Prevalence and factors associated with disordered eating behaviors, food addiction, and compulsive exercise among females studying clinical nutrition in Saudi Arabia.

The primary aim of this study was to examine sex differences in energy availability (EA) and its relationships with disordered eating, compulsive exercise, and body mass index (BMI) among adolescent athletes. Cross-sectional study. University hospital pediatric sports medicine center. Sixty-four participants (61% female) of ages 13 to 18 years, actively participating in at least 1 organized sport. Participant sex. Average 7-day EA (kcal/kg FFM/d; calculated using participant-recorded dietary intake and exercise expenditure from a wrist-worn heart rate/activity monitor), Eating Disorder Examination Questionnaire (EDE-Q) score (range 0-6), Compulsive Exercise Test (CET) score (range 0-25), and age- and sex-adjusted BMI percentile. There were no significant sex differences in EA (females: 40.37 ± 12.17 kcal/kg FFM/d; males: 35.99 ± 12.43 kcal/kg FFM/d; P = 0.29), EDE-Q (females: 0.68 ± 0.70; males: 0.68 ± 0.83; P = 0.99), or CET scores (females: 11.07 ± 0.44; males: 10.73 ± 0.63; P = 0.66). There were low and insignificant negative correlations between EA and EDE-Q and CET scores for female athletes (EDE-Q: r = -0.22, P = 0.18; CET: r = -0.21, P = 0.09) and male athletes (EDE-Q: r = -0.09, P = 0.66; CET: r = -0.35, P = 0.08). EA and BMI-for-age percentile were inversely correlated in both male (r = -0.451, P = 0.009) and female (r = -0.37, P = 0.02) participants. In our sample of adolescent athletes, lower EA occurred in the absence of notable disordered eating or compulsive exercise behaviors, suggesting unintentional underfueling (and/or underreporting of energy intake), without significant sex differences. Low BMI can be an imperfect surrogate marker for low EA. These findings inform risk factors and screening practices for low EA among adolescent athletes.

BackgroundThe aim of this study was to explore changes in the Compulsive Exercise Test (CET) following a family-based intervention in adolescents with restrictive eating disorders (ED). It was hypothesized that compulsive exercise would improve with successful intervention against the ED but also that a high level of compulsive exercise at presentation would be associated with a less favourable outcome.MethodThe CET, the Eating Disorders Examination-Questionnaire (EDE-Q), and body mass index were available for 170 adolescents at presentation and at a one-year follow-up. Treatment was a family-based intervention and included that all exercise was stopped at start of treatment. Recovery was defined as EDE-Q score < 2.0 or absence of an ED at an interview.ResultsExercise for weight control and for avoiding low mood, which are related to ED cognitions, decreased in recovered patients. Exercise for improving mood did not change in either recovered or not recovered patients. The CET subscale scores at presentation did not independently predict recovery.ConclusionCompulsive exercise is one of several ED related behaviours which needs to be targeted at the start of treatment. With successful treatment it decreases in parallel with other ED related cognitions and behaviours but without a loss of the ability to enjoy exercise.

Measures Used with Populations with Food Insecurity: A Call for Increased Psychometric Validation

Compulsive exercise is a symptom and a maintenance factor of eating disorders, which increases the risk of relapse. It has been considered a target for treatment, particularly for anorexia nervosa (AN). This audit aims to review the efficacy and acceptability of a new seven-week JuniorLEAP group therapy programme, for children and adolescents with anorexia nervosa. JuniorLEAP was adapted by the authors and based on the Loughborough Eating Disorder Activity Programme (LEAP) for adults. 32 children and adolescents with anorexia nervosa were allocated to the group in an in-patient setting using entry criteria. All children and adolescents completed seven weekly sessions of the JuniorLEAP programme, as well as pre- and post-treatment questionnaires, including the Eating Disorder Examination Questionnaire (EDE-Q) and the Compulsive Exercise Test (CET). The children and adolescents were also asked to provide qualitative responses about the acceptability of the group. A paired t test was conducted to review the efficacy of the JuniorLEAP programme. Significant changes in eating disorder psychopathology was observed, as measured by the EDE-Q, with total mean scores reducing from 3.53 to 2.77 (p = 0.001). Compulsive exercise attitudes were also observed to reduce, as measured by the CET, with total mean scores reducing from 15.39 to 10.90 (p ≤ 0.001). Furthermore, there was a significant reduction in all five subscales of the CET following completion of the group. Qualitative results also demonstrate the group to be acceptable to the patients. This study finds that a new manualised JuniorLEAP group therapy, specifically adapted for adolescents and children with AN, when used as an adjuvant with other therapies in a residential setting, significantly reduces their compulsive exercise, as measured by CET. The patients reported that the treatment was acceptable. Further research testing the new treatment in a randomised controlled trial is now needed, particularly to disentangle the impact of other aspects of standard treatment in reducing compulsive exercise. II.

