Eating Disorders In Adolescents Research Articles

Commentary: Considerations for the use of registry data to study adolescent eating disorders.

Commentary: Considerations for the use of registry data to study adolescent eating disorders.

The role of family meals in the treatment of eating disorders: a scoping review of the literature and implications.

Family meal research is a fast growing field that has significant implications for the prevention and treatment of eating disorders (ED). Using a scoping review procedure, this article overviewed major historical and clinical trends that have guided the use of family meals or lunch sessions in adolescent ED family therapy over the past 40years, and synthesized essential findings from current therapeutic family meal research. The relevant body of literature is reported within the framework of three models of family therapy (Maudsley model, family-based treatment, multi-family therapy), with a focus on their specific use of family lunch sessions and related empirical evidence. Although promising, current evidence remains contradictory, tentative and colored by therapists' convictions, resistance and fears. Future research priorities are discussed, including the need for a more direct examination of the impact of the family meal practice on therapeutic change, as well as a better understanding of its active ingredients and of the characteristics of patients/families that may benefit most from it. This review of the literature may help clinicians and family therapists (1) adhere more reliably and confidently to ED-focused treatment protocols that include a strong family meal component, and (2) make more informed decisions regarding the inclusion or exclusion of family meals in their practice. When feasibility or acceptability issues preclude their use, alternatives to family meals are also discussed, including family meal role-plays and drawings, coaching of home-based family meals and manual/DVD-based guidance.

Psychotropic medications in adult and adolescent eating disorders: clinical practice versus evidence-based recommendations

The current study examined the frequency of psychotropic prescriptions in a clinical sample of eating disorder (ED) patients confirming earlier research indicating their use is very common but inconsistent with evidence-based recommendations. The sample consisted of 501 ED patients admitted to an adult partial hospitalization or adolescent residential program. Patients were divided into two diagnostic groups: anorexia nervosa (AN=287) and bulimia nervosa (BN=214), as well as two age groups: adults (age ≥18; N=318) and adolescents (age <18; N=183). Forty-one different psychotropic medications (891 prescriptions in all) were prescribed for 429 patients. Overall, 85.6% of the total sample reported using one or more psychotropic medications. Of 429 patients using any medications, 46.9% were on two or more, 25.3% on three or more, and 11.0% four or more. Antidepressants were most commonly prescribed (89.5% of those on medication) with no significant differences in usage patterns based on diagnosis. However, there was greater medication use among adults (89.6%) compared to adolescents (78.7%). Results indicate psychotropic medication prescription is more widespread in a clinical sample than in an earlier report screening for osteoporosis in AN women. Treatment recommendations suggest medication should not be the primary treatment for EDs and empirical evidence demonstrates their ineffectiveness in AN. Nevertheless, there were no differences in frequency found between diagnostic groups, confirming little relationship between evidence-based recommendations and actual clinical use for those referred to a specialized ED treatment facility. This study adds new evidence regarding age-based comparisons of psychotropic prescription frequency in clinical EDs and comparison between AN and BN which has not been examined in earlier studies.

Type of setting for the inpatient adolescent with an eating disorder: Are specialized inpatient clinics a must or will the pediatric ward do?

There are a range of different services for treating adolescent eating disorders (ED) but there is no clinical consensus and a paucity of research indicating which type of treatment setting is the best. Although it would be ideal to have a specialized ward for these patients what happens when this is not possible? The aim of this study was to evaluate patients with ED hospitalized on a general pediatric ward. A retrospective chart review for 37 patients hospitalized for an ED and followed by a team consisting of an adolescent medicine specialist, a child and adolescent psychiatrist and a dietician on a pediatric ward were re-evaluated. Twenty-four (64.9%) patients were diagnosed with anorexia nervosa (AN) restricting type, 8 (21.6%) with anorexia nervosa binging purging type, 3 (8.1%) with bulimia nervosa (BN) and 2 (5.4%) with eating disorder otherwise not specified. The mean age at admission was 14.79 ± 1.75 years and 7 (20%) were males. A majority were hospitalized due to medical instability. Mean period of time from admittance to medical stabilization was 6.04 ± 4.79 days. The mean period of admittance was 26.4 ± 11.9 days for AN and 23.7 ± 15.03 days for BN patients. The mean calorie intake of the AN group was 607 ± 333 kcal and 2,358 ± 605 kcal at hospitalization and discharge, respectively. Hypophosphatemia occurred in 2 patients during refeeding. Mean total weight gained during the whole hospitalization period was 3,950 ± 3,524grs. This study shows that although not ideal, EDs can successfully be followed on general pediatric wards and could have implications at centers with no specialized wards.

Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders.

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations. Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review. Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047; p = 0.039). No statistical significance was found between electrolytes and calories provided during refeeding. Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

The feasibility, acceptability and possible benefit of a positive psychology intervention group in an adolescent inpatient eating disorder service

Positive affect focused therapies could increase subjective happiness and life satisfaction for patients with eating disorders (EDs), illnesses known to significantly impact quality of life. This longitudinal pilot study aimed to develop and implement a five session ‘Positivity Group’ using positive psychology interventions (PPIs) in an adolescent ED inpatient service. Eight female inpatients aged 11–18 years attended the group and subjective happiness and life satisfaction were assessed before, after and at 6-month follow-up. Patients provided feedback on acceptability and feasibility was assessed via patient engagement, facilitator and team feedback and the data support the feasibility and acceptability of the group. A possible benefit was derived from the group, with 75% of patients reporting meaningful improvement in subjective happiness and 87.5% in life satisfaction. Involving the wider team and supporting homework were identified as considerations for future replication alongside the assessment of implementation, acceptability, feasibility and effectiveness in other clinical contexts.

Evaluating a new inpatient program for adolescent AN: impacts on admission rates and patient outcomes

Anorexia nervosa (AN) is particularly dangerous for adolescent sufferers, as the potential for long term damage is heightened during this critical developmental period. Hospitalisation is necessary for many adolescents with AN, and in Australia, around 90% of such admissions are to public hospitals. Given the high costs associated with this treatment modality, the economic impact on public health systems is substantial. In 2013, a new adolescent eating disorder program was introduced in a large public paediatric unit. Informed by the Maudsley Model, the program had the dual aim of improving patient outcomes and managing service demand. We evaluated the program's success in terms of its impact on admission rates and duration, and on patient outcomes. Despite an increased demand for inpatient services since the new program commenced, it has achieved significant reductions in occupied bed days without compromising patient outcomes. Weight gain and decreases in eating psychopathology were maintained at 3-month follow-up. This presentation will detail the results of the evaluation, and discuss its implications for other services facing similar challenges. We will also discuss the implications of this research for informing improvements in the provision of effective inpatient treatment for adolescent AN.

A risk profile of compulsive exercise in adolescents with an eating disorder, and their affective responses to an inpatient exercise program

Compulsive exercise is known to be a problematic feature of adult eating disorders (ED), however, there is little research investigating compulsive exercise in adolescents with EDs. In particular, the acute anxiolytic and anti-depressant properties of exercise are yet to be determined in adolescent ED inpatients. Thus, the current study examined the prevalence and psychopathological correlates of compulsive exercise in a sample of 60 female adolescent ED inpatients. The study also aimed to identify the psychological benefits of a supervised inpatient physiotherapy-lead exercise program, and if these benefits were greater in participants reporting higher levels of compulsive exercise. At the commencement of their inpatient treatment participants completed a series of standardised self-report questionnaires, assessing eating and psychiatric pathology as well as compulsive exercise features. Participants' mood state was then repeatedly assessed immediately before and after participating in physiotherapy sessions (exercise condition) and school classes (control condition) using visual analogue scales for an admission period of up to three weeks. Results indicated that higher levels of ED symptomology and anxiety were significantly associated with compulsive exercise. Significant acute mood benefits in response to the exercise intervention were also identified in preliminary analyses. The findings support the relevance of assessing compulsive exercise in adolescents with EDs and provide an understanding of the positive and negative reinforcement functions of exercise, which may guide future treatment efforts within ED inpatient settings.

