Past Eating Disorders Research Articles

Infant feeding behaviours and attitudes to feeding amongst mothers with eating disorders: A longitudinal study.

This study aims to investigate breastfeeding, infant feeding behaviours, and attitudes to feeding amongst women with eating disorders (ED) and healthy controls (HC). Women with active ED (C-ED; N=25), past ED (P-ED; N=28), and HC (N=46) were recruited in pregnancy and followed up longitudinally. Post-natally infant feeding behaviour was investigated at 8weeks, 6months, and 1year and parental modelling at 1 and 2years. Women with P-ED and C-ED reported higher concerns about their infant being/becoming overweight compared with HC, respectively, at 8weeks and 6months and 6months only post-partum. Women with P-ED showed less awareness of infant hunger and satiety cues compared with HC at 8weeks. Despite few differences between ED and HC, both P-ED and C-ED predicted maternal attitudes and worries about child's eating. These are likely to impact on child's growth and later eating behaviours and might impact on the intergenerational transmission of ED.

Genetic and hormonal modulation of androstadienone-effects on emotional interference control and visuo-spatial cueing

Psychiatric illness is associated with heightened hypothalamic-pituitary-adrenal (HPA) axis activity during pregnancy which may have long term effects on infant stress regulation. HPA axis regulation has not previously been investigated in women with eating disorders (ED) or their infants during the perinatal period.Women were recruited to a prospective longitudinal study in three groups: 1) current or active ED (C-ED = 31), 2) past ED (P-ED = 29) and healthy control (HC = 57). Maternal psychopathology, diurnal cortisol levels, corticotropin-releasing hormone (CRH) and CRH binding protein (CRH-BP) were measured during the third trimester of pregnancy. At eight weeks postpartum infant cortisol was obtained before and after routine immunisations to determine infant hormonal response to a stressful situation.Women with current ED had a significantly lower cortisol decline throughout the day compared to HC, in both adjusted and unadjusted analyses. Lower cortisol decline among women with a current ED were associated with higher levels of psychopathology during pregnancy. Women’s cortisol awakening response, CRH and CRH-BP levels did not differ across the three groups. Infants’ stress response was also significantly higher among those in the C-ED group, although this effect was attenuated after controlling for confounders.During pregnancy women with ED have lower cortisol declines, suggestive of blunted diurnal cortisol rhythms. Postnatally, their infants also have a heightened response to stress. This is the first study to identify HPA axis dysfunction in pregnancy in women with ED, and to show an intergenerational effect. Since dysfunctions in HPA activity during childhood may represent a risk factor for psychological and physical health problems later in life, further investigation of the potential long-term implications of these findings is crucial.

Orthorexia Nervosa and Eating Disorder Symptoms in Registered Dietitian Nutritionists in the United States

BackgroundRegistered dietitian nutritionists are trained to identify optimal food choices for clients based on medical state and lifestyle. Orthorexia nervosa (ON) is a proposed disorder related to obsessions about eating healthfully. Eating disorders (EDs) are serious mental illnesses with symptoms related to eating, body image, and self-esteem. Both ON and EDs are more common among RDNs than the general population. ObjectiveThis study examined the prevalence of ON and EDs in RDNs in the United States and, among this sample, assessed whether the presence of ON symptoms related to symptoms of EDs, including weight, shape, eating, and restraint. DesignA cross-sectional design compared responses for participants after dividing into three groups: those scoring at-risk for ON, those with a current or past ED, and a comparison group. ParticipantsA sample of 2,500 RDNs were invited to complete surveys electronically; 636 responses were received. Main outcome measuresScores on the Orthorexia Nervosa Questionnaire (ORTO-15) and Eating Disorder Examination Questionnaire (EDE-Q) determined prevalence of ON and EDs. Differences in these measures, and body mass index were compared among the three groups. Statistical analysesAnalysis of variance and χ2 analyses were used to compare the groups. ResultsFor the entire sample, scores on the ORTO-15 suggested 49.5% were at risk for ON, and scores on the EDE-Q suggested 12.9% were at risk for an ED, with 8.2% of RDNs self-disclosing treatment for an ED. Both the group disclosing ED treatment and the group at risk for ON had a lower mean body mass index, lower scores on the ORTO-15, and higher scores on the EDE-Q and all its subscales than the comparison group. ConclusionsClarifying the relationship between ON and EDs is warranted because ON symptoms appear to be associated not only with disturbances in eating, but also with elevated shape and weight concerns.

