comparing three time points: prior to hospitalization, at hospitalization (n = 566) and after receiving HDMs for two months posthospitalization (n = 377). Food anxiety during hospitalization was significantly higher among Hispanic ethnicity, current and former smokers, diabetics, and those who eat alone or have difficulty shopping. Food anxiety was significantly lower from baseline to two months follow-up (P < 0.0001), and participants showed improvements in certain coping strategies they used to get their meals. Indicators of food anxiety can help the health care system and community nutrition programs target those at highest risk of negative health outcomes.