Adolescent eating disorder behaviours and cognitions: gender-specific effects of child, maternal and family risk factors.

BackgroundEating disorder behaviours begin in adolescence. Few longitudinal studies have investigated childhood risk and protective factors.AimsTo investigate the prevalence of eating disorder behaviours and cognitions and associated childhood psychological, physical and parental risk factors among a cohort of 14-year-old children.MethodData were collected from 6140 boys and girls aged 14 years. Gender-stratified models were used to estimate prospective associations between childhood body dissatisfaction, body mass index (BMI), self-esteem, maternal eating disorder and family economic disadvantage on adolescent eating disorder behaviours and cognitions.ResultsChildhood body dissatisfaction strongly predicted eating disorder cognitions in girls, but only in interaction with BMI in boys. Higher self-esteem had a protective effect, particularly in boys. Maternal eating disorder predicted body dissatisfaction and weight/shape concern in adolescent girls and dieting in boys.ConclusionsRisk factors for eating disorder behaviours and cognitions vary according to gender. Prevention strategies should be gender-specific and target modifiable predictors in childhood and early adolescence.

Total parenteral nutrition treatment efficacy in adolescent eating disorders.

Management of adolescent patients with severe eating disorders who refuse treatment for weight loss is complicated. Nutritional rehabilitation is most important during the growth period; thus, strong support in the form of total parenteral nutrition (TPN) as soon as possible is necessary in severe cases. No studies involving detailed, long-term follow up have evaluated biochemical markers and gonadotropin in patients undergoing TPN treatment. Twenty-five adolescent female patients admitted to hospital received TPN immediately, and biochemical marker and gonadotropin levels were measured and analyzed. If subsequent weight gain was observed, TPN treatment was gradually reduced and stopped. No patients dropped out of the study. A significant increase in weight was observed during hospitalization (average, 8.0 kg). Under this treatment, serum total bilirubin was significantly decreased at 3 months, total cholesterol was significantly decreased at 2 months, and alkaline phosphatase (ALP) was significantly increased at 3 and 6 months. Follicle-stimulating hormone response significantly preceded both luteinizing hormone response and appetite recovery. After this treatment, nine of the 25 patients were readmitted for recurrence of appetite loss. Two patients required additional TPN treatment, but seven immediately recovered their appetite after hospitalization without TPN treatment. Bodyweight gain per day was significantly lower and ALP on admission was significantly higher in patients with than without recurrence. Most patients had a remarkable recovery of appetite without refusal behaviors and without evidence of malnutrition after admission. Nutrition maintenance with TPN support is particularly important during the growth period.

Family-based Treatment of Child and Adolescent Eating Disorders

Best-practice guidelines for the treatment of child and adolescent eating disorders recommend the inclusion of parents. Family-based treatment (FBT) posits that families are not only important in supporting their children but are critical change agents in the recovery process. As originally developed for anorexia nervosa, parents take a central role in managing and disrupting eating disorder symptoms. The most evidence-based treatment model for adolescent anorexia nervosa, FBT has also recently been found to be useful in the treatment of adolescent bulimia nervosa. This article provides a summary of the theoretic model, evidence base, and application of FBT.

Adolescent Eating Disorders Predict Psychiatric, High-Risk Behaviors and Weight Outcomes in Young Adulthood