Neurobehavioural and cognitive development in infants born to mothers with eating disorders

Although recent research has focused on the effects of maternal eating disorders (EDs) on children, little is known about the effect of maternal EDs on neurobiological outcomes in newborns and infants. This study is the first to investigate neurobehavioural regulation and cognitive development in newborns and infants of mothers with EDs. Women with an active and past ED and healthy controls were recruited to a prospective longitudinal study during their first trimester or second trimester of pregnancy. Newborns and infants of mothers with ED were compared with newborns and infants of healthy controls on (a) neurobehavioural dysregulation using the Brazelton Neonatal Behavioural Assessment Scale at 8days postpartum (active ED, n=15; past ED, n=20; healthy controls, n=28); and (b) cognitive development using the Bayley Scales of Infant and Toddler Development at 1-year postpartum (active ED, n=18; past ED, n=19; healthy controls, n=28). In order to maintain the largest possible sample at each time point, sample size varied across time points. Newborns of mothers with an active ED had worse autonomic stability when compared with newborns of healthy controls [B=-0.34 (-1.81, -0.26)]. Infants of mothers with a past ED had poorer language [B=-0.33 (-13.6, -1.9)] and motor development [B=-0.32 (-18.4, -1.3)] compared with healthy controls. Children of mothers with ED display neurobehavioural dysregulation early after birth and poorer language and motor development at 1year. These characteristics suggest evidence of early neurobiological markers in children at risk. Differential outcomes in children of women with active versus past ED suggest that active symptomatology during pregnancy might have an effect on physiological reactivity while cognitive characteristics might be more stable markers of risk for ED.

Care experiences of young people with eating disorders and their parents: a qualitative study

BackgroundIn the UK, young people with eating disorders have different care pathways—general to highly specialised—depending on geographical location. A clear consensus on the most cost-effective and most valued treatment pathway is currently lacking. This study aimed to identify the most beneficial aspects of care through the perspectives of young people and their parents. We aimed to add depth to a parallel investigation of the cost-effectiveness of UK community-based eating disorder pathways. MethodsThis qualitative study recruited participants and used online focus groups through Beat (Beating Eating Disorders, a UK National Charity). 19 young women aged 16–25 years with an existing or past eating disorder and 11 parents participated in four and two focus groups, respectively. The sample size was informed by saturation of themes. Data were analysed using thematic analysis. All participants provided written informed consent. The study was approved by the University of Exeter Medical School Research Ethics Committee. FindingsFocus group discussions showed that seven features were essential for a good level of care: professionals' knowledge of eating disorders and care pathways, and early provision of psychoeducation to young people and their families; a holistic approach balancing physical and psychological aspects of care from referral and early intervention to recovery and relapse prevention; early, rapid access to services including crisis and out-of-hours support; peer support for young people and support for family members; consistency and continuity, especially around interprofessional communication and transition from child to adult services; long-term view focusing on recovery and lifelong skills to facilitate relapse prevention; and an individually tailored, flexible approach. InterpretationTo our knowledge, this is the first exploration through online focus groups of patients' perspectives of UK-based eating disorder pathways. Our findings suggest that no existing pathway is more beneficial; rather, a cluster of features are perceived as essential for a good level of care across services. Although small, our study collated the views of both young people and parents from various geographical locations, and covered a wide range of health-care services. FundingNone.

The Prevalence of Past 12-Month and Lifetime DSM-IV Eating Disorders by BMI Category in US Men and Women.

