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Campbell C, Greig X, Griffiths J, Hashman D, Sottile T, Isobe M, Bahji A, Dimitropoulos G, Devoe D. The Prevalence of Excessive Exercise in Eating Disorders: A Systematic Review and Meta-Analysis. EUROPEAN EATING DISORDERS REVIEW 2025. [PMID: 40252210 DOI: 10.1002/erv.3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 03/18/2025] [Accepted: 03/23/2025] [Indexed: 04/21/2025]
Abstract
OBJECTIVE Individuals with eating disorders (EDs) often present with maladaptive behaviours such as excessive exercise (EE). The consequences of EE include physical injuries, increased risk of anxiety and depression, and impaired social functioning. No systematic reviews have been conducted on the prevalence of EE in EDs. This study aimed to assess the prevalence of EE in EDs and by ED type. METHOD An electronic database search of the peer-reviewed literature was conducted from inception to October 2024. Review eligibility was restricted to research studies reporting prevalence data for EE in individuals diagnosed with EDs. RESULTS Fifty-six studies met the inclusion criteria (n = 21,518; mean age: 22.34 years). The current prevalence of EE in all EDs was 48%. Current prevalence was highest in AN (48%), followed by BN (45%), OSFED (38%), and BED (11%). The lifetime prevalence of EE in all EDs was 63%. Lifetime prevalence was highest in AN (72%), followed by BN (57%) and OSFED (21%). CONCLUSIONS Nearly half of individuals with an ED engage in EE. High heterogeneity across the included studies likely influenced the prevalence found in this study. Data suggest clinical screening and longitudinal monitoring of EE in those with EDs. Future research into early intervention and treatment for EE in those with EDs is recommended. TRIAL REGISTRATION PROSPERO: CRD42023464148; Open Science Framework: https://doi.org/10.17605/OSF.IO/MYVXW.
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Affiliation(s)
- Connor Campbell
- Department of Psychology, Mount Royal University, Calgary, Canada
| | - Xander Greig
- Department of Psychology, Mount Royal University, Calgary, Canada
| | | | - Devon Hashman
- Department of Psychology, Mount Royal University, Calgary, Canada
| | - Thomas Sottile
- Department of Psychology, Mount Royal University, Calgary, Canada
| | - Masanori Isobe
- Department of Psychiatry, Kyoto University, Kyoto, Japan
| | - Anees Bahji
- Department of Psychiatry, Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
| | | | - Dan Devoe
- Department of Psychology, Mount Royal University, Calgary, Canada
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Banna MHA, Kundu S, Arafat SMY. Eating Disorders in Bangladesh: A Narrative Review. Health Sci Rep 2025; 8:e70537. [PMID: 40060296 PMCID: PMC11885170 DOI: 10.1002/hsr2.70537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 02/17/2025] [Accepted: 02/18/2025] [Indexed: 05/03/2025] Open
Abstract
BACKGROUND AND AIMS Eating disorders are complex psychiatric illnesses mostly prominent in Western countries. Little has been researched about these disorders in countries like Bangladesh. The purpose of this narrative review was to summarize the studies on eating disorders in Bangladesh, focusing on rates and associated factors. METHODS A search was performed in PubMed, Scopus, Google, Google Scholar, and BanglaJOL on February 20, 2024, to identify the available studies on eating disorders in Bangladesh. After considering the inclusion and exclusion criteria, 10 articles were included in this review. RESULTS Studies were published between 2015 and 2023 with a sample size ranging from 196 to 4076. All the studies were conducted among university students and used screening tools to assess eating disorders where the majority of the studies utilized the Eating Attitudes Test-26. The rate of at risk of eating disorders varies between 20.4% and 38%. Sociocultural factors, age, sex, academic attainment, marital status, family income, smoking, nutritional status, anxiety, depression, internet addiction, high religious practice, previous cosmetic surgery, and binge drinking were associated with eating disorder risk. However, all studies focused on a single population group, and no nationwide studies or research involving community populations or clinical samples were identified. CONCLUSION Although there has been an increase in research on eating disorders in Bangladesh since 2015, community-based studies using diagnostic tools are warranted. Adaptation and development of culture sensitive instruments could be an important necessity along with an enduring collaboration among researchers, stakeholders, and clinicians.
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Affiliation(s)
- Md. Hasan Al Banna
- Faculty of Nutrition and Food SciencePatuakhali Science and Technology UniversityPatuakhaliBangladesh
| | - Satyajit Kundu
- Public Health, School of Medicine and DentistryGriffith UniversityGold CoastAustralia
| | - S. M. Yasir Arafat
- Department of PsychiatryBangladesh Specialized HospitalDhakaBangladesh
- Biomedical Research FoundationDhakaBangladesh
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Lu M, Zhang J, Zhang Q, Sun J, Zou D, Huang J, Liu W. The parasubthalamic nucleus: A novel eating center in the brain. Prog Neuropsychopharmacol Biol Psychiatry 2025; 136:111250. [PMID: 39788409 DOI: 10.1016/j.pnpbp.2025.111250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/21/2024] [Accepted: 01/04/2025] [Indexed: 01/12/2025]
Abstract
Eating behavior stands as a fundamental determinant of animal survival and growth, intricately regulated by an amalgamation of internal and external stimuli. Coordinated movements of facial muscles and the mandible orchestrate prey capture and food processing, propelled by the allure of taste and rewarding food properties. Conversely, satiation, pain, aversion, negative emotion or perceived threats can precipitate the cessation or avoidance of eating activities. In recent years, the parasubthalamic nucleus (PSTN), located in the lateral hypothalamic area, has emerged as a focal point in feeding research. PSTN neurons assume pivotal roles within multiple feeding circuits, bridging central feeding centers with peripheral organs. They intricately modulate regulation of oral sensorimotor functions, hedonic feeding, appetite motivation and the processing of satiation and aversive signals, thereby orchestrating the initiation or termination of feeding behaviors. This review delves into the distinctive neuronal subpopulations within the PSTN and their associated neural networks, aiming to refine our comprehension of the neural underpinnings of feeding while also seeking to unearth more efficacious therapeutic avenues for feeding and eating disorders.
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Affiliation(s)
- Mingxuan Lu
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai 200072, China
| | - Jiayao Zhang
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai 200072, China
| | - Qi Zhang
- Shanghai Key Laboratory of Brain Functional Genomics (Ministry of Education), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China; Shanghai Changning Mental Health Center, Shanghai 200335, China
| | - Jiyu Sun
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai 200072, China
| | - Danni Zou
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai 200072, China
| | - Jinyin Huang
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai 200072, China
| | - Weicai Liu
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai 200072, China.
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Ahmed M, Islam MD, Aouad P, Miskovic‐Wheatley J, Touyz S, Maguire S, Cunich M. Global and Regional Economic Burden of Eating Disorders: A Systematic Review and Critique of Methods. Int J Eat Disord 2025; 58:91-116. [PMID: 39542867 PMCID: PMC11784850 DOI: 10.1002/eat.24302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 09/25/2024] [Accepted: 09/25/2024] [Indexed: 11/17/2024]
Abstract
OBJECTIVE This systematic review aims to comprehensively examine up-to-date evidence on the economic burden of eating disorders (EDs), both globally and by region. METHODOLOGY A comprehensive search within five electronic databases, MEDLINE, Embase, CINAHL, PsycINFO, and EconLit, retrieved studies published from August 1, 2013, to June 30, 2024. Cost of illness (COI) studies, burden of disease, and other cost studies that reported costs in monetary values were included, and cost-effectiveness analysis studies were excluded. The quality of COI studies was assessed using Schnitzler's checklist. All cost estimates were converted into 2024 USD purchasing power parity (PPP). The PROSPERO registration number is CRD42022358136. FINDINGS Twenty-six studies were identified for inclusion in this review, with 11 COI studies. The nationwide annual financial cost of EDs is estimated at PPP-USD 70.5 billion. Indirect costs contributed 70%-93% of total financial costs in the reviewed studies. Intangible costs (burden of disease) were estimated to be PPP-USD 355.6 billion. About half of the COI studies met 60% of the elements of Schnitzler's checklist, either completely or partly. DISCUSSION The number of COI studies has more than doubled in the last 10 years. Findings can inform healthcare administrators/policymakers to understand the magnitude of this burden when setting healthcare priorities and allocating resources to maximize social welfare. However, there are variations in the methods (thus quality) and perspectives used to assess this economic burden. Findings suggest that there is potential for enhancing the methodological rigor of future research.
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Affiliation(s)
- Moin Ahmed
- MAINSTREAM The Australian National Centre for Health System Research and TranslationSydneyNew South WalesAustralia
- Boden Initiative, Charles Perkins Centre, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Md Deen Islam
- Department of EconomicsUniversity of DhakaDhakaBangladesh
| | - Phillip Aouad
- MAINSTREAM The Australian National Centre for Health System Research and TranslationSydneyNew South WalesAustralia
- InsideOut Institute for Eating DisordersThe University of Sydney and Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Jane Miskovic‐Wheatley
- MAINSTREAM The Australian National Centre for Health System Research and TranslationSydneyNew South WalesAustralia
- InsideOut Institute for Eating DisordersThe University of Sydney and Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Stephen Touyz
- MAINSTREAM The Australian National Centre for Health System Research and TranslationSydneyNew South WalesAustralia
- InsideOut Institute for Eating DisordersThe University of Sydney and Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Sarah Maguire
- MAINSTREAM The Australian National Centre for Health System Research and TranslationSydneyNew South WalesAustralia
- InsideOut Institute for Eating DisordersThe University of Sydney and Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Michelle Cunich
- MAINSTREAM The Australian National Centre for Health System Research and TranslationSydneyNew South WalesAustralia
- Boden Initiative, Charles Perkins Centre, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Cardiovascular Initiative, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Sydney Institute for Women, Children and Their FamiliesSydneyNew South WalesAustralia
- Sydney Local Health DistrictSydneyNew South WalesAustralia
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Chen Q, Huang S, Peng JY, Xu H, Wang P, Shi XM, Li SQ, Luo R, Zhang W, Shi L, Peng Y, Wang XH, Tang XW. Trends and prevalence of eating disorders in children and adolescents. World J Psychiatry 2024; 14:1815-1826. [PMID: 39704355 PMCID: PMC11622011 DOI: 10.5498/wjp.v14.i12.1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 10/05/2024] [Accepted: 10/28/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) have increasingly become a public health problem globally, especially among children and adolescents. AIM To estimate the burden of EDs in children and adolescents (ages 5-19 years) at the global, regional, and national levels. METHODS Retrieved from Global Burden of Disease Study 2019 for EDs, including anorexia nervosa and bulimia nervosa, we extracted the disability-adjusted life years (DALYs) and prevalence rates with 95% uncertainty intervals between 1990-2019. The temporal trends of the DALYs and prevalence rates of EDs were assessed according to the estimated annual percentage changes. RESULTS In our study, we found that the burden of EDs continuously increased globally from 1990 to 2019. Although females accounted for more EDs cases, the burden of EDs in males had a greater increment. Meanwhile, the burden of EDs was associated with the high sociodemographic index (SDI) over the past 30 years and the human development indexes in 2019. CONCLUSION EDs, predominantly in high-income countries, are rising globally, especially in Asia, highlighting the need for resource planning and medical policy prioritization across all SDI quintiles.