To investigate whether anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorders (OSFED), including purging disorder (PD), subthreshold BN, and BED at ages 14 and 16 years, are prospectively associated with later depression, anxiety disorders, alcohol and substance use, and self-harm. Eating disorders were ascertained at ages 14 and 16 years in 6,140 youth at age 14 (58% of those eligible) and 5,069 at age 16 (52% of those eligible) as part of the prospective Avon Longitudinal Study of Parents and Children (ALSPAC). Outcomes (depression, anxiety disorders, binge drinking, drug use, deliberate self-harm, weight status) were measured using interviews and questionnaires about 2 years after predictors. Generalized estimating equation models adjusting for gender, socio-demographic variables, and prior outcome were used to examine prospective associations between eating disorders and each outcome. All eating disorders were predictive of later anxiety disorders. AN, BN, BED, PD, and OSFED were prospectively associated with depression (respectively AN: odds ratio [OR]= 1.39, 95% CI =1.00-1.94; BN: OR=3.39, 95% CI= 1.25-9.20; BED: OR=2.00, 95% CI=1.06-3.75; and PD: OR= 2.56, 95% CI= 1.38-4.74). All eating disorders but AN predicted drug use and deliberate self-harm (BN: OR= 5.72, 95% CI= 2.22-14.72; PD: OR= 4.88, 95% CI= 2.78-8.57; subthreshold BN: OR= 3.97, 95% CI= 1.44-10.98; and subthreshold BED: OR= 2.32, 95% CI= 1.43-3.75). Although BED and BNpredicted obesity (respectively OR= 3.58, 95% CI=1.06-12.14 and OR= 6.42, 95% CI=1.69-24.30), AN was prospectively associated with underweight. Adolescent eating disorders, including subthreshold presentations, predict negative outcomes, including mental health disorders, substance use, deliberate self-harm, and weight outcomes. This study highlights the high public health and clinical burden of eating disorders among adolescents.

The Risk of Eating Disorders in Adolescence and its Association with the Impact of the Sociocultural Attitudes Towards Appearance

This paper studies whether there is an association between the risk of developing an eating disorder in adolescence and social attitudes concerning appearance, especially those circulated in the media. The sample was composed of 119 subjects, and the instruments used were EAT-26 and SATAQ. The results indicate the existence of statistically significant correlations between the risk of eating disorders in adolescence and all facets of social and cultural attitudes regarding appearance: importance, pressure, internalization/TV-magazines, internalizing/athlete, internalizing/comparison, awareness. When statistical analyses are performed differently in boys and girls, we see the existence of different intensities of these correlations. This result indicates that future studies could orientate to test the hypothesis of the existence of gender differences in this regard.

The Risk of Eating Disorders in Adolescence and its Association with the Value of the Body Mass Index, Level of Anxiety and Level of Depression

The paper is aimed at studying whether there is any connection between the risk of developing an eating disorder in adolescence and the BMI, anxiety and depression. These connections are studied at a global level as well as making a differentiation between boys and girls. The results indicate that there is a positive correlation statistically significant of low intensity between the risk of developing an eating disorder and the BMI and that there is some positive correlations statistically significant and moderate between the risk of developing an eating disorder and the anxiety (viewed as a state and as a trait) and depression. When statistic analysis is performed making a differentiation between boys and girls, the results evidence that while in boys these correlations are not statistically relevant, they are in girls.

Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives.

Admission to hospital is the treatment of choice for anorexia nervosa in adolescent patients who are medically unstable; however, stays are often prolonged and frequently disrupt normal adolescent development, family functioning, school and work productivity. We sought to determine the costs of inpatient treatment in this population from a hospital and caregiver perspective, and to identify determinants of such costs. We used micro-costing methods for this cohort study involving all adolescent patients (age 12-18 yr) admitted for treatment of anorexia nervosa at a tertiary care child and adolescent eating disorder program in Toronto, between Sept. 1, 2011, and Mar. 31, 2013. We used hospital administrative data and Canadian census data to calculate hospital and caregiver costs. We included 73 adolescents in our cohort for cost-analysis. We determined a mean total hospital cost in 2013 Canadian dollars of $51 349 (standard deviation [SD] $26 598) and a mean total societal cost of $54 932 (SD $27 864) per admission, based on a mean length of stay of 37.9 days (SD 19.7 d). We found patient body mass index (BMI) to be the only significant negative predictor of hospital cost (p < 0.001). For every unit increase in BMI, we saw a 15.7% decrease in hospital cost. In addition, we found higher BMI (p < 0.001) and younger age (p < 0.05) to be significant negative predictors of caregiver costs. The economic burden of inpatient treatment for adolescents with anorexia nervosa on hospitals and caregivers is substantial, especially among younger patients and those with lower BMI. Recognizing the symptoms of eating disorders early may preclude the need for admission to hospital altogether or result in admissions at higher BMIs, thereby potentially reducing these costs.