This study aims to determine whether the prevalence of lifetime and past 12-month DSM-IV eating disorders (ED) diagnoses differed by body mass index category among men and women in a general population sample. Data from the Collaborative Psychiatric Epidemiology Surveys (n = 12 337 adults) were analysed using logistic regression. Analyses were conducted separately by gender. Lifetime ED prevalence was 2.22% in men and 4.93% in women. In both genders, the prevalence of any lifetime and past 12-month ED, binge eating disorder and recurrent binge eating was highest among obese individuals. Among obese men and women, lifetime and past 12-month ED prevalence was highest among those with class III obesity. Eating disorders were most prevalent among high-weight individuals. This information is important for planning targeted public health ED and obesity prevention and intervention activities, as well as for informing the clinical care of obese individuals. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Perinatal hypothalamic-pituitary-adrenal axis regulation among women with eating disorders and their infants

BackgroundPsychiatric illness is associated with heightened hypothalamic-pituitary-adrenal (HPA) axis activity during pregnancy which may have long term effects on infant stress regulation. HPA axis regulation has not previously been investigated in women with eating disorders (ED) or their infants during the perinatal period. MethodsWomen were recruited to a prospective longitudinal study in three groups: 1) current or active ED (C-ED=31), 2) past ED (P-ED=29) and healthy control (HC=57). Maternal psychopathology, diurnal cortisol levels, corticotropin-releasing hormone (CRH) and CRH binding protein (CRH-BP) were measured during the third trimester of pregnancy. At eight weeks postpartum infant cortisol was obtained before and after routine immunisations to determine infant hormonal response to a stressful situation. ResultsWomen with current ED had a significantly lower cortisol decline throughout the day compared to HC, in both adjusted and unadjusted analyses. Lower cortisol decline among women with a current ED were associated with higher levels of psychopathology during pregnancy. Women’s cortisol awakening response, CRH and CRH-BP levels did not differ across the three groups. Infants’ stress response was also significantly higher among those in the C-ED group, although this effect was attenuated after controlling for confounders. ConclusionsDuring pregnancy women with ED have lower cortisol declines, suggestive of blunted diurnal cortisol rhythms. Postnatally, their infants also have a heightened response to stress. This is the first study to identify HPA axis dysfunction in pregnancy in women with ED, and to show an intergenerational effect. Since dysfunctions in HPA activity during childhood may represent a risk factor for psychological and physical health problems later in life, further investigation of the potential long-term implications of these findings is crucial.

Engaging Healthcare Providers to Help Mothers with Eating Disorders Create Healthy Eating Environments for Their Children

Eating disorders (EDs), such as anorexia, bulimia, and bingeeating disorder, involve extreme emotions, attitudes, and behaviors surrounding weight, food, and body image, all of which can lead to destructive health consequences. While EDs have innumerable effects on affected individuals, less is known about the consequences for the offspring of childbearing women with past or current EDs. Children of mothers with EDs are at increased risk of various problems during gestation and childhood, including higher rates of miscarriage, cesarean-section deliveries, and stillbirth; greater likelihood of preterm delivery, small- or large-for-gestational-age, low or high birth weight, and growth disturbances; and lower likelihood of being breastfed. These children are also more likely to develop dysfunctional eating habits, behaviors, and attitudes throughout adolescence. Possible effects of maternal EDs on parenting include withholding food from children, using food to reward or punish, a preoccupation with weight interfering with the mother’s responsiveness to her child, failure to express positive attitudes toward eating, and higher tension during mealtimes. These risks are influenced by a variety of factors and the consequences for children are difficult to predict. Complicating matters, the foundations of an ED are established long before diagnosis. The familial setting provides a unique opportunity for integrated and concurrent primary and tertiary ED-prevention strategies for both child and mother. It is imperative for healthcare providers to consider the potential value of educational programs and support for mothers with EDs, as early intervention could interrupt the cycle of risk associated with eating disorders and their effects on the developing child.

Maternal and family factors and child eating pathology: risk and protective relationships.

