Validation of a childhood eating disorder outcome scale

Shinichiro Nagamitsu,Ryoko Otani,Yuki Suzuki,Chikako Fujii,Yoshimitsu Fukai,Shunya Uchida ,Tetsuhiro Iguchi ,Shinya Kitayama ,Yoshino Sumi,Michiko Matsuoka,Yuichi Suzuki,Ryuta Ishii,Yasuko Tsurumaru,Shizuo Takamiya,Kenshi Koyanagi,Takeshi Inoue,Tatsuyuki Kakuma,Ryoichi Sakuta,Ayumi Okada,Yushiro Yamashita

doi:10.1186/s13030-019-0162-3

Abstract

We developed and validated a childhood eating disorder outcome scale based on outcomes associated with body mass index standard deviation score (BMI-SDS). This prospective observational study included 131 children with eating disorders (aged 5–15 years). Participants’ outcomes scales were completed at the first visit and at 1, 3, 6, and 12 months. The scale evaluated 12 outcomes: body weight change (BW), eating attitude (EA), fear of being fat (FF), body image distortion (BD), menstruation (ME), perceived physical condition (PC), attending school (AS), disease recognition by school (RS), family function (FA), disease recognition by parent (RP), social adaptation (SA), and relationships with friends (RF). Responses to all items were on a four-point Likert scale. Exploratory factor analysis was used to determine the number of factors based on the 12 outcomes. The relation between outcome scale scores and BMI-SDS over the 12-month follow-up period was analyzed. Two types of factors were extracted: disease-specific factors (EA, FF, BD) and biopsychosocial factors (BW, PC, AS, FA, SA, RF). Three items (ME, RS, RP) were excluded because they showed no significant loading effect. There was a significant negative correlation between the outcome scale and BMI-SDS, and changes in outcome scale scores from baseline to 12 months were significantly associated with improvement in BMI-SDS. We developed a childhood eating disorder outcome scale characterized by disease-specific and biopsychosocial factors. Biopsychosocial management combined with a therapeutic approach for disease-specific symptoms may support body weight recovery for children with eating disorders.

Highlights

Childhood eating disorders are serious psychiatric illnesses that confer substantial morbidity and mortality and manifest as disturbances in eating habits, excessive preoccupation with weight, restricted caloric intake, and body image distortion
Total parental nutrition was reported for 14 children and enteral feeding through a nasogastric tube was reported for seven children
At the first visit assessment, the subtotal for the disease-specific factor was not significantly correlated with body mass index standard deviation score (BMI-SDS)

Summary

Introduction

Childhood eating disorders are serious psychiatric illnesses that confer substantial morbidity and mortality and manifest as disturbances in eating habits, excessive preoccupation with weight, restricted caloric intake, and body image distortion. The Morgan-Russell Outcome Assessment Schedule was developed to identify outcome predictors using data from clinical observation, premorbid personality, and the patient’s family background at the time of first assessment [12]. It covers nutritional status, menstrual function, mental state, sexual adjustment, and socioeconomic status; those scales are not standardized and each rating scale is relatively subjective. The Morgan-Russell Outcome Scale is widely used for Nagamitsu et al BioPsychoSocial Medicine (2019) 13:21 eating disorders in adulthood [9, 13, 14]; many studies used body weight and the presence of menstruation to evaluate prognosis. An eating disorder outcome scale that is specific for children’s developmental physical condition is needed

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Conclusion