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Affiliation(s)
- Qi Chen
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Shu Huang
- Department of Gastroenterology, Lianshui People’ Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian 223499, Jiangsu Province, China
| | - Jie-Yu Peng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Huan Xu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ping Wang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Xiao-Min Shi
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Shi-Qi Li
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Rui Luo
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Wei Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Lei Shi
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Yan Peng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Xiao-Hong Wang
- Department of Gastroenterology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Xiao-Wei Tang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Milliren CE, Crowley M, Zhang RS, Bern EM, Richmond TK. Pediatric Hospital Utilization During Medical Stabilization for Patients With Eating Disorders. Hosp Pediatr 2024; 14:982-991. [PMID: 39497540 DOI: 10.1542/hpeds.2024-007874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/30/2024] [Accepted: 08/29/2024] [Indexed: 12/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Few studies have examined pediatric hospital utilization across the spectrum of eating disorder (ED) diagnoses among hospitalized patients. We describe sociodemographic and clinical characteristics, hospital utilization, and enteral tube feeding and examine factors associated with hospital utilization among patients with EDs. METHODS Using data from the Pediatric Health Information System, we included patients aged 4 to 20 years with primary ED diagnoses hospitalized from 2018 to 2022. We examined sociodemographic factors, length of stay, costs, and enteral tube feeding by ED diagnosis. Adjusted regression models compared hospital utilization by diagnosis, adjusting for sociodemographic and clinical factors. RESULTS Among N = 10 279 hospitalizations from 49 hospitals, anorexia nervosa (AN) was most common (70.9%), followed by avoidant restrictive food intake disorder (ARFID) (15.6%). Mean age was 15.1 years (SD = 2.5), and most were female (86.6%), of white non-Hispanic race (70.9%), with private insurance (70.1%), with 63.9% occurring after the coronavirus disease 2019 pandemic onset. Median (interquartile range) length of stay was 8.0 days (7.0), and hospital costs were $18 099 ($15 592). A total of 18.8% received enteral tube feeding, with significant hospital variation. In adjusted models, compared with AN, ARFID, binge disorders, and unspecified feeding and ED had shorter stays, whereas hospital costs were lower for binge disorders, and enteral feeding was more likely for ARFID. CONCLUSIONS Our findings indicate long and costly hospitalizations, especially for AN, with implications for hospital and treatment capacity, highlighting the need for earlier diagnosis and treatment to prevent the need for hospitalization.
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Affiliation(s)
| | - McGreggor Crowley
- Divisions of bGastroenterology, Hepatology, and Nutrition
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rebecca S Zhang
- Divisions of bGastroenterology, Hepatology, and Nutrition
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Elana M Bern
- Divisions of bGastroenterology, Hepatology, and Nutrition
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Tracy K Richmond
- Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Gurcan H, Couturier J, Matheson B, Jo B, Lock J. Protocol for a randomized clinical trial to confirm the effectiveness of online guided self-help family-based treatment for adolescent anorexia nervosa. Contemp Clin Trials 2024; 144:107618. [PMID: 38971303 PMCID: PMC11323053 DOI: 10.1016/j.cct.2024.107618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The leading evidence-based treatment for anorexia nervosa (AN) in adolescents is Family-based Treatment (FBT). However, due to the intensive training requirements and lack of practitioners, it is often difficult for families to access FBT. Thus, innovations that improve access to care are needed. A pilot randomized study of a guided self-help version of Family-based Treatment (GSH-FBT) that utilized approximately 1/4 the amount of therapist time compared to FBT found that the approach was acceptable and appeared to achieve similar outcomes. The study protocol detailed in this manuscript compares the efficiency (clinician time) of GSH-FBT to Family-based Treatment via Videoconferencing (FBT-V) in a fully powered study in achieving clinical outcomes through a multi-site randomized clinical trial across the US and Ontario, Canada. METHODS This study will randomize the families of adolescents ages 12-18 (n = 200) who meet DSM-5 criteria for AN to receive either GSH-FBT or FBT-V. Participants will be randomized to 15 sixty-minute sessions of FBT-V or to 10 twenty-minute sessions of online GSH-FBT. Major assessments will be conducted by a masked assessor at baseline, within treatment, at the end of treatment (EOT), and 6 and 12 months after the end of treatment (EOT). The primary outcomes of this study are changes to body weight and eating disorder cognitions relative to clinician time used (relative efficiency of treatment modality). CONCLUSIONS The findings of this study may help increase access to care by providing a time efficient, affordable, more scalable intervention for adolescent AN compared to standard FBT.
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Affiliation(s)
- Hazal Gurcan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer Couturier
- Department of Psychiatry & Behavioural Neurosciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Brittany Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Philippe FL, Carbonneau N, Fortin A, Guilbault V, Bouizegarene N, Antunes JM, Chua SN. Toward a memory perspective on eating psychopathology: An investigation of the types of childhood and adolescence memories that are associated with eating disorder symptoms. Appetite 2024; 198:107364. [PMID: 38642722 DOI: 10.1016/j.appet.2024.107364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
The cognitive mechanisms through which specific life events affect the development and maintenance of eating disorders (ED) have received limited attention in the scientific literature. The present research aims to address this gap by adopting a memory perspective to explore the type of life events associated with eating psychopathology and how these events are encoded and reconstructed as memories. Two studies (n = 208 and n = 193) were conducted to investigate the relationship between specific memories and eating disorder psychopathology. Study 1 focused on parent-related memories, while Study 2 examined childhood/adolescence memories. Results from both studies revealed that need thwarting and shame in memories were associated with eating disorder symptoms, but only when individuals drew symbolic connections between these memories and food or eating behavior. Moreover, need thwarting and shame in such memories were associated with other eating and body image outcomes, including uncontrolled eating and body esteem. These results also held after controlling for a host of known predictors of eating disorder psychopathology, such as BMI, perfectionism, or thin ideal internalization. Overall, the present findings suggest that the reprocessing of memories symbolically and idiosyncratically linked to food and eating behavior might be a fruitful clinical intervention.
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Mares SHW, Roelofs J, Zinzen J, Béatse M, Elgersma HJ, Drost RMWA, Evers SMAA, Elburg AAV. Clinical effectiveness, cost-effectiveness and process evaluation of group schema therapy for eating disorders: study protocol for a multicenter randomized controlled trial. BMC Psychol 2024; 12:123. [PMID: 38439092 PMCID: PMC10913254 DOI: 10.1186/s40359-024-01624-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Eating disorders (EDs), such as (atypical) Anorexia (AN) and Bulimia Nervosa (BN), are difficult to treat, causing socioeconomic impediments. Although enhanced cognitive behavioral therapy (CBT-E) is widely considered clinically effective, it may not be the most beneficial treatment for (atypical) AN and BN patients who do not show a rapid response after the first 4 weeks (8 sessions) of a CBT-E treatment. Alternatively, group schema therapy (GST) may be a valuable treatment for this ED population. Even though GST for EDs has yielded promising preliminary findings, the current body of evidence requires expansion. On top of that, data on cost-effectiveness is lacking. In light of these gaps, we aim to describe a protocol to examine whether GST is more (1) clinically effective and (2) cost-effective than CBT-E for (atypical) AN and BN patients, who do not show a rapid response after the first 4 weeks of treatment. Additionally, we will conduct (3) process evaluations for both treatments. METHODS Using a multicenter RCT design, 232 Dutch (atypical) AN and BN patients with a CBT-E referral will be recruited from five treatment centers. Clinical effectiveness and cost-effectiveness will be measured before treatment, directly after treatment, at 6 and at 12 months follow-up. In order to rate process evaluation, patient experiences and the degree to which treatments are implemented according to protocol will be measured. In order to assess the quality of life and the achievement of personalized goals, interviews will be conducted at the end of treatment. Data will be analyzed, using a regression-based approach to mixed modelling, multivariate sensitivity analyses and coding trees for qualitative data. We hypothesize GST to be superior to CBT-E in terms of clinical effectiveness and cost-effectiveness for patients who do not show a rapid response to the first 4 weeks of a CBT-E treatment. DISCUSSION To our knowledge, this is the first study protocol describing a multicenter RCT to explore the three aforementioned objectives. Related risks in performing the study protocol have been outlined. The expected findings may serve as a guide for healthcare stakeholders to optimize ED care trajectories. TRIAL REGISTRATION clinicaltrials.gov (NCT05812950).
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Affiliation(s)
- Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands.
| | - Jeffrey Roelofs
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Experimental Psychopathology, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Janôt Zinzen
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Experimental Psychopathology, Maastricht University, Maastricht, 6200 MD, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Manouk Béatse
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hermien J Elgersma
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Trimbos Institute, Centre for Economic evaluation and Machine Learning, National Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
- Co-eur, Utrecht, The Netherlands
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10
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van Kaam FE, Rohrbach PJ, van den Akker-Van Marle ME, van Furth EF, Dingemans AE. Sensitivity to change in well-being and health-related quality of life in adults with eating disorder symptoms: ICECAP-A versus EQ-5D-5L. Int J Eat Disord 2024; 57:593-601. [PMID: 38240329 DOI: 10.1002/eat.24142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Economic evaluations of treatments help to inform decisions on allocating health care resources. These evaluations involve comparing costs and effectiveness in terms of quality of life. To calculate quality-adjusted life years, generic health related quality of life is often used, but is criticized for not being sensitive to change in mental health populations. Another approach, using experienced well-being measured through capabilities with the ICECAP-A, has been proposed as an alternative. The aim of this study was to investigate whether changes in individuals with eating disorder (ED) symptoms can be better captured using health related quality of life (EQ-5D-5L) or well-being (ICECAP-A). METHOD Measurements at two time points with an interval of 1 year were used from a sample of 233 participants with self-reported ED symptoms. An analysis of variance was used to test whether the EQ-5D-5L and ICECAP-A differed in sensitivity to change over time. In order to compare the two questionnaires in terms of clinically significant outcome, the reliable change index and clinical cut-off score were calculated. RESULTS The two questionnaires did not differ in sensitivity to change. More individuals had recovered but also more had deteriorated according to the EQ-5D-5L compared to the ICECAP. DISCUSSION The present study revealed no differences in sensitivity to change in health-related quality of life or well-being in individuals with ED symptoms in the context of mild clinical change. Results corroborated the pervasiveness of low quality of life in this population, even after alleviation of ED symptoms. PUBLIC SIGNIFICANCE STATEMENT Measuring treatment benefits in terms of improvements in quality of life is an integral part of economic evaluations in health care. It was expected that these treatment benefits would be better captured as changes in well-being (measured with the ICECAP-A) than as changes in health-related quality of life (measured with the EQ-5D-5L) for individuals with ED symptoms. Based on the results of this study, no preference for one of the two approaches was found.