ObjectiveUltra-processed food addiction (UPFA) is increasingly recognized but remains controversial among eating disorder (ED) clinicians, partly due to concerns that introducing food addiction concepts might intensify dietary restraint, a core feature of EDs. This study examined whether integrating UPFA assessment, psychoeducation and treatment into residential treatment (RT) impacts ED symptomatology, particularly dietary restraint.MethodsAdults (N = 132) admitted to RT completed the Eating Disorder Examination Questionnaire (EDE-Q) and the modified Yale Food Addiction Scale 2.0 (mYFAS2.0) at admission and discharge. Changes in EDE-Q global scores and EDE-Q restraint subscale scores were analyzed using repeated-measures analysis of variance (RANOVA) with ED diagnosis as a between-subjects factor and age, gender identity, sexual orientation, and admission BMI as covariates. Pearson correlations between mYFAS2.0 and EDE-Q scores were calculated at both time points to assess construct overlap.ResultsBoth EDE-Q global and EDE-Q restraint scores decreased significantly in the ED patients (p ≤ 0.001) and remained low in the non-ED patients. mYFAS2.0 scores were not significantly correlated with EDE-Q restraint scores at either admission or discharge, while they were weakly correlated with EDE-Q global scores at both time points.ConclusionsUPFA-informed assessment, psychoeducation and/or treatment did not increase EDE-Q restraint scores. Instead, they declined significantly in ED patients, with no worsening observed. Modest post-treatment correlations between UPFA and EDE-Q global scores but not EDE-Q restraint scores suggest partial but incomplete overlap between EDs and UPFA symptomatology, with caloric restraint confined to EDs alone. These results support their nosological distinction and the feasibility of concurrent treatment without worsening ED-related dietary restraint.

BackgroundProblematic use of social media and smartphones has been increasingly linked to unhealthy lifestyle behaviors and weight-related problems. However, limited evidence exists on how these digital behaviors are associated with food addiction and obesity in young adults.AimsThe aim of this study is to investigate the relationship between problematic digital media use and food addiction, eating behaviours, and obesity among Turkish university students.MethodA cross-sectional study was conducted between December 2024 and March 2025 with 331 students. Participants completed validated instruments, including the Social Media Addiction Scale–Adult Form, the Smartphone Addiction Scale–Short Form, the Modified Yale Food Addiction Scale 2.0, and the Eating Disorder Examination Questionnaire–Short Form (EDE-Q13). Anthropometric measurements were used to calculate body mass index (BMI).ResultsThe mean age of the participants was 20.49 ± 3.88 years, and 81% were female. Problematic smartphone use was significantly higher among students with moderate food addiction compared to those without food addiction (p < 0.001). Severe food addic-tion was associated with higher prevalence of eating disorders (p < 0.001) and higher BMI values (p < 0.001). Weak but significant correlations were found between problematic so-cial media use and binge eating (r = 0.133, p = 0.015) as well as purging behaviors (r = 0.190, p = 0.001). Similar associations emerged between problematic smartphone use and binge eating (r = 0.136, p = 0.013).ConclusionsFindings indicate that problematic social media and smartphone use are associated with food addiction, eating disorders, and higher BMI among young adults. Nevertheless, these results highlight the need for preventive strategies addressing digital media use in the context of eating behaviors and obesity risk.

IntroductionTransdiagnostically relevant psychological traits associated with psychiatric disorders are increasingly being researched, notably in substance use and addictive behaviors. We investigated whether emotion dysregulation mediated by impulsivity and/or compulsivity could explain variance in binge eating, food addiction, self‐starvation, and compulsive exercise, as well as alcohol use (addictive‐like behaviors relevant to the obesity and eating disorder fields).MethodA general population sample of adults (N = 500, mean age = 32.5 years), females (n = 376) and males (n = 124), completed the Difficulties in Emotion Regulation Scale‐16, the Trait Rash Impulsivity Scale, the Obsessive‐Compulsive Inventory—Revised, the Eating Disorders Examination Questionnaire, the Self‐Starvation Scale, the Exercise Dependence Scale, the Yale Food Addiction Scale, and the Alcohol Use Disorders Identification Test online. Besides gender comparisons and intercorrelations between measures, we used predefined multiple mediation models with emotion dysregulation as independent variable, impulsivity and compulsivity as parallel mediators, to investigate whether these factors contributed explanatory power to each addictive‐like behavior as outcome, also using age and body mass index as covariates.ResultsFemales scored higher than males on emotion dysregulation and the eating‐related addictive‐like behaviors food addiction, self‐starvation, and binge eating. Intercorrelations between measures showed that emotion dysregulation and compulsivity were associated with all outcome variables, impulsivity with all except compulsive exercise, and the eating‐related behaviors intercorrelated strongly. Mediation models showed full or partial mediation of emotion dysregulation for all behaviors, especially via compulsivity, suggesting a behavior‐specific pattern. Mediation models were not affected by age or gender.DiscussionAddictive‐like behaviors seemed to be maintained by trait levels of emotion dysregulation, albeit channeled via trait levels of compulsivity and/or impulsivity. The role of emotion dysregulation may help us to understand why addictive‐like behaviors can be difficult to change in both clinical and nonclinical groups, and may be informative for treatment‐planning in patients where these behaviors are present. Our findings support adopting a more dimensional approach to psychiatric classification by focusing psychological facets such as those studied.

The association between adult ADHD and food addiction: A mediation analysis

Back to table of contents Previous article Next article Clinical & ResearchFull AccessIntermittent Fasting Linked to Eating Disorder BehaviorsTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:26 Jan 2023https://doi.org/10.1176/appi.pn.2023.02.2.3AbstractA study points to the potential pitfalls of a dieting practice often touted as beneficial, or at least harmless.Intermittent fasting—the practice of limiting eating to certain hours of the day—may be associated with eating disorder behaviors in adolescents and young adults, a study in Eating Behaviors has found.Medical professionals should screen for intermittent fasting, says Kyle Ganson, Ph.D., M.S.W.University of Toronto“Public attention on intermittent fasting is only going to keep growing, so we need to continue to research the dietary practice holistically, not just how it may be beneficial, but also how it may be problematic,” lead author Kyle Ganson Ph.D., M.S.W., told Psychiatric News. He is an assistant professor at the Factor-Inwentash Faculty of Social Work at the University of Toronto. “We also need to continue to bring greater knowledge to [health professionals] on intermittent fasting to ensure proper guidance and oversight for patients.”Ganson and colleagues analyzed data from 2,762 people between the ages of 16 and 30 years who participated in the Canadian Study of Adolescent Health Behaviors. The participants answered questions about whether they engaged in intermittent fasting over the past 12 months or past 30 days, and if so, how often. The researchers used the Eating Disorder Examination Questionnaire (EDE-Q) 6.0 Global Score to assess the participants for eating disorder behaviors such as overeating, binge eating, vomiting, laxative use, compulsive exercise, and fasting.Overall, 47.7% of women, 38.4% of men, and 52% of transgender/gender nonconforming participants engaged in intermittent fasting in the past 12 months and 24.6% of women, 17.8% of men, and 24.1% of transgender/nonconforming participants engaged in intermittent fasting in the past 30 days. “Engagement in intermittent fasting is much more common than many might believe among a vulnerable age group—adolescents and young adults—where the codification of health behaviors largely occurs,” Ganson said. “It is important that medical professionals screen for intermittent fasting and are cautious about recommending intermittent fasting, particularly to young people.”Intermittent fasting in the past 12 months was associated with the following:All eating disorder behaviors (overeating, binge eating, vomiting, laxative use, compulsive exercise, and fasting) and higher EDE-Q global scores in women.Compulsive exercise, fasting, and higher EDE-Q scores in men.Fasting and higher EDE-Q scores in transgender/gender nonconforming people.The study is a reminder that eating disorders and their related behaviors cut across all genders, says Jason Nagata, M.D., M.Sc.Susan MerrellIntermittent fasting in the past 30 days was associated with the following:All eating disorder behaviors and higher EDE-Q global scores in women.Compulsive exercise, fasting, vomiting, and higher EDE-Q scores in men.Higher EDE-Q scores in transgender/gender nonconforming people.According to coauthor Jason Nagata, M.D., M.Sc., an assistant professor of pediatrics in the Division of Adolescent and Young Adult Medicine at the University of California, San Francisco, the results speak to the heterogeneity of eating disorders and their related behaviors.“Eating disorders can affect people of all genders, races, ethnicities, sexual orientations, ages, and sizes. You cannot tell that someone has an eating disorder based on appearance alone,” Nagata said. Ganson noted the visibility of intermittent fasting in both popular culture and research.“We often see ads for intermittent fasting apps on social media, influencers promoting it, and some research promoting it as a mechanism for weight loss, disease prevention, and increasing longevity,” Ganson said. “It is important to begin to change the popular conversation around intermittent fasting [and acknowledge] that it is not a benign dietary practice and can instead be connected to problematic behaviors.” ■“Intermittent Fasting: Describing Engagement and Associations With Eating Disorder Behaviors and Psychopathology Among Canadian Adolescents and Young Adults” ISSUES NewArchived

ObjectivesThe objectives of this study were to (1) validate the Norwegian version of the Compulsive Exercise Test (CET) in adults with longstanding eating disorders, and (2) explore predictors of high CET-score.Methods:Adult inpatients (n = 166) with longstanding DSM-IV Anorexia Nervosa, Bulimia Nervosa (BN) or Eating Disorder not Otherwise Specified (EDNOS) completed the CET instrument, Eating Disorder examination questionnaire (EDE-Q), Beck Depression Inventory-II (BDI-II) and Symptom checklist-90 (SCL-90). A total CET score of 15 or above was defined as high CET-score. ANOVA, Confirmatory factor analysis, Pearson’s correlation, and logistic regression were used to analyze the data.ResultsCronbach’s alpha varied from 0.68 to 0.96 for the CET and its subscales. The confirmatory factor analysis showed adequate fit. Convergent validity of the CET demonstrated correlation between EDE-Q global and subscale scores and CET total score. The same pattern was found for correlation between CET subscales and EDE-Q subscales. EDE-Q global score and frequency of exercise episodes predicted high CET-score, yet 21% of the patients with high CET score had less than one episode of exercise per week.ConclusionThe Norwegian version of CET is valid and useful for assessing compulsive exercise in a sample with longstanding ED. The understanding of compulsive exercise must to a greater extent differ between obsessions and compulsions, as a significant number of patients with high CET score showed no or little exercise behavior.

Compulsive exercise or exercise dependence? Clarifying conceptualizations of exercise in the context of eating disorder pathology