BackgroundPrevious studies have found associations between maternal and family factors and child eating disorder symptoms. However, it is not clear whether family factors predict eating disorder symptoms specifically, or relate to more general child psychopathology, of which eating disorder symptoms may be one component. This study aimed to identify maternal and family factors that may predict increases or decreases in child eating disorder symptoms over time, accounting for children’s body mass index z-scores and levels of general psychological distress.MethodsParticipants were 221 mother-child dyads from the Childhood Growth and Development Study, a prospective cohort study in Western Australia. Participants were assessed at baseline, 1-year follow-up and 2-year follow-up using interview and self-report measures. Children had a mean age of 10 years at baseline and 46% were male. Linear mixed models and generalised estimating equations were used to identify predictors of children’s eating disorder symptoms, with outcome variables including a global index of eating disorder psychopathology, levels of dietary restraint, levels of emotional eating, and the presence of loss of control (‘binge’) eating.ResultsChildren of mothers with a current or past eating disorder reported significantly higher levels of global eating disorder symptoms and emotional eating than other children, and mothers with a current or past eating disorder reported significantly more concern about their children’s weight than other mothers. Maternal concern about child weight, rather than maternal eating disorder symptoms, was significant in predicting child eating disorder symptoms over time. Family exposure to stress and low maternal education were additional risk factors for eating disorder symptoms, whilst child-reported family satisfaction was a protective factor.ConclusionsAfter adjusting for relevant confounding variables, maternal concern about child weight, children’s level of family satisfaction, family exposure to stress, and maternal education are unique predictors of child eating disorder symptoms.

Eating Disorders During Compulsory Service in the Israeli Defense Forces

This study examines how compulsory service in the Israeli Defense Forces (IDF) might influence the trajectory of eating disorders (EDs) among young women soldiers. The narratives of 19 women with past or present EDs who served in the IDF were qualitatively analyzed for factors associated with negative and positive experiences of military service. Perceived incompatibility with assigned military roles was cited as the most important factor in negative experiences of service and was associated with worsening EDs. Perceived meaning and purpose was cited as the most important factor in positive experiences of service. The findings reveal that, for young women soldiers with EDs or susceptibility to EDs, subjective experiences of assigned military roles carry important emotional and behavioral health implications.

Fertility treatment, twin births, and unplanned pregnancies in women with eating disorders: findings from a population‐based birth cohort

ObjectiveTo investigate fertility treatment, twin births, and unplanned pregnancies in pregnant women with eating disorders in a population-based sample.DesignA longitudinal population-based birth cohort (Generation R).SettingRotterdam, the Netherlands.SampleWomen from the Generation R study who reported a history of (recent or past) anorexia nervosa (n = 160), bulimia nervosa (n = 265), or both (n = 130), and a history of psychiatric disorders other than eating disorders (n = 1396) were compared with women without psychiatric disorders (n = 4367).MethodsWomen were compared on the studied outcomes using logistic regression. We performed crude and adjusted analyses (adjusting for relevant confounding factors).Main outcome measuresFertility treatment, twin births, unplanned pregnancies, and women's feelings towards unplanned pregnancies.ResultsRelative to women without psychiatric disorders, women with bulimia nervosa had increased odds (odds ratio, OR, 2.3; 95% confidence interval, 95% CI, 1.1–5.2) of having undergone fertility treatment. Women with all eating disorders had increased odds of twin births (anorexia nervosa, OR 2.7, 95% CI 1.0–7.7; bulimia nervosa, OR 2.7, 95% CI 1.1–6.6; anorexia and bulimia nervosa, OR 3.795% CI 1.3–10.7). Anorexia nervosa was associated with increased odds of unplanned pregnancies (OR 1.8, 95% CI 1.2–2.6) and mixed feelings about these pregnancies (adjusted OR 5.0, 95% CI 1.7–14.4). Pre-pregnancy body mass index did not explain the observed associations.ConclusionsEating disorders are associated with increased odds of receiving fertility treatment and twin births. Women with anorexia nervosa were more likely to have an unplanned pregnancy and have mixed feelings about the unplanned pregnancy. Fertility treatment specialists should be aware that both active and past eating disorders (both anorexia nervosa and bulimia nervosa) might underlie fertility problems.

Altered brain reward circuits in eating disorders: chicken or egg?

The eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) are severe psychiatric disorders with high mortality. Our knowledge about the neurobiology of eating disorders is very limited, and the question remains whether alterations in brain structure or function in eating disorders are state related, remnants of the illness or premorbid traits. The brain reward system is a relatively well-characterized brain circuitry that plays a central role in the drive to eat and individuals with current or past eating disorders showed alterations in those pathways compared to controls. Here we propose that structural and functional alterations in the insula and frontal cortex, including orbitofrontal and cingulate regions, areas that contribute to reward and anxiety processing, could predispose to developing an eating disorder and that adaptive changes in those circuits in response to malnutrition or repeated binge eating and purging could further promote illness behavior, hinder recovery and contribute to relapse.