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Affiliation(s)
- Fleur E van Kaam
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - Pieter J Rohrbach
- Department of Clinical Psychology, Open University, Heerlen, The Netherlands
| | - M Elske van den Akker-Van Marle
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Eric F van Furth
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra E Dingemans
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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11
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Thai TTH, Le HND, Mihalopoulos C, Austin SB, Le LKD. Economic costs associated with unhealthy weight control behaviors among Australian adolescents. Int J Eat Disord 2024; 57:341-352. [PMID: 38054343 DOI: 10.1002/eat.24107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study explored the relationship between unhealthy weight control behaviors (UWCBs) and their associated economic costs among adolescents using the 2014-2018 Longitudinal Study of Australian Children (LSAC). METHODS LSAC data in Wave 6 (n = 3538 adolescents aged 14-15 years), Wave 7 n = 3089 adolescents aged 16-17 years), and Wave 8 (n = 3037 adolescents aged 18-19 years) were derived from a representative sample of Australian adolescents. UWCBs were measured using the self-reported Branched Eating Disorder Test questionnaire. UWCBs were sub-classified into having fasting behaviors, using weight loss supplements or purging behaviors. Economic costs include healthcare and productivity costs to caregivers. Healthcare costs were measured using data from the Medicare and Pharmaceutical Benefits, which includes both medical and pharmaceutical costs. Productivity losses were measured using caregivers' lost leisure time due to UWCBs among adolescents. RESULTS The mixed effect model identified statistically significant higher economic costs (mean difference = $453, 95% CIs $154, $752), higher health care costs (mean difference = $399, 95% CIs $102, $695), and higher productivity costs (mean difference = $59, 95% CIs $29, $90) for adolescents with UWCBs compared to their peers with no UWCBs. Subgroup analysis revealed that higher costs were associated with fasting and purging behaviors. DISCUSSION UWCBs were associated with increased economic costs during adolescence. Our finding suggests there should be a policy focus on tackling UWCBs to reduce the economic burden on the healthcare system and society. PUBLIC SIGNIFICANCE The study contributes to existing knowledge by investigating the direct healthcare costs and productivity losses associated with unhealthy weight control behaviors in Australian adolescents (14-18 years old) using a dataset that follows Australian adolescents over time. We found that engaging in unhealthy weight control behaviors such as fasting, using weight loss supplements, and purging was linked to higher costs among adolescents, suggesting policies should focus on addressing these behaviors.
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Affiliation(s)
- Thao T H Thai
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ha N D Le
- Institute of Health Transformation, Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Long Khanh-Dao Le
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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12
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Eren N, Tunc P, Yücel B. Effect of a long-term art-based group therapy with eating disorders. MEDICAL HUMANITIES 2023; 49:576-582. [PMID: 37068943 DOI: 10.1136/medhum-2022-012573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
Eating disorders (EDs) affect the physical, psychological, emotional and interpersonal areas of the individual and cause serious medical and mental consequences. Their treatment should be handled in a multidisciplinary manner.The objective of this study was to investigate potential benefits of long-term art-based group therapy (ABGT) as an adjunct to treatment for a variety of EDs. This study examined the effects of ABGT on disease symptoms, difficulty regulating emotions, depression, anxiety, targeted problems, functioning of individuals with EDs and therapeutic efficiency of the group. The study was carried out as a pre-test-post-test, quasi-experimental study with a control group, with a small sample diagnosed with an ED. In addition to their standard treatment at the outpatient centre, participants were included in a 30-week long-term semistructured ABGT focused on raising awareness of their psychological problems. Participants who received ABGT had significantly better functioning and lower severity of target problems compared with the control group. The severity of the three most important problems reported by patients post-ABGT compared with pre-ABGT and the effects of these problems on their social/private lives reduction was observed. The participants mostly benefited from catharsis, universality, self-understanding, existential factors and family re-enactment in the group process. Through the artwork, participants recognised the mental conflicts causing the symptoms of their ED. We found that art-based interventions are useful in the treatment of EDs, as they positively changed the functioning and symptoms of people with EDs. We recommend that clinicians keep these interventions in mind in formulating treatment protocols for these disorders.
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Affiliation(s)
- Nurhan Eren
- Faculty of Medicine, Department of Mental Health and Diseases, Social Psychiatry Service, Istanbul Universitesi, Istanbul, Turkey
| | - Pervin Tunc
- Psychology Department, İstinye Üniversitesi, Istanbul, Turkey
| | - Başak Yücel
- Faculty of Medicine, Department of Mental Health and Diseases, Istanbul Universitesi, Istanbul, Turkey
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13
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Huang H, Liu Z, Xiong H, Herold F, Kuang J, Chen E, Taylor A, Yeung A, Sun J, Hossain MM, Kramer A, Guo T, Zou L. Validation of sociocultural attitudes towards appearance questionnaire and its associations with body-related outcomes and eating disorders among Chinese adolescents. Front Psychiatry 2023; 14:1088769. [PMID: 36993923 PMCID: PMC10041934 DOI: 10.3389/fpsyt.2023.1088769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION The Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised (SATAQ-4R) has been widely used in Western countries to link body appearance that is related to eating disorders and body dissatisfaction being commonly reported by adolescents. However, a comprehensive psychometric validation of the SATAQ-4R in Chinese adolescent samples is still lacking. To this end, the aim of the current study was to validate the gender-appropriate SATAQ-4R in a sample of Chinese adolescents, following by an investigation of its associations with body-related outcomes and eating disorder symptoms. METHODS Two gender-specific studies were conducted to examine the psychometric properties of the SATAQ-4R-Female and SATAQ-4R-Male respectively among adolescent girls (Study1, N=344, with 73 participants at retest) and boys (Study2, N=335, with 64 participants at retest). Confirmatory factor analysis was employed to examine the factor structure and their test-retest reliability, the internal consistency and convergent validity were subsequently examined. RESULTS For the SATAQ-4R-Females, the seven-factor model has a reasonable fit, with Chi-square =1112.769 (p < 0.001), CFI = 0.91, RMSEA = 0.071, SRMR = 0.067. For the SATAR-4R-Males, an acceptable seven-factor model with Chi-square = 982.92 (p<0.001), CFI = 0.91, RMSEA = 0.08, SRMR= 0.06 was observed. With respect to test-retest reliability, the internal consistency for 7 subscales was rated as good (Cronbach's alpha =0.74 to 0.95) among female adolescents, likewise the internal consistency of the seven subscales was also rated as good (Cronbach's alpha =0.70 to 0.96) among male participants. Good convergent validity was observed, reflected by associations of the subscales of the gender-specific SATAQ-4R with muscularity-related attitude, body image-acceptance, body appearance, perceived stress level, symptoms of eating disorder and self-esteem. DISCUSSION For women and men, the original 7-factor structure was validated among Chinese adolescents, internal reliability coefficients for the seven subscale scores were good and test-retest reliability was acceptable. Our results also confirmed the convergent validity of the two different gender-appropriate scales.
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Affiliation(s)
- Houyi Huang
- Body-Brain-Mind Laboratory, The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, School of Psychology, Shenzhen University, Shenzhen, China
| | - Zhongting Liu
- Body-Brain-Mind Laboratory, The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, School of Psychology, Shenzhen University, Shenzhen, China
| | - Haoran Xiong
- Body-Brain-Mind Laboratory, The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, School of Psychology, Shenzhen University, Shenzhen, China
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Jin Kuang
- Body-Brain-Mind Laboratory, The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, School of Psychology, Shenzhen University, Shenzhen, China
| | - Erle Chen
- Shenzhen College of International Education, Shenzhen, China
| | - Alyx Taylor
- AECC University College, School of Rehabilitation, Sport and Psychology, Bournemouth, United Kingdom
| | - Albert Yeung
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - Jing Sun
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Birtinya, QLD, Australia
| | - Md M. Hossain
- Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX, United States
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, United States
| | - Arthur Kramer
- Center for Cognitive & Brain Health, Northeastern University, Boston, MA, United States
- Beckman Institute, University of Illinois, Champaign, IL, United States
| | - Tianyou Guo
- Body-Brain-Mind Laboratory, The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, School of Psychology, Shenzhen University, Shenzhen, China
| | - Liye Zou
- Body-Brain-Mind Laboratory, The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, School of Psychology, Shenzhen University, Shenzhen, China
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
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14
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Social physical anxiety and eating disorders: A systematic review and meta-analysis. Body Image 2023; 45:133-141. [PMID: 36871312 DOI: 10.1016/j.bodyim.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 03/07/2023]
Abstract
The present study's aim was to summarize existing quantitative evidence linking social physique anxiety (SPA) and eating disorders (ED). Eligible studies were searched for up to June 2, 2022 in six databases: MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global. Studies were considered eligible if they included information derived from self-report instruments that allowed for computing the relationship between SPA and ED. Pooled effect sizes (r) were computed using three-level meta-analytic models. Potential sources of heterogeneity were examined using univariable and multivariable meta-regressions. Influence analyses and a three-parameter selection model (3PSM) were used for the purpose of examining the robustness of the results and publication bias, respectively. Results summarizing 170 effect sizes from 69 studies (N = 41,257) showed two main groups of findings. Firstly, that SPA and ED were very largely related (i.e., r = .51). Secondly, that this relationship was stronger (i) among individuals from Western countries, and (ii) when ED scores concerned the diagnostic feature of bulimia/anorexia nervosa involving body image disturbances. The present study adds to the current understanding of ED by suggesting that SPA is a maladaptive emotion with a potential role in the onset and maintenance of these group of pathologies.
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15
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İnce B, Phillips M, Schmidt U. Intensive community and home-based treatments for eating disorders: a scoping review study protocol. BMJ Open 2023; 13:e064243. [PMID: 36792335 PMCID: PMC9933757 DOI: 10.1136/bmjopen-2022-064243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Institutionally based intensive treatment modalities (inpatient, day patient and residential treatments) for eating disorders (EDs) are associated with high treatment costs and significant challenges for patients and carers, including access difficulties and disruption to daily routines. Intensive community and home-based treatments have been suggested as alternatives to institutionally based intensive treatments for other severe mental illnesses, with promising clinical, social and health economic outcomes. The possible advantages of these treatments have been proposed for EDs, but this emerging area of research has not yet been systematically investigated. This scoping review aims to map the available literature on intensive community and home treatments for EDs, focusing on their conceptualisation, implementation and clinical outcomes. METHODS This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. This review will include any peer-reviewed study concerning intensive community and home-based treatments for any EDs, with no restrictions on geographical context or study design. Grey literature will also be considered. The literature search will be conducted in four databases: PubMed, PsycInfo, MEDLINE and Web of Science. Two researchers will independently screen the titles, abstracts and text of the returned articles for eligibility. Data charting and analysis will consist of a narrative description of the included studies, quantitative and qualitative findings relative to the aims of this scoping review. Gaps in the literature will be highlighted to inform future research, clinical practice, and policy. ETHICS AND DISSEMINATION Ethical approval is not required as all data are available from public sources. The results of this scoping review will be disseminated through peer-reviewed publication, conference presentation, and social media.
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Affiliation(s)
- Başak İnce
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Phillips
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Eating Disorder Outpatients Service, South London and Maudsley NHS Foundation Trust, London, UK
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16
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Psychometric Examination of the Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) among Spanish Adolescents and Young Adults. Nutrients 2023; 15:nu15030626. [PMID: 36771333 PMCID: PMC9921885 DOI: 10.3390/nu15030626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
The Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) has been frequently used within the context of research on eating disorders (ED). Although both long (BEECOM-L) and short (BEECOM-S) versions of the instrument exist, their psychometric properties have not yet been concurrently investigated across different populations in terms of age and gender. The present study aimed to compare the psychometric properties of both the BEECOM-L and the BEECOM-S among Spanish male and female non-clinical adolescents and young adults. Data from 4 samples including 1213 middle school and college students enrolled in 10 education centers from southern Spain (age ranging from 12 to 35 years, Mage = 17.796, SDage = 4.796, 53% females) were analyzed using factorial, correlation, and regression analysis techniques. Results provided evidence that support the reliability, measurement invariance according to age and gender, and convergent/incremental validity for the scores from both the BEECOM-L and BEECOM-S. Concerning factorial validity, marginally acceptable and adequate goodness-of-fit indices were obtained for the BEECOM-L and BEECOM-S, respectively. The BEECOM-S proves to be a psychometrically sound instrument with potential value for assessing social comparisons focused on body, eating, and exercise in non-clinical adolescents and young adults from Spain.