Compulsive exercise is a prominent feature for the majority of patients with Anorexia Nervosa (AN), but there is a dearth of research evaluating assessment instruments. This study assessed the concurrent validity of the exercise items of the Eating Disorder Examination (EDE) and Eating Disorder Examination-Questionnaire (EDE-Q), with the Compulsive Exercise Test (CET) and other self-report exercise measures in patients with AN. We also aimed to perform validation of the CET in an adult clinical sample. The sample consisted of 78 adults with AN, recruited for the randomized controlled trial "Taking a LEAP forward in the treatment of anorexia nervosa." At baseline, participants completed the EDE, EDE-Q, CET, Reasons for Exercise Inventory (REI), Commitment to Exercise Scale (CES) and Exercise Beliefs Questionnaire (EBQ). Correlational and regression analyses were performed. EDE exercise days and exercise time per day were positively correlated with each other and with all CET subscales (except Lack of exercise enjoyment), CES mean, EBQ total and REI total. Exercise time per day was associated with a higher EDE global score. The CET demonstrated good concurrent validity with the CES, the REI and the EBQ. Of the self-reports, the CET explained the greatest variance in eating disorder psychopathology and demonstrated good to excellent reliability in this sample. The EDE and EDE-Q demonstrated good concurrent validity with the CET. Further research is required to evaluate the CET's factor structure in a large clinical sample. However, the CET has demonstrated strong clinical utility in adult patients with AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:533-541).

BackgroundSome physically active people exercise compulsively, which can be associated with several mental health challenges. Fitness instructors are considered important role models for an active, healthy lifestyle; yet little is known about their exercise motives and mental health. The aim of this study was to examine the presence of compulsive exercise and mental health challenges, and their interaction, in fitness instructors.MethodsA total of 270 fitness instructors from Norwegian fitness clubs were recruited for this cross-sectional study. Inclusion criteria were operating as instructors within the current year and understanding Norwegian language. Data were collected by an electronic questionnaire and included demographic information, hours of classes instructed and of personal physical activity, Compulsive Exercise Test (CET), Symptom Check List – 10 (SCL-10), Beck Depression Inventory (BDI), and Eating Disorder Examination Questionnaire (EDE-Q)).ResultsFemales had higher CET scores than males, and 9% of all respondents had CET score above clinical cutoff. Respondents with clinical CET score had higher SCL-10, BDI and EDE-Q global- and subscale scores compared with their counterparts. Although CET was positively and significantly associated with BDI, SCL-10, and EDE-Q, only the latter explained the CET score (ß = 1.23, 99% CI = 0.87, 1.59).ConclusionAbout one out of eleven instructors were above clinical CET cut-off, revealing symptoms of compulsive exercise. EDE-Q significantly contributed in a model explaining 43% of the variation of compulsive exercise.

To explore the relationships between the use of food intake and activity monitoring tools with compulsive exercise, eating psychopathology, and psychological wellbeing. Participants (N = 352; mean age 21.90 years) indicated their use of activity and food intake monitoring tools, and completed the Compulsive Exercise Test (CET), Eating Disorders Examination Questionnaire (EDE-Q), and the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Users of monitoring tools reported significantly higher CET and EDE-Q scores than nonusers. Positive associations were detected between the frequency of activity monitoring tool use with CET and EDE-Q scores. Participants who reported using monitoring tools primarily to manage weight and shape reported higher levels of eating and compulsive exercise psychopathology than those who reported using tools to improve health and fitness. Features of compulsive exercise and eating psychopathology are elevated among users of food intake and activity monitoring tools; and particularly among those who report using the tools for weight and shape purposes. Longitudinal and experimental research is needed to further our understanding of these observed associations, and specifically to explore the prospective relationships between monitoring tool use, eating psychopathology, and compulsive exercise.

Purpose: The current study evaluated associations between exercise identity (Exercise Identity Scale; EIS), compulsive exercise (Compulsive Exercise Test; CET), and their association with Eating Disorder Examination – Questionnaire (EDE-Q) scores among adult runners registered for mid- and long-distance races (N = 282, 48.2% male). Methods: Runners of half and full marathon races completed the EIS, CET, and EDE-Q. Results: Regression analyses indicated that increased EIS, b = −.21, and CET, b = −3.25, scores contribute to decreased eating pathology amongst half-marathon runners; a significant interaction effect emerged for EIS × CET scores, b = .08, such that relations between EIS and EDEQ scores were significant among runners reporting either lower or higher CET scores. These associations were not demonstrated in marathon runners. Conclusions: Results suggest that it is beneficial to consider running status when addressing the effect that exercise identity and compulsive exercise may have on eating pathology in competitive runners.