Prevalence of Abnormal Eating Attitudes and Behaviors in Hospital-Based Primary and Tertiary Care Clinics: A Window of Opportunity?

Abstract

ObjectiveThe “athletic triad” of amenorrhea, os-teopenia, and eating disorders (EDs) has received increasing attention in the past decade. Adolescents may seek care for amenorrhea or other menstrual irregularity before disclosure of an eating disorder to a primary care clinician. The purpose of this study was to determine the prevalence of abnormal eating attitudes and behaviors in adolescent girls going to a clinic for reproductive endocrinology (RE) visits versus the prevalence in girls going for health maintenance (HM) visits. DesignAll patients aged 8–22 years going to RE or HM clinics were given a 26-item modified eating attitudes test (EAT) and two pages of questions on other eating issues and demographics. Informed consent was obtained from all participants, and also from the parents of those less than 18 years of age. SettingAll subjects were seen at a hospital-based ambulatory (HM) or subspecialty (RE) clinic, with both clinics located on the same floor. ParticipantsThe study included 53 girls from the RE clinic and 108 girls from the HM clinic. All demographics were similar except that the RE patients were slightly older and had significantly more parents with masters or doctorate degrees. Main Outcome MeasuresStudy variables were compared between RE and HM groups using either the Student's t test or the Chi-‘square test, with statistical significance defined as p < 0.05. A score of 20 or higher on the modified EAT was correlated with a high risk of EDs and was used as a measure of prevalence of abnormal eating attitudes and behaviors. ResultsModified EAT scores were 11.8±8.9 in RE patients vs 7.0±7.2 in HM patients (p < 0.001), with 10 (18.9%) RE patients and 7 (6.5%) HM patients having scores of at least 20 (p = 0.016). No differences in daily exercise, dairy consumption, or use of vomiting or laxatives to control weight were found. As expected, RE patients were significantly more likely to experience menstrual irregularities than the HM patients (p < 0.001). ConclusionsAdolescents attending a reproductive endocrinology clinic showed a higher prevalence of abnormal eating attitudes and behaviors than did those going to a clinic for HM visits. Early detection of eating disorders may occur both within and outside of the primary care setting through use of a modified EAT.