'My teacher saved my life' versus 'Teachers don't have a clue': an online survey of pupils' experiences of eating disorders.

Eating disorders (ED) have a peak rate of onset in school-aged children. Little is known about pupils' experiences of ED within a school setting. Five hundred and eleven 11- to 19-year-old school pupils completed an online questionnaire exploring their experiences of ED (72% female, 28% male). Responses were analysed using content analysis principles. Of the participants, 38% had a current or past ED, 49% of these had never received a formal diagnosis. Of the respondents, 59% saw a need to raise ED awareness. Only 7% would confide in a teacher about an ED. Efforts are needed to break down barriers to disclosure and support teachers to play an effective role in the detection and early intervention for ED.

Structural Magnetic Resonance Imaging in Eating Disorders: A Systematic Review of Voxel‐Based Morphometry Studies

This systematic review summarises and critically appraises the literature on structural magnetic resonance imaging in people with a current or past eating disorder. Studies using voxel-based morphometry image analysis were included. Ten studies reported on a total of 236 people with a current or past eating disorder and 257 healthy controls. Sample heterogeneity prohibited a meta-analytic approach. The findings do not unequivocally indicate grey or white matter volume abnormalities in people with an eating disorder. Nevertheless, these preliminary data suggest that, compared with healthy controls, people with anorexia nervosa have decreased grey matter in a range of brain regions and that those with bulimia nervosa have increased grey matter volumes in frontal and ventral striatal areas. Research in the recovery phase and longitudinal studies suggest that potential brain tissue abnormalities may recover with clinical improvement. Overall, as the available data are inconclusive, further efforts in this field are warranted.

Eating Disorder Symptomatology in Normal‐Weight vs. Obese Individuals With Binge Eating Disorder

Although normal-weight individuals comprise a substantial minority of the binge eating disorder (BED) population, little is known about their clinical presentation. This study sought to investigate the nature and severity of eating disturbances in normal-weight adults with BED. We compared 281 normal-weight (n = 86) and obese (n = 195) treatment-seeking adults with BED (mean age = 31.0; s.d. = 10.8) on a range of current and past eating disorder symptoms using ANOVA and χ(2) analyses. After controlling for age and sex, normal-weight participants reported more frequent use of a range of healthy and unhealthy weight control behaviors compared to their obese peers, including eating fewer meals and snacks per day; exercising and skipping meals more frequently in the past month; and avoiding certain foods for weight control. They also endorsed more frequent attempts at dieting in the past year, and feeling more frequently distressed about their binge eating, at a trend level. There were no group differences in binge eating frequency in the past month, age at onset of binge eating, overvaluation of shape/weight, or likelihood of having used certain weight control behaviors (e.g., vomiting, laxative use) or having sought treatment for an eating disorder in the past. Based on our findings, normal-weight individuals appear to be a behaviorally distinct subset of the BED population with significantly greater usage of both healthy and unhealthy weight control behaviors compared to their obese peers. These results refute the notion that distress and impairment in BED are simply a result of comorbid obesity.

FC23-05 - Pregnancy and post-partum depression and anxiety in a longitudinal general population cohort: the effect of eating disorders and past depression

AimsTo investigate the effect of past depression, past and current eating disorders (ED) on perinatal anxiety and depression in a large general population cohort of pregnant women, the Avon Longitudinal Study of Parents And Children (ALSPAC).MethodsAnxiety and depression were measured during and after pregnancy in 10,887 women, using the Crown-Crisp Experiential Inventory and Edinburgh Postnatal Depression Scale. Women were grouped according to depression and ED history: past ED with (n = 123) and without past depression (n = 50), pregnancy ED symptoms with (n = 77) and without past depression (n = 159), past depression only (n = 818) and controls (n = 9,660). We compared the course of depression and anxiety with linear mixed-effect regression models; and probable depressive and anxiety disorders using logistic regression.ResultsWomen with both past depression and past/current ED had high anxiety and depression across time perinatally; this was most marked in the group with pregnancy ED symptoms and past depression (b coefficient:5.1 (95% CI 4.1-6.1), p < 0.0001), especially at 8 months post-partum. At 18 weeks in pregnancy all women (apart from those with past ED only) had a higher risk for a probable depressive and anxiety disorder compared to controls. At 8 months post-partum pregnancy ED symptoms and/or past depression conferred the highest risk for a probable depressive and anxiety disorder.ConclusionsPregnancy ED symptoms and past depression have an additive effect in increasing the risk for depression and anxiety perinatally. Screening at risk women for anxiety and depression in the perinatal period might be beneficial.