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17
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Long MW, Ward ZJ, Wright DR, Rodriguez P, Tefft NW, Austin SB. Cost-Effectiveness of 5 Public Health Approaches to Prevent Eating Disorders. Am J Prev Med 2022; 63:935-943. [PMID: 36109308 DOI: 10.1016/j.amepre.2022.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Eating disorders cause suffering and a high risk of death. Accelerating the translation of research into implementation will require intervention cost-effectiveness estimates. The objective of this study was to estimate the cost-effectiveness of 5 public health approaches to preventing eating disorders among adolescents and young adults. METHODS Using data from 2001 to 2017, the authors developed a microsimulation model of a closed cohort starting at the age of 10 years and ending at 40 years. In 2021, an analysis was conducted of 5 primary and secondary prevention strategies for eating disorders: school-based screening, primary care‒based screening, school-based universal prevention, excise tax on over-the-counter diet pills, and restriction on youth purchase of over-the-counter diet pills. The authors estimated the reduction in years lived with eating disorders and the increase in quality-adjusted life-years. Intervention costs and net monetary benefit were estimated using a threshold of $100,000/quality-adjusted life year. RESULTS All the 5 interventions were estimated to be cost-saving compared with the current practice. Discounted per person cost savings (over the 30-year analytic time horizon) ranged from $63 (clinic screening) to $1,102 (school-based universal prevention). Excluding caregiver costs for binge eating disorder and otherwise specified feeding and eating disorders substantially reduced cost savings (e.g., from $1,102 to $149 for the school-based intervention). CONCLUSIONS A range of public health strategies to reduce the societal burden of eating disorders are likely cost saving. Universal prevention interventions that promote healthy nutrition, physical activity, and media use behaviors without introducing weight stigma may prevent additional negative health outcomes, such as excess weight gain.
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Affiliation(s)
- Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Patricia Rodriguez
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington
| | | | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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18
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Haas V, Nadler J, Crosby RD, Madden S, Kohn M, Le Grange D, Gonçalves ASO, Hebebrand J, Correll CU. Comparing randomized controlled trials of outpatient family-based or inpatient multimodal treatment followed by outpatient care in youth with anorexia nervosa: Differences in populations, metrics, and outcomes. EUROPEAN EATING DISORDERS REVIEW 2022; 30:693-705. [PMID: 35474627 DOI: 10.1002/erv.2907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Various approaches exist to treat youth with anorexia nervosa (AN). Family-based treatment (FBT) has never been compared to long inpatient, multimodal treatment (IMT) in a randomized controlled trial (RCT). The aim of this study was to compare data on body weight trajectories, change in eating disorder psychopathology, hospital days and treatment costs in RCTs delivering FBT or IMT. METHOD Review of RCTs published between 2010 and 2020 in youth with AN, delivering FBT or IMT. RESULTS Four RCTs delivering FBT (United States, n = 2; Australia, n = 2), one RCT delivering Family Therapy for AN (United Kingdom) and two RCTs delivering IMT (France, n = 1; Germany, n = 1) were identified from previous meta-analyses. The comparison of studies was limited by (1) significant differences in patient baseline characteristics including pretreated versus non-pretreated patients, (2) use of different psychometric and weight measures and (3) different initial velocity of weight recovery. Minimal baseline and outcome reporting standards for body weight metrics and nature/dose of interventions allowing international comparison are needed and suggestions to developing these standards are presented. DISCUSSION An RCT should investigate, whether FBT is a viable alternative to IMT, leading to comparable weight and psychopathology improvement with less inpatient time and costs.
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Affiliation(s)
- Verena Haas
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Janine Nadler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | | | - Michael Kohn
- Department of Adolescent and Young Adult Medicine, Centre for Research into Adolescent'S Health, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Ana Sofia Oliveira Gonçalves
- Institute of Public Health, Charité - Universitätsmedizin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph U Correll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA
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19
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Ciążyńska J, Maciaszek J. Various Types of Virtual Reality-Based Therapy for Eating Disorders: A Systematic Review. J Clin Med 2022; 11:jcm11174956. [PMID: 36078886 PMCID: PMC9456485 DOI: 10.3390/jcm11174956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Interactive VR (virtual reality) environments (i.e., using three-dimensional graphics presented with a head-mounted display) have recently become a popular professional tool for the treatment of patients with eating disorders (EDs). However, there are no published review reports that have analyzed the original papers between 2015 and 2021, which additionally focused only on HMD (head-mounted display) 3DVR (three-dimensional virtual reality) exposure and included only three therapeutic categories for ED patients. (2) Methods: The EbscoHost and Scopus databases were searched to identify relevant papers on VR research employing VR in the assessment and treatment of eating disorders. (3) Results: In addition to the known therapeutic divisions for ED, there are new forms of therapy based on 360 cameras, eye-tracking, and remote therapy. (4) Conclusions: The potential of VR in combination with different therapies may offer an alternative for future research. More rigorous testing, especially in terms of larger sample sizes, the inclusion of control groups or multisessions, and follow-up measures, is still needed. The current state of research highlights the importance of the nature and content of VR interventions for ED patients. Future research should look to incorporate more home-based and remote forms of VR tools.
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20
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Rohrbach PJ, Dingemans AE, van Furth EF, Spinhoven P, van Ginkel JR, Bauer S, van den Akker‐Van Marle ME. Cost-effectiveness of three internet-based interventions for eating disorders: A randomized controlled trial. Int J Eat Disord 2022; 55:1143-1155. [PMID: 35748112 PMCID: PMC9546196 DOI: 10.1002/eat.23763] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The primary aim was assessing the cost-effectiveness of an internet-based self-help program, expert-patient support, and the combination of both compared to a care-as-usual condition. METHOD An economic evaluation from a societal perspective was conducted alongside a randomized controlled trial. Participants aged 16 or older with at least mild eating disorder symptoms were randomly assigned to four conditions: (1) Featback, an online unguided self-help program, (2) chat or e-mail support from a recovered expert patient, (3) Featback with expert-patient support, and (4) care-as-usual. After a baseline assessment and intervention period of 8 weeks, five online assessments were conducted over 12 months of follow-up. The main result constituted cost-utility acceptability curves with quality-of-life adjusted life years (QALYs) and societal costs over the entire study duration. RESULTS No significant differences between the conditions were found regarding QALYs, health care costs and societal costs. Nonsignificant differences in QALYs were in favor of the Featback conditions and the lowest societal costs per participant were observed in the Featback only condition (€16,741) while the highest costs were seen in the care-as-usual condition (€28,479). The Featback only condition had the highest probability of being efficient compared to the alternatives for all acceptable willingness-to-pay values. DISCUSSION Featback, an internet-based unguided self-help intervention, was likely to be efficient compared to Featback with guidance from an expert patient, guidance alone and a care-as-usual condition. Results suggest that scalable interventions such as Featback may reduce health care costs and help individuals with eating disorders that are currently not reached by other forms of treatment. PUBLIC SIGNIFICANCE STATEMENT Internet-based interventions for eating disorders might reach individuals in society who currently do not receive appropriate treatment at low costs. Featback, an online automated self-help program for eating disorders, was found to improve quality of life slightly while reducing costs for society, compared to a do-nothing approach. Consequently, implementing internet-based interventions such as Featback likely benefits both individuals suffering from an eating disorder and society as a whole.
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Affiliation(s)
- Pieter J. Rohrbach
- GGZ Rivierduinen Eetstoornissen UrsulaLeidenNetherlands,Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| | | | - Eric F. van Furth
- GGZ Rivierduinen Eetstoornissen UrsulaLeidenNetherlands,Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| | - Philip Spinhoven
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands,Institute of PsychologyLeiden UniversityLeidenNetherlands
| | | | - Stephanie Bauer
- Center for Psychotherapy ResearchUniversity of HeidelbergHeidelbergGermany
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21
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Compulsive Study Behaviors Are Associated with Eating Disorders and Have Independent Negative Effects on Well-Being: A Structural Equation Model Study among Young Musicians. SUSTAINABILITY 2022. [DOI: 10.3390/su14148617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Compulsive overworking and eating disorders (EDs) show considerable similarities in terms of risk factors (e.g., rigid perfectionism), clinical manifestation (e.g., excessive controlling behaviors), and consequences (e.g., physical exhaustion and depression). This study aimed to examine the hypotheses that compulsive study behaviors (conceptualized as study addiction) are related to EDs and that they have independent negative effects on well-being among young musicians, who constitute a highly vulnerable population for these types of problematic behaviors. The relatively high prevalence of study addiction and its pronounced negative relationship with psychosocial functioning make it a pending challenge for sustainable education. A total of 255 students from various music academies in Poland took part in the study. The Bergen Study Addiction Scale, assessing compulsive studying (conceptualized as addictive behavior), the Eating Attitude Test-26 (EAT-26), the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, and the quality-of-life measure were used. A structural equation model was investigated. Study addiction was positively related to the general factor of EDs and the social pressure component. Both problematic behaviors showed negative and independent effects on the well-being of young musicians. EDs may be 8 to 16 times more prevalent among the students of music academies who are addicted to studying than among the general population. About 80% of those students showing all seven symptoms of study addiction exhibited at least mild depression, while more than half had clinically significant levels of depression. Almost 90% had clinically significant levels of anxiety. Without addressing co-occurring study addiction and eating disorders, including their commonalities and idiosyncrasies, their prevention and treatment cannot be effective and it will substantially affect the sustainability of education and work.
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22
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Tang L, Rifas-Shiman SL, Field AE, Austin SB, Haines J. Self-Reported Total Screen Time and Viewing Modes Are Associated with Body Dissatisfaction, Disordered Eating, and Cosmetic Surgery Intentions among Young Adults. Nutrients 2022; 14:nu14102027. [PMID: 35631168 PMCID: PMC9145134 DOI: 10.3390/nu14102027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
While numerous studies have shown that media exposure is linked to body dissatisfaction and disordered eating behavior, limited research has examined these associations by screen-viewing mode. This study examined associations of total screen-time and screen-viewing modes with body dissatisfaction, disordered eating, and cosmetic surgery intention among young adults. Men (n = 3466) and women (n = 7300), aged 19 to 34 years, self-reported their screen-time on various TV viewing modes, and their body dissatisfaction, overeating, disordered weight control behaviors, and cosmetic surgery intentions. We fit linear, logistic, and multivariate models to examine cross-sectional associations between total screen-time and screen-viewing modes and body dissatisfaction, disordered eating, and cosmetic surgery intention. Handheld viewing was associated with body dissatisfaction for women only, and online viewing was associated with greater body dissatisfaction among both men (βˆ = 0.40; 95% CI, 0.15 to 0.65) and women (βˆ = 0.25; 95% CI, 0.10 to 0.40). Downloaded viewing was associated with higher odds of overeating behaviors among both men (OR = 1.24; 95% CI, 1.10 to 1.40) and women (OR = 1.21; 95% CI, 1.12 to 1.32), respectively. Although total screen time was associated with greater cosmetic surgery intention for both men (βˆ = 0.24; 95% CI, 0.09 to 0.39) and women (βˆ = 0.43; 95% CI, 0.28 to 0.58), sex differences were found for the viewing modes. Our results suggest that different viewing modes may be differently associated with men and women’s body image, disordered eating behavior, and cosmetic surgery intention. Future research should consider all modes of screen-viewing in our media environment.
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Affiliation(s)
- Lisa Tang
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada;
- Correspondence:
| | - Sheryl L. Rifas-Shiman
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA;
| | - Alison E. Field
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA;
| | - S. Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada;
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23
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Keshishian AC, Christian C, Williams BM, Spoor SP, Peiper NC, Levinson CA. A Network Analysis Investigation of Disordered Eating Across Demographic and Developmental Subpopulations Using a National Epidemiological Sample of High School Students. Behav Ther 2022; 53:535-545. [PMID: 35473655 DOI: 10.1016/j.beth.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/09/2021] [Accepted: 12/19/2021] [Indexed: 11/15/2022]
Abstract
Disordered eating (DE) poses a large societal burden, yet limited research has examined DE from a developmental epidemiological perspective. It is important to consider how demographics influence DE symptoms to inform prevention and early intervention programs across diverse subpopulations. Therefore, we conducted network analyses using a large nationally representative epidemiological sample of high school students (Youth Risk Behavior Survey, United States; n = 59,582) to identify the most important symptoms and symptom relationships among six DE behaviors. We compared networks by sex, grade, and race to identify differences in symptom networks. Dieting for weight loss was highly central across networks. Networks significantly differed across sex, grade, and race. Our results suggest that dieting for weight loss may be an early intervention target for eating disorders, regardless of demographic and developmental factors. In addition, sex, race, and age should be accounted for when researching and developing prevention programs for DE and eating disorders. Public health officials, as well as mental health professionals, should present a more balanced message about dieting and weight loss to high school students to prevent the detrimental impact of DE on physical and mental health. Notably, this study is the first large, nationwide epidemiological sample using DE symptoms in network analysis.
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Affiliation(s)
| | | | | | | | - Nicholas C Peiper
- University of Louisville School of Public Health and Information Sciences
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24
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Cost-of-illness for non-underweight binge-eating disorders. Eat Weight Disord 2022; 27:1377-1384. [PMID: 34327651 PMCID: PMC9079013 DOI: 10.1007/s40519-021-01277-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study examined economic costs associated with untreated eating disorders (EDs) characterised by regular binge eating in the absence of low weight. Both direct and indirect costs were assessed, reporting a limited societal perspective of economic impact as some costs were not included. METHODS One hundred and twenty six adults seeking treatment for recurrent binge eating were asked to report impairment associated with an ED. Costs were calculated using 2017 prices, including an examination of variables associated with costs. RESULTS Estimated societal costs for the year preceding assessment were £3268.47 (€3758.54) per person. In multivariate analyses, no reliable baseline associates of cost were identified. CONCLUSION The economic burden of EDs characterised by regular binge eating is significant, and underscores the need for efficacious and cost-effective treatments. Individuals with binge-eating disorders report work impairment and healthcare use that may cost the United Kingdom economy upwards of £3.5 billion (€4bn) per annum. Further studies should consider academic impairment and the economic impact of EDs on families. LEVEL OF EVIDENCE III: evidence obtained from well-designed cohort or case-control analytic studies.
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25
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Navas-León S, Sánchez-Martín M, Tajadura-Jiménez A, De Coster L, Borda-Más M, Morales L. Eye movements and eating disorders: protocol for an exploratory experimental study examining the relationship in young-adult women with subclinical symptomatology. J Eat Disord 2022; 10:47. [PMID: 35395955 PMCID: PMC8991955 DOI: 10.1186/s40337-022-00573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Recent research indicates that patients with anorexia (AN) show specific eye movement abnormalities such as shorter prosaccade latencies, more saccade inhibition errors, and increased rate of saccadic intrusions compared to participants without AN. However, it remains unknown whether these abnormal eye movement patterns, which may serve as potential biomarkers and endophenotypes for an early diagnosis and preventive clinical treatments, start to manifest also in people with subclinical eating disorders (ED) symptomatology. Therefore, we propose a protocol for an exploratory experimental study to investigate whether participants with subclinical ED symptomatology and control participants differ in their performance on several eye movement tasks. METHODS The sample will be recruited through convenience sampling. The Eating Disorder Examination Questionnaire will be administered as a screening tool to split the sample into participants with subclinical ED symptomatology and control participants. A fixation task, prosaccade/antisaccade task, and memory-guided task will be administered to both groups. Additionally, we will measure anxiety and premorbid intelligence as confounding variables. Means comparison, exploratory Pearson's correlations and discriminant analysis will be performed. DISCUSSION This study will be the first to elucidate the presence of specific eye movement abnormalities in participants with subclinical ED symptomatology. The results may open opportunities for developing novel diagnostic tools/therapies being helpful to the EDs research community and allied fields.
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Affiliation(s)
- Sergio Navas-León
- Department of Psychology, Universidad Loyola Andalucía, Sevilla, Spain
| | | | - Ana Tajadura-Jiménez
- DEI Interactive Systems Group, Department of Computer Science and Engineering, Universidad Carlos III de Madrid, Leganés, Spain
- UCL Interaction Centre (UCLIC), University College London, University of London, London, UK
| | - Lize De Coster
- UCL Interaction Centre (UCLIC), University College London, University of London, London, UK
| | | | - Luis Morales
- Department of Psychology, Universidad Loyola Andalucía, Sevilla, Spain
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26
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Presskreischer R, Steinglass JE, Anderson KE. Eating disorders in the U.S. Medicare population. Int J Eat Disord 2022; 55:362-371. [PMID: 35023194 PMCID: PMC8917996 DOI: 10.1002/eat.23676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The social and economic burden of eating disorders is significant and often financially devastating. Medicare is the largest public insurer in the United States and provides coverage for older adults and some disabled individuals. This study explores prevalence, sociodemographic and clinical characteristics, and health care spending for Medicare enrollees with eating disorders. METHOD A cross-sectional study was conducted with the nationally representative 20% sample of 2016 Medicare inpatient, outpatient, carrier, and home health fee-for-service claims and Medicare Advantage encounter records. Sociodemographic characteristics and comorbid somatic conditions were compared between individuals with versus without an eating disorder diagnosis. Mean spending was compared overall and separately for inpatient, outpatient, home health, and pharmacy claims. RESULTS The sample included 11,962,287 Medicare enrollees of whom 0.15% had an eating disorder diagnosis. Compared to those without a 2016 eating disorder diagnosis, a greater proportion of individuals with an eating disorder were female (73.8% vs. 54.3%), under age 65 (41.6% vs. 15.5%), and dually eligible for Medicaid due to disability or low-income qualification (48.0% vs. 19.6%). Individuals with eating disorders had higher rates of comorbid conditions, with the greatest differences in cardiac arrythmias (35.3% vs. 19.9%), arthritis (40.1% vs. 26.6%), and thyroid conditions (32.2% vs. 19.4%). Spending was higher for enrollees with eating disorders compared to those without overall ($29,456 vs. $7,418) and across settings. DISCUSSION The findings establish that eating disorders occur in the Medicare population, and that enrollees with these illnesses have risk factors associated with significant healthcare spending and adverse health outcomes.
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Affiliation(s)
- Rachel Presskreischer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, New York, USA
| | - Kelly E. Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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27
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Bothe T, Walker J, Kröger C. Gender-related differences in health-care and economic costs for eating disorders: A comparative cost-development analysis for anorexia and bulimia nervosa based on anonymized claims data. Int J Eat Disord 2022; 55:61-75. [PMID: 34599621 DOI: 10.1002/eat.23610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) impose a significant financial burden and immense sufferings on affected individuals. Yet little is known about the differences between how each disorder affects males and females, respectively. METHOD We performed a retrospective cost-development analysis of anonymized claims data from the German statutory health-insurance system. Insured persons who suffered from an onset of AN (F50.0; N = 1,242 females and 71 males) or BN (F50.2; N = 1,104 females and 64 males) were analyzed for cost-of-illness over a 5-year period, beginning 2 years before the index diagnosis. RESULTS In total, all groups incurred similar distributions of total costs over the 5-year observation period, with roughly 14,000-20,000 EUR median costs. About two-thirds of the total costs for females and males with AN are associated with mental illness, whereas for females and males with BN, this applies to approximately half the total costs. Analyses revealed differences between disorders and genders for single outcomes. AN is associated with a stronger increase in costs within a short period following onset and higher inpatient treatment costs, whereas BN entails more instances of incapacity to work before and after onset. Compared to females, males incurred lower costs in outpatient treatments. DISCUSSION Our study adds evidence as to the disparities in health-care utilizations and costs over the course of illness, in outcome ratios, and between genders, for both AN and BN.
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Affiliation(s)
- Tim Bothe
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany.,Department of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Jochen Walker
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany
| | - Christoph Kröger
- Department of Psychology, University of Hildesheim, Hildesheim, Germany
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28
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Atkinson MJ, Diedrichs PC. Examining the efficacy of video-based microinterventions for improving risk and protective factors for disordered eating among young adult women. Int J Eat Disord 2021; 54:708-720. [PMID: 33415790 DOI: 10.1002/eat.23460] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Brief self-guided activities designed for focused and immediate benefits, termed microinterventions, have the potential to aid reach and engagement in mental health interventions; however further validation is needed. This study evaluated effects of two microinterventions for responding to appearance-ideal media on risk and protective factors for disordered eating. METHOD Undergraduate women (N = 202, Mage = 19.90, SD = 2.75) were allocated quasi-randomly to one of three 15-min video-based microinterventions (mindfulness, cognitive dissonance, educational control) in the lab and assessed on state outcomes at baseline and immediate posttest. One week later, trait factors were assessed and participants underwent an appearance-ideal media exposure task. RESULTS Both mindfulness and dissonance groups reported significant immediate benefits to state appearance-ideal internalization, perceived sociocultural pressures and related distress, and mood, compared to educational control (Glass's Δ effect sizes = .40-.94), but not state weight or appearance satisfaction. At 1-week follow-up, mindfulness and dissonance groups demonstrated improved trait appearance-ideal internalization (Δ = .40 and .42), weight and shape concerns (Δ = .27 [ns] and .44), and body appreciation (Δ = .39 and .46) compared to the educational control. There were no effects on trait perceived pressures, negative affect, or body image psychological flexibility, and no differential changes in state outcomes from premedia to postmedia exposure. DISCUSSION Microinterventions using mindfulness and dissonance techniques show promise for improving some risk and potential protective factors for disordered eating in the immediate and short-term. Further research is required to substantiate their place within the spectrum of eating disorder prevention, early intervention and treatment techniques.
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Affiliation(s)
- Melissa J Atkinson
- Department of Psychology, University of Bath, Bath, UK.,Centre for Appearance Research, University of the West of England, Bristol, UK
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29
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Streatfeild J, Hickson J, Austin SB, Hutcheson R, Kandel JS, Lampert JG, Myers EM, Richmond TK, Samnaliev M, Velasquez K, Weissman RS, Pezzullo L. Social and economic cost of eating disorders in the United States: Evidence to inform policy action. Int J Eat Disord 2021; 54:851-868. [PMID: 33655603 DOI: 10.1002/eat.23486] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate one-year costs of eating disorders in the United States (U.S.) from a societal perspective, including the costs to the U.S. health system, individual and family productivity costs, lost wellbeing, and other societal economic costs, by setting and payer. Findings will inform needed policy action to mitigate the impact of eating disorders in the U.S. METHOD Costs of eating disorders were estimated using a bottom-up cost-of-illness methodology, based on the estimated one-year prevalence of eating disorders. Intangible costs of reduced wellbeing were also estimated using disability-adjusted life years. RESULTS Total economic costs associated with eating disorders were estimated to be $64.7 billion (95% CI: $63.5-$66.0 billion) in fiscal year 2018-2019, equivalent to $11,808 per affected person (95% CI: $11,754-$11,863 per affected person). Otherwise Specified Feeding or Eating Disorder accounted for 35% of total economic costs, followed by Binge Eating Disorder (30%), Bulimia Nervosa (18%) and Anorexia Nervosa (17%). The substantial reduction in wellbeing associated with eating disorders was further valued at $326.5 billion (95% CI: $316.8-$336.2 billion). DISCUSSION The impact of eating disorders in the U.S. is substantial when considering both economic costs and reduced wellbeing (nearly $400 billion in fiscal year 2018-2019). Study findings underscore the urgency of identifying effective policy actions to reduce the impact of eating disorders, such as through primary prevention and screening to identify people with emerging or early eating disorders in primary care, schools, and workplaces and ensuring access to early evidence-based treatment.
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Affiliation(s)
- Jared Streatfeild
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| | - Josiah Hickson
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| | - S Bryn Austin
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | - Rebecca Hutcheson
- Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA.,School of Public Health, University of Washington, Seattle, Washington, USA
| | - Johanna S Kandel
- Alliance for Eating Disorders Awareness, West Palm Beach, Florida, USA
| | - Jillian G Lampert
- The Emily Program, St Paul, Minnesota, USA.,REDC Consortium (REDC), New York, New York, USA
| | | | - Tracy K Richmond
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | - Mihail Samnaliev
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | | | - Ruth S Weissman
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Lynne Pezzullo
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
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30
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Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study. J Clin Med 2021; 10:jcm10071511. [PMID: 33916374 PMCID: PMC8038593 DOI: 10.3390/jcm10071511] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.
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Santomauro DF, Melen S, Mitchison D, Vos T, Whiteford H, Ferrari AJ. The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019. Lancet Psychiatry 2021; 8:320-328. [PMID: 33675688 PMCID: PMC7973414 DOI: 10.1016/s2215-0366(21)00040-7] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anorexia nervosa and bulimia nervosa are the only eating disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, yet binge-eating disorder and other specified feeding or eating disorder (OSFED) are more prevalent. This study sought to estimate the prevalence and burden of binge-eating disorder and OSFED globally and present a case for their inclusion in GBD. METHODS We sourced studies from the GBD 2019 anorexia nervosa and bulimia nervosa epidemiological databases, two systematic reviews that included studies with epidemiological estimates of binge-eating disorder and OSFED, and experts in the field. Studies, published between Jan 1, 1998, and March 1, 2019, were included if they reported non-zero prevalence of two or more eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, or OSFED) and diagnosed cases according to DSM-IV or DSM-5. The proportions of total eating disorder cases that met diagnostic criteria for each individual eating disorder were estimated via network meta-regression and simulation using studies reporting eating disorder prevalence. The global cases unrepresented in GBD 2019 were estimated using the proportions from the simulation and the GBD 2019 eating disorder prevalence. Disability weights for binge-eating disorder and OSFED were then estimated along with disability-adjusted life-years (DALYs). Estimates are presented with 95% uncertainty intervals (UIs). FINDINGS 54 studies, of which 36 were from high-income countries, were included in the analysis. The number of global eating disorder cases in 2019 that were unrepresented in GBD 2019 was 41·9 million (95% UI 27·9-59·0), and consisted of 17·3 million (11·3-24·9) people with binge-eating disorder and 24·6 million (14·7-39·7) people with OSFED (vs 13·6 million [10·2-17·5] people with eating disorders in GBD 2019). Together, binge-eating disorder and OSFED caused 3·7 million (95% UI 2·0-6·5) DALYs globally, bringing the total eating disorder DALYs to 6·6 million (3·8-10·6) in 2019. INTERPRETATION Binge-eating disorder and OSFED accounted for the majority of eating disorder cases and DALYs globally. These findings warrant the inclusion of binge-eating disorder and OSFED in future iterations of GBD, which will bring the burden experienced by people living with these disorders to the attention of policy makers with the means to target this burden. FUNDING Queensland Health, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Damian F Santomauro
- School of Public Health, The University of Queensland, Herston, QLD, Australia; Queensland Centre for Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Sarah Melen
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW, Australia; Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Harvey Whiteford
- School of Public Health, The University of Queensland, Herston, QLD, Australia; Queensland Centre for Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alize J Ferrari
- School of Public Health, The University of Queensland, Herston, QLD, Australia; Queensland Centre for Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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32
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Golden NH, Cheng J, Kapphahn CJ, Buckelew SM, Machen VI, Kreiter A, Accurso EC, Adams SH, Le Grange D, Moscicki AB, Sy AF, Wilson L, Garber AK. Higher-Calorie Refeeding in Anorexia Nervosa: 1-Year Outcomes From a Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-037135. [PMID: 33753542 PMCID: PMC8015147 DOI: 10.1542/peds.2020-037135] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We recently reported the short-term results of this trial revealing that higher-calorie refeeding (HCR) restored medical stability earlier, with no increase in safety events and significant savings associated with shorter length of stay, in comparison with lower-calorie refeeding (LCR) in hospitalized adolescents with anorexia nervosa. Here, we report the 1-year outcomes, including rates of clinical remission and rehospitalizations. METHODS In this multicenter, randomized controlled trial, eligible patients admitted for medical instability to 2 tertiary care eating disorder programs were randomly assigned to HCR (2000 kcals per day, increasing by 200 kcals per day) or LCR (1400 kcals per day, increasing by 200 kcals every other day) within 24 hours of admission and followed-up at 10 days and 1, 3, 6, and 12 months post discharge. Clinical remission at 12 months post discharge was defined as weight restoration (≥95% median BMI) plus psychological recovery. With generalized linear mixed effect models, we examined differences in clinical remission over time. RESULTS Of 120 enrollees, 111 were included in modified intent-to-treat analyses, 60 received HCR, and 51 received LCR. Clinical remission rates changed over time in both groups, with no evidence of significant group differences (P = .42). Medical rehospitalization rates within 1-year post discharge (32.8% [19 of 58] vs 35.4% [17 of 48], P = .84), number of rehospitalizations (2.4 [SD: 2.2] vs 2.0 [SD: 1.6]; P = .52), and total number of days rehospitalized (6.0 [SD: 14.8] vs 5.1 [SD: 10.3] days; P = .81) did not differ by HCR versus LCR. CONCLUSIONS The finding that clinical remission and medical rehospitalization did not differ over 1-year, in conjunction with the end-of-treatment outcomes, support the superior efficacy of HCR as compared with LCR.
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Affiliation(s)
- Neville H. Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jing Cheng
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California
| | - Cynthia J. Kapphahn
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sara M. Buckelew
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Vanessa I. Machen
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Anna Kreiter
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | - Sally H. Adams
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Daniel Le Grange
- Psychiatry and Behavioral Sciences,,Department of Psychiatry and Behavioral Neuroscience, School of Medicine, The University of Chicago, Chicago, Illinois; and
| | - Anna-Barbara Moscicki
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Allyson F. Sy
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Leslie Wilson
- Medicine, and Clinical Pharmacy, University of California, San Francisco, San Francisco, California
| | - Andrea K. Garber
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
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The majority of professionally active women diagnosed with eating disorders may be at risk of work addiction: an overlooked comorbidity. HEALTH PSYCHOLOGY REPORT 2021. [DOI: 10.5114/hpr.2020.98734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tseng MCM, Tu CY, Chang YT. Healthcare use and costs of adults with anorexia nervosa and bulimia nervosa in Taiwan. Int J Eat Disord 2021; 54:69-80. [PMID: 33210331 DOI: 10.1002/eat.23419] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to examine the health service use and healthcare costs of adults with anorexia nervosa (AN) and bulimia nervosa (BN) in Taiwan. METHOD AN and BN cases between 2002-2013 were extracted from a national health insurance database. For each AN and BN case, we randomly selected 10 controls with no eating disorder, matched for sex, age, urbanization of residence, and year of medical visit. The percentage and frequency of health services use and costs in the year preceding and after the diagnosis of AN/BN were compared between groups. We used generalized linear models with gamma distribution and log link function to determine the effects of age, sex, and psychiatric comorbidities on the total cost adjusting for physical comorbidities and to calculate the mean cost difference between groups by using marginal and incremental effects. RESULTS Both individuals with AN and BN had significantly elevated healthcare utilization and costs compared to controls during the baseline and one-year period after diagnosis. Patients with AN had more than three times higher total costs (US $792) and patients with BN had two times higher total costs (US $320) than individuals without eating disorders. Comorbidity of depressive disorder and older age significantly increased healthcare costs among both individuals with AN and BN. DISCUSSION There are high medical and economic burdens of care for individuals with AN and BN. Early diagnosis and integrated care for eating disorders are important tasks to reduce disease burden in Taiwan.
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Affiliation(s)
- Mei-Chih Meg Tseng
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital, Yunlin, Taiwan
| | - Yuan-Ting Chang
- National Taiwan University Health Data Research Center, Taipei, Taiwan
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Abstract
PURPOSE OF REVIEW To review the recent literature on the burden of eating disorders in terms of mortality, disability, quality of life, economic cost, and family burden, compared with people without an eating disorder. RECENT FINDINGS Estimates are that yearly over 3.3 million healthy life years worldwide are lost because of eating disorders. In contrast to other mental disorders, in anorexia nervosa and bulimia nervosa years lived with disability (YLDs) have increased. Despite treatment advances, mortality rates of anorexia nervosa and bulimia nervosa remain very high: those who have received inpatient treatment for anorexia nervosa still have a more than five times increased mortality risk. Mortality risks for bulimia nervosa, and for anorexia nervosa treated outside the hospital, are lower but still about twice those of controls. In people with an eating disorder, quality of life is reduced, yearly healthcare costs are 48% higher than in the general population, the presence of mental health comorbidity is associated with 48% lower yearly earnings, the number of offspring is reduced, and risks for adverse pregnancy and neonatal outcomes are increased. SUMMARY People with a current or former eating disorder are at risk of increased mortality, high YLD rates, a reduced quality of life, increased costs, and problems with childbearing.
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Alcaraz-Ibáñez M, Paterna A, Griffiths MD, Sicilia Á. Examining the role of social physique anxiety on the relationship between physical appearance comparisons and disordered eating symptoms among Spanish emerging adults. Scand J Psychol 2020; 61:803-808. [PMID: 32720342 DOI: 10.1111/sjop.12663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Abstract
The present study extends previous research by examining the moderating/mediating role of social physique anxiety (SPA) on the relationship between physical appearance comparisons (PAC) and symptoms of disordered eating (DE) in adolescent population. A total of 555 emerging adults (59% women) ranging from 18 to 30 years of age (M = 21.34, SD = 2.80) were recruited from two public universities from Spain using a non-probabilistic sampling technique. Participants completed a self-reported questionnaire comprising the variables of research interest. Once the effects of sex (i.e., being men or women), age, body mass index, and depressive symptoms were controlled for, the results from bootstrapping cross-sectional regression analyses supported both the moderating and mediating effect of SPA on the relationship between PAC and DE. Sex did not moderate any of these relationships. From these findings, it follows that incorporating strategies aimed at decreasing PAC and SPA may contribute to improved prevention efforts aimed at decreasing DE among Spanish emerging adults of both sexes.
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Affiliation(s)
- Manuel Alcaraz-Ibáñez
- Department of Education, University of Almería, Spain.,Health Research Centre, University of Almería, Spain
| | - Adrian Paterna
- Department of Education, University of Almería, Spain.,Health Research Centre, University of Almería, Spain
| | | | - Álvaro Sicilia
- Department of Education, University of Almería, Spain.,Health Research Centre, University of Almería, Spain
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Sase Y, Kumagai D, Suzuki T, Yamashina H, Tani Y, Fujiwara K, Tanikawa T, Enomoto H, Aoyama T, Nagai W, Ogasawara K. Characteristics of Type-2 Diabetics Who are Prone to High-Cost Medical Care Expenses by Bayesian Network. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155271. [PMID: 32707809 PMCID: PMC7432350 DOI: 10.3390/ijerph17155271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 01/04/2023]
Abstract
Objective: This study aims to determine the characteristics of Type 2 diabetic patients who are more likely to cause high-cost medical expenses using the Bayesian network model. Methods: The 2011-2015 receipt data of Iwamizawa city, Japan were collected from the National Health Insurance Database. From the record, we identified patients with Type 2 diabetes with the following items: age, gender, area, number of days provided medical services, number of diseases, number of medical examinations, annual healthcare expenditures, and the presence or absence of hospitalization. The Bayesian network model was applied to identify the characteristics of the patients, and four observed values were changed using a model for patients who paid at least 3607 USD a year for medical expenses. The changes in the conditional probability of the annual healthcare expenditures and changes in the percentage of patients with high-cost medical expenses were analyzed. Results: After changing the observed value, the percentage of patients with high-cost medical expense reimbursement increased when the following four conditions were applied: the patient "has ever been hospitalized", "had been provided medical services at least 18 days a year", "had at least 14 diseases listed on medical insurance receipts", and "has not had specific health checkups in five years". Conclusions: To prevent an excessive rise in healthcare expenditures in Type 2 diabetic patients, measures against complications and promoting encouragement for them to undergo specific health checkups are considered as effective.
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Affiliation(s)
- Yuji Sase
- Faculty of Medical Informatics, Hokkaido Information University, Hokkaido 069-8585, Japan;
| | - Daiki Kumagai
- School of Health Sciences, Hokkaido University, Hokkaido 060-0812, Japan;
| | - Teppei Suzuki
- Art & Sports Business, Iwamizawa, Hokkaido University of Education, Hokkaido 068-8642, Japan;
- Faculty of Health Sciences, Hokkaido University, Hokkaido 060-0812, Japan;
| | - Hiroko Yamashina
- Faculty of Health Sciences, Hokkaido University, Hokkaido 060-0812, Japan;
| | - Yuji Tani
- Department of Medical Informatics and Hospital Management, Asahikawa Medical University, Hokkaido 078-8510, Japan;
| | - Kensuke Fujiwara
- Graduate School of Commerce, Otaru University of Commerce, Hokkaido 047-8501, Japan;
| | - Takumi Tanikawa
- Faculty of Health Sciences, Hokkaido University of Science, Hokkaido 006-8585, Japan;
| | - Hisashi Enomoto
- Iwamizawa City, Hokkaido 068-0828, Japan; (H.E.); (T.A.); (W.N.)
| | - Takeshi Aoyama
- Iwamizawa City, Hokkaido 068-0828, Japan; (H.E.); (T.A.); (W.N.)
| | - Wataru Nagai
- Iwamizawa City, Hokkaido 068-0828, Japan; (H.E.); (T.A.); (W.N.)
| | - Katsuhiko Ogasawara
- Faculty of Health Sciences, Hokkaido University, Hokkaido 060-0812, Japan;
- Correspondence: ; Tel.: +81-11-706-3409
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Hanly F, Torrens-Witherow B, Warren N, Castle D, Phillipou A, Beveridge J, Jenkins Z, Newton R, Brennan L. Peer mentoring for individuals with an eating disorder: a qualitative evaluation of a pilot program. J Eat Disord 2020; 8:29. [PMID: 32626579 PMCID: PMC7329554 DOI: 10.1186/s40337-020-00301-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND After receiving intensive medical treatment; individuals with eating disorders often require ongoing care to maintain their recovery, build social networks, and reduce risk of relapse. METHODS To address this important transition period, a six-month peer mentoring program was developed and piloted in Melbourne, Australia. Twelve adults with a past history of an eating disorder (mentors) were paired with 14 individuals with a current eating disorder (mentees). Pairs met for thirteen mentoring sessions in community settings. Throughout the program mentees and mentors completed reflective questions online. Upon completion of the program, qualitative interviews were conducted. Both online reflections and interviews explored themes relating to perceived benefits and challenges of participation in the peer mentoring program, and the differences between mentoring and traditional treatment. RESULTS Thematic analysis identified several benefits for mentees; including hope, reconnection with others, and re-engaging with the world. The majority of mentees described their mentor as uniquely supportive due to their past experience of an eating disorder. Mentors reported experiencing benefits such as increased connection with self and others, and indicated that the experience helped them positively reframe their past experience of an eating disorder. Ending the relationship at the completion of the program was a significant challenge for both groups, and managing boundaries was deemed a main challenge by mentors. CONCLUSIONS Overall, results indicated that this mode of informal support may be worthy of further investigation as an adjunct to clinical treatment programs for this population. TRIAL REGISTRATION Australian and New Zealand Clinical Trials registration number - ACTRN12617001412325 - Date of registration - 05/10/2017 (Retrospectively registered).
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Affiliation(s)
- Freya Hanly
- School of Behavioural and Health Science, Australian Catholic University, Melbourne, VIC Australia
| | | | - Narelle Warren
- School of Social Sciences, Monash University, Melbourne, VIC Australia
| | - David Castle
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC Australia
| | - Andrea Phillipou
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC Australia
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
- Department of Mental Health, Austin Health, Melbourne, VIC Australia
| | | | - Zoe Jenkins
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC Australia
| | - Richard Newton
- Department of Psychiatry, Monash University, Melbourne, Victoria Australia
- Peninsula Health, Frankston, Victoria Australia
| | - Leah Brennan
- School of Behavioural and Health Science, Australian Catholic University, Melbourne, VIC Australia
- Centre for Eating, Weight and Body Image, Melbourne, VIC Australia
- School of Psychology and Public Health, La Trobe University, Wodonga, VIC Australia
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Churruca K, Ussher JM, Perz J, Rapport F. 'It's Always About the Eating Disorder': Finding the Person Through Recovery-Oriented Practice for Bulimia. Cult Med Psychiatry 2020; 44:286-303. [PMID: 31602551 DOI: 10.1007/s11013-019-09654-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bulimia is an eating disorder characterised primarily by binging and 'inappropriate' compensatory behaviours, such as purging or excessive exercise. Many individuals with bulimia experience chronic disordered eating, dissatisfaction with treatment, and difficulty establishing a 'new life'. Recovery-oriented practice, which focuses holistically on the person and their own aspirations for treatment, has recently been advocated in the treatment of eating disorders in Australia and other countries. However, questions have been raised about how this practice might be integrated into existing treatment approaches. Taking a social constructionist approach and using a case study of one woman's account, together with literature on patients' treatment experiences, we examined recovery from bulimia. Three themes were identified: bulimia was constructed as 'consuming one's life', an experience protracted through treatment ('treatment and becoming the eating disorder'), which makes life 'beyond treatment and attempting to live without bulimia' challenging. Based on this analysis, we argue that recovery-oriented practice, while seemingly commensurate with patients' needs, may be challenged by long-standing meanings of mental illness and experience of bulimia specifically.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
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Abstract
AbstractEating disorders (EDs) are one of the most severe and complex mental health problems facing researchers and clinicians today. The effective prevention and treatment of these conditions is therefore of paramount importance. However, at present our treatments fall short: generally demonstrating only poor to moderate efficacy, and often completely ineffective for severe or chronic cases. A possible reason for this is that the current theories underlying these treatments are flawed. In this paper, we review and evaluate several prominent theoretical explanations associated with current frontline and promising treatments for ED. In doing so, we identify fundamental problems within the construction of current ED explanations and their implications for treatment. In response to these findings, we propose several strategies for the construction of future ED explanations which we believe have the power to ameliorate these problems and potentially help to develop more efficacious treatment downstream.
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Grammer AC, Fitzsimmons-Craft EE, Laing O, Pietro BD, Wilfley DE. Eating Disorders on College Campuses in the United States: Current Insight on Screening, Prevention, and Treatment. CURRENT PSYCHOPHARMACOLOGY 2020; 9:91-102. [PMID: 32905358 PMCID: PMC7470246 DOI: 10.2174/2211556009999200416153022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eating disorders are prevalent on college campuses and pose significant risks to student health, well-being, and academic performance. However, few students receive access to evidence-based prevention and treatment. OBJECTIVE The present review synthesizes the recent literature on ED screening, prevention, and treatment approaches on college campuses in the United States. We provide an overview of ED screening efforts on college campuses, including relevant screening tools, summarize the extant literature on prevention programming, as well psychological and pharmacological treatment approaches, and outline limitations of current programming and provide future directions for research. CONCLUSION Recent advances in ED screening, prevention, and treatment efforts highlight the importance of early detection and intervention. Innovative approaches to screening and dissemination of evidence-based prevention and treatment programs on college campuses are warranted. Implications for future research are discussed.
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Affiliation(s)
- Anne C. Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Olivia Laing
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Bianca De Pietro
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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Abstract
PURPOSE OF REVIEW This review summarizes emerging evidence for the relationship between food insecurity and eating disorder (ED) pathology, outlines priorities for future research in this area, and comments on considerations for clinical and public health practice. RECENT FINDINGS Among adults, food insecurity is cross-sectionally associated with higher levels of overall ED pathology, binge eating, compensatory behaviors, binge-eating disorder, and bulimia nervosa. Evidence for similar relationships among adolescents has been less robust; however, compared to studies of adults, there have been substantially fewer studies conducted in adolescents to date. Emerging evidence consistently indicates that food insecurity is cross-sectionally associated with bulimic-spectrum ED pathology among adults. Findings emphasize the need for ED research to include marginalized populations who have historically been overlooked in the ED field. Much more research is needed to better understand the relationship between food insecurity and ED pathology and to determine effective ways to intervene.
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Affiliation(s)
- Vivienne M Hazzard
- Sanford Center for Biobehavioral Research, 120 Eighth Street South, Fargo, ND, 58103, USA.
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Laura Hooper
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Thielemann D, Richter F, Strauss B, Braehler E, Altmann U, Berger U. Differential Item Functioning in Brief Instruments of Disordered Eating. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2019. [DOI: 10.1027/1015-5759/a000472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Most instruments for the assessment of disordered eating were developed and validated in young female samples. However, they are often used in heterogeneous general population samples. Therefore, brief instruments of disordered eating should assess the severity of disordered eating equally well between individuals with different gender, age, body mass index (BMI), and socioeconomic status (SES). Differential item functioning (DIF) of two brief instruments of disordered eating (SCOFF, Eating Attitudes Test [EAT-8]) was modeled in a representative sample of the German population ( N = 2,527) using a multigroup item response theory (IRT) and a multiple-indicator multiple-cause (MIMIC) structural equation model (SEM) approach. No DIF by age was found in both questionnaires. Three items of the EAT-8 showed DIF across gender, indicating that females are more likely to agree than males, given the same severity of disordered eating. One item of the EAT-8 revealed slight DIF by BMI. DIF with respect to the SCOFF seemed to be negligible. Both questionnaires are equally fair across people with different age and SES. The DIF by gender that we found with respect to the EAT-8 as screening instrument may be also reflected in the use of different cutoff values for men and women. In general, both brief instruments assessing disordered eating revealed their strengths and limitations concerning test fairness for different groups.
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Affiliation(s)
- Desiree Thielemann
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany
| | - Felicitas Richter
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany
| | - Bernd Strauss
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany
| | - Elmar Braehler
- Department of Medical Psychology and Medical Sociology, Leipzig University Hospital, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Germany
| | - Uwe Altmann
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany
| | - Uwe Berger
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany
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Alcaraz‐Ibáñez M, Sicilia Á, Paterna A. Exploring the differentiated relationship between appearance and fitness‐related social anxiety and the risk of eating disorders and depression in young adults. Scand J Psychol 2019; 60:569-576. [DOI: 10.1111/sjop.12584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
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Salas-Wright CP, Vaughn MG, Miller DP, Hahm HC, Scaramutti C, Cohen M, Delva J, Schwartz SJ. Overeating and binge eating among immigrants in the United States: new terrain for the healthy immigrant hypothesis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1007-1017. [PMID: 30806725 PMCID: PMC6675658 DOI: 10.1007/s00127-019-01677-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/12/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Prior research indicates that, compared to individuals born in the United States (US), immigrants are less likely to experience mental health and inhibitory control problems. However, our understanding of overeating and binge eating-both related to mental health and inhibitory control-among immigrants in the US remains limited. Drawing from a large national study, we report the prevalence of overeating and binge eating among immigrants vis-à-vis the US-born. METHODS The data source used for the present study is the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, 2012-2013), a nationally representative survey of 36,309 civilian, non-institutionalized adults ages 18 and older in the US. Logistic regression was employed to examine the relationship between immigrant status and key outcomes. RESULTS The prevalence of any (immigrants = 7.8%, US-born = 17.0%) and recurrent overeating (immigrants = 2.9%, US-born = 5.3%) was lower among immigrants than US-born individuals. Among those reporting recurrent overeating, the prevalence of binge eating with loss of control was comparable among immigrant (37.2%) and US-born participants (39.9%), in general. However, stratified analyses revealed that risk of binge eating with loss of control was lower among immigrant women compared to US-born women (AOR 0.54, 95% CI 0.29-0.98). CONCLUSIONS Findings from the present study provide clear results that immigrants are substantially less likely to overeat as compared to US-born individuals and that, among women but not men, immigrant status is associated with lower risk of binge eating with loss of control.
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Affiliation(s)
| | - Michael G Vaughn
- School of Social Work, Saint Louis University, St. Louis, MO, USA
- Yonsei University, Seoul, Republic of Korea
| | - Daniel P Miller
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, USA
| | - Hyeouk Chris Hahm
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, USA
| | | | - Mariana Cohen
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, USA
| | - Jorge Delva
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, USA
| | - Seth J Schwartz
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Graham AK, Trockel M, Weisman H, Fitzsimmons-Craft EE, Balantekin KN, Wilfley DE, Taylor CB. A screening tool for detecting eating disorder risk and diagnostic symptoms among college-age women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:357-366. [PMID: 29979922 PMCID: PMC6320726 DOI: 10.1080/07448481.2018.1483936] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/30/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
Objective: As eating disorders (EDs) often emerge during college, managing EDs would ideally integrate prevention and treatment. To achieve this goal, an efficient tool is needed that detects clinical symptoms and level of risk. This study evaluated the performance of a screen designed to identify individuals at risk for or with an ED. Participants: Five hundred forty-nine college-age women. Methods: Participants completed a screen and diagnostic interview. Results: Using parsimonious thresholds for ED diagnoses, screen sensitivity ranged from 0.90 (anorexia nervosa) to 0.55 (purging disorder). Specificity ranged from 0.99 (anorexia nervosa) to 0.78 (subthreshold binge eating disorder) compared to diagnostic interview. Moderate to high area under the curve values were observed. The screen had high sensitivity for detecting high risk. Conclusions: The screen identifies students at risk and has acceptable sensitivity and specificity for identifying most ED diagnoses. This tool is critical for establishing stepped care models for ED intervention.
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Affiliation(s)
- Andrea K. Graham
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mickey Trockel
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hannah Weisman
- Department of Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | | | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C. Barr Taylor
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
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McBride C, Costello N, Ambwani S, Wilhite B, Austin SB. Digital Manipulation of Images of Models' Appearance in Advertising: Strategies for Action Through Law and Corporate Social Responsibility Incentives to Protect Public Health. AMERICAN JOURNAL OF LAW & MEDICINE 2019; 45:7-31. [PMID: 31293209 DOI: 10.1177/0098858819849990] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT Widespread digital retouching of advertising imagery in the fashion, beauty, and other consumer industries promotes unrealistic beauty standards that have harmful effects on public health. In particular, exposure to misleading beauty imagery is linked with greater body dissatisfaction, worse mood, poorer self-esteem, and increased risk for disordered eating behaviors. Moreover, given the social, psychological, medical, and economic burden of eating disorders, there is an urgent need to address environmental risk factors and to scale up prevention efforts by increasing the regulation of digitally altered advertising imagery. METHODS This manuscript summarizes the health research literature linking digital retouching of advertising to increased risk of eating disorders, disordered weight and appearance control behaviors, and body dissatisfaction in consumers, followed by a review of global policy initiatives designed to regulate digital retouching to reduce health harms to consumers. Next, we turn to the US legal context, reporting on findings generated through legal research via Westlaw and LexisNexis, congressional records, federal agency websites, law review articles, and Supreme Court opinions, in addition to consulting legal experts on both tax law and the First Amendment, to evaluate the viability of various policy initiatives proposed to strengthen regulation on digital retouching in the United States. FINDINGS Influencing advertising practices via tax incentives combined with corporate social responsibility initiatives may be the most constitutionally feasible options for the US legal context to reduce the use of digitally alternated images of models' bodies in advertising. CONCLUSIONS Policy and corporate initiatives to curtail use of digitally altered images found to be harmful to mental and behavioral health of consumers could reduce the burden of eating disorders, disordered weight and appearance control behaviors, and body dissatisfaction and thereby improve population health in the United States.
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Affiliation(s)
- Caitlin McBride
- Michigan State University College of Law, East Lansing, MI, USA
| | - Nancy Costello
- Michigan State University College of Law, East Lansing, MI, USA
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, PA, USA
| | - Breanne Wilhite
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA. The authors report no conflict of interest. This project was supported by the Ellen Feldberg Gordon Fund for Eating Disorders Prevention Research, Jennifer Perini Fund for Eating Disorders Prevention Research, and Strategic Training Initiative for the Prevention of Eating Disorders. S.B.A. is supported by Maternal and Child Health Bureau, HRSA grants T71-MC00009 and T76-MC00001. S.A. is supported by a Faculty Sabbatical Grant from the Research and Development Committee at Dickinson College. The authors wish to thank Jennifer L. Pomeranz, JD, MPH, Randall Vesprey, JD, and Ariane Moss, JD, MS, for their contributions to the legal research for this manuscript and thank Jordan Levinson for her help preparing this manuscript for publication. No human subjects were involved in this study; therefore, IRB approval was not needed
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Siegel JA, Sawyer KB. Eating Disorders in the Workplace: A Qualitative Investigation of Women’s Experiences. PSYCHOLOGY OF WOMEN QUARTERLY 2018. [DOI: 10.1177/0361684318812475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Though employment is typically associated with positive mental health outcomes for individuals with disabilities, the ubiquity of stress and stigma at work may complicate the relation between work and well-being for women with eating disorders (EDs). To date, however, the experiences of women with EDs in the workplace have not been examined. By utilizing a qualitative methodology to form an initial framework for the examination of EDs in the workplace, we address this gap in the literature. Seventy adult women with anorexia, bulimia, and binge eating disorder discussed the relation between work and their condition. The data analysis led to the delineation of a theoretical model, which we propose explains the interconnections between key study constructs, including individual characteristics; workplace stressors; identity, stigma, and stress management techniques; and related personal and organizational outcomes. Our research suggests that, depending on how stress is managed, the workplace can serve as a bridge or a barrier to ED recovery. This study lays the groundwork for understanding the ways in which workplace life interacts and interferes with ED management, opening up a new line of investigation for researchers working to enhance the lives of individuals with EDs across life domains.
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Affiliation(s)
- Jaclyn A. Siegel
- Department of Psychology, Western University, London, Ontario, Canada
| | - Katina B. Sawyer
- Department of Management, George Washington University, Washington, DC, USA
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Cruz AM, Gonçalves-Pinho M, Santos JV, Coutinho F, Brandão I, Freitas A. Eating disorders-Related hospitalizations in Portugal: A nationwide study from 2000 to 2014. Int J Eat Disord 2018; 51:1201-1206. [PMID: 30265756 DOI: 10.1002/eat.22955] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Recent evidence suggests that incidence of Anorexia nervosa (AN) has remained stable over the last decades in Western Europe, while decreasing for Bulimia nervosa (BN). It is well-known that most individuals with an ED (Eating disorder) do not seek medical treatment. OBJECTIVE The present study analyses hospitalizations related with EDs held in mainland Portuguese public hospitals between 2000 and 2014. METHOD A retrospective observational study was performed gathering all inpatient episodes with primary or secondary diagnosis of ED. Number of patients, gender, mean age at discharge, suicide-attempts related hospitalizations, in-hospital mortality, length of stay, and mean charges were analyzed. RESULTS There were a total of 4,485 hospitalizations with an associated ED. AN was the most frequent ED (n = 2,806). Suicide attempt-related hospitalizations were most common among patients with BN (10.1% of BN hospitalizations) or AN (5.2% of AN hospitalizations). DISCUSSION AN has higher in-hospital mortality than BN. We observed a higher proportion of suicide related hospitalizations in BN when compared to AN. Although pica, rumination disorder, and psychogenic vomiting represent a smaller portion of all EDs, this study was the first to describe hospitalization trends for this set of EDs for a 15-year period, to the best of our knowledge.
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Affiliation(s)
- Ana Margarida Cruz
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Gonçalves-Pinho
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - João Vasco Santos
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Public Health Unit, AceS Grande Porto VIII - Espinho/Gaia, Portugal
| | - Francisco Coutinho
- Faculty of Medicine, Department of Clinical Neurosciences and Mental Health, University of Porto, Alameda Hernâni Monteiro, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Hospital São João, Porto, Portugal
| | - Isabel Brandão
- Faculty of Medicine, Department of Clinical Neurosciences and Mental Health, University of Porto, Alameda Hernâni Monteiro, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Hospital São João, Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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50
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Regionale Inanspruchnahme des Versorgungssystems und Behandlungsprävalenz bei Essstörungen. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0290-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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