A Pilot Study of Maudsley Family Therapy With Group Dialectical Behavior Therapy Skills Training in an Intensive Outpatient Program for Adolescent Eating Disorders

The goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley-based family therapy and group dialectical behavior therapy skills training. Measures of physical and psychological status were gathered upon admission, discharge, and at 3 follow-up intervals. Adolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1-year follow-up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment. This pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.

Funcionalidad familiar en pacientes con anorexia nerviosa y bulimia

Anorexia nervosa and bulimia are health problems that manifest themselves as eating behavior disorders that if they are not appropriately addressed may compromise the life of patients. The suspicion of adolescent eating disorders is related to the perception of family dysfunction. Prevention and treatment of eating disorders may be more effective if there is a family approach during adolescence; moments for a great opportunity for intervention, but at the same time a formidable commitment for Family physicians.

The influence of adolescent eating disorders or disordered eating behaviors on socioeconomic achievement in early adulthood.

Much research documents the etiology and health consequences of adolescent eating disorders (ED), but very little is known about the long-term effects of EDs on the transition to adulthood. This study explores gender differences in the influence of EDs or disordered eating behaviors (DEB) on measures of socioeconomic independence in early adulthood. Using the National Longitudinal Study of Adolescent Health (Add Health), this study compares individuals who self-identified as have been diagnosed with an ED or engaged in DEBs in late adolescence to those without ED or DEB on three measures of socioeconomic independence during early adulthood, including educational attainment, income, and likelihood of owning a home. This study uses multiple regression techniques and attempts to account for early-life conditions and health outcomes associated with EDs and DEBs. For females, ED or DEB in late adolescence had a statistically significant, negative association with educational attainment (coefficient = -0.20, p = .05), personal income (coefficient = -0.12, p < .05) and odds of owning a home (odds ratio = 0.73, p < .02) in early adulthood. For males, ED or DEB was not associated with socioeconomic attainment. Our findings suggest that EDs and DEBs are negatively associated with socioeconomic achievement during early adulthood for females, but not for males. EDs or DEBs during adolescence may set individuals on a different trajectory whereby they do not have the same life chances or opportunities for success in adulthood. These results confirm the public health message that EDs or DEBs have lasting negative consequences for women.

Favorable effects of clearly defined interventions by parents at the start of treatment of adolescents with restrictive eating disorders

To study the effect of clearly defined and decisive parental interventions at the start of treatment of restrictive eating disorders (ED) in adolescents. Forty-seven adolescents with ED (anorexia nervosa = 6, bulimia nervosa = 1, EDNOS = 40) and their families participated. Parents were advised to (1) keep the adolescent home from school, (2) eat all meals together with the adolescent, (3) prevent any form of exercise, and (4) prevent vomiting during the first week of treatment. Weight change was followed up to three months and EDE-Q administered at start of treatment and at three months. Thirty (64%) of the families accomplished all four interventions during the first week of treatment. Their adolescents gained ∼ 1 kg of weight at one week, 2 kg at one month, and 4 kg at three months while adolescents in families who did not accomplish all four interventions gained only 1.4 kg up to three months. Scores on the EDE-Q decreased during treatment and in adolescents of families who accomplished all four interventions they were in the range of a reference population. Decisive parental management of eating disturbed behaviors at the start of treatment of adolescents with ED promotes later clinical outcome. The finding supports the view that family based therapies are effective in adolescent ED. Results has to be followed up for evaluation of the long term effects of this type of intervention.

Short-term intensive family therapy for adolescent eating disorders: 30-month outcome.

Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)-a 5-day treatment based on the principles of family-based therapy for EDs. We retrospectively examined the long-term efficacy of IFT in both single-family (S-IFT) and multi-family (M-IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (≥ 95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE-Q) global score within 1 SD of norms, and absence of binge-purging behaviours. Partial remission was defined as weight ≥ 85% of expected or ≥ 95% but with elevated EDE-Q global score and presence of binge-purging symptoms (<1/week). Over a mean follow-up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S-IFT and M-IFT showing comparable outcomes. Short-term, intensive treatments may be cost-effective and clinically useful where access to regular specialist treatment is limited.