Pregnancy and post-partum depression and anxiety in a longitudinal general population cohort: The effect of eating disorders and past depression

BackgroundThis study investigated the effect of past depression, past and current eating disorders (ED) on perinatal anxiety and depression in a large general population cohort of pregnant women, the Avon Longitudinal Study of Parents and Children (ALSPAC). MethodsAnxiety and depression were measured during and after pregnancy in 10,887 women using the Crown-Crisp Experiential Inventory and Edinburgh Postnatal Depression Scale. Women were grouped according to depression and ED history: past ED with (n=123) and without past depression (n=50), pregnancy ED symptoms with (n=77) and without past depression (n=159), past depression only (n=818) and controls (n=9,660). We compared the course of depression and anxiety with linear mixed-effect regression models; and probable depressive and anxiety disorders using logistic regression. ResultsWomen with both past depression and past/current ED had high anxiety and depression across time perinatally; this was most marked in the group with pregnancy ED symptoms and past depression (b coefficient:5.1 (95% CI: 4.1–6.1), p<0.0001), especially at 8months post-partum. At 18weeks in pregnancy all women (apart from those with past ED only) had a higher risk for a probable depressive and anxiety disorder compared to controls. At 8months post-partum pregnancy ED symptoms and/or past depression conferred the highest risk for a probable depressive and anxiety disorder. LimitationsData were based on self-report. There was some selective attrition. ConclusionsPregnancy ED symptoms and past depression have an additive effect in increasing the risk for depression and anxiety perinatally. Screening at risk women for anxiety and depression in the perinatal period might be beneficial.

Heterogeneity moderates treatment response among patients with binge eating disorder.

The purpose of the study was to explore heterogeneity and differential treatment outcome among a sample of patients with binge eating disorder (BED). A latent class analysis was conducted with 205 treatment-seeking, overweight or obese individuals with BED randomized to interpersonal psychotherapy (IPT), behavioral weight loss (BWL), or guided self-help based on cognitive behavioral therapy (CBTgsh). A latent transition analysis tested the predictive validity of the latent class analysis model. A 4-class model yielded the best overall fit to the data. Class 1 was characterized by a lower mean body mass index (BMI) and increased physical activity. Individuals in Class 2 reported the most binge eating, shape and weight concerns, compensatory behaviors, and negative affect. Class 3 patients reported similar binge eating frequencies to Class 2, with lower levels of exercise or compensation. Class 4 was characterized by the highest average BMI, the most overeating episodes, fewer binge episodes, and an absence of compensatory behaviors. Classes 1 and 3 had the highest and lowest percentage of individuals with a past eating disorder diagnosis, respectively. The latent transition analysis found a higher probability of remission from binge eating among those receiving IPT in Class 2 and CBTgsh in Class 3. The latent class analysis identified 4 distinct classes using baseline measures of eating disorder and depressive symptoms, body weight, and physical activity. Implications of the observed differential treatment response are discussed.

Eating disorders symptoms in pregnancy: A longitudinal study of women with recent and past eating disorders and obesity

Objective To determine the impact of pregnancy on eating disorders (ED) symptoms using data from a large prospective, community-based cohort study. Methods Women (12,254) were classified according to whether they had a recent or past history of ED, were obese before pregnancy, or constituted part of the general population control group. We evaluated self-induced vomiting (SIV), laxative use, exercise behavior, and appraisals about weight gain during pregnancy, as well as dieting, and shape and weight concern before and during pregnancy. Results Women with a recent episode of ED dieted, used laxatives, reported SIV, and exercised more than other groups during pregnancy. They were also more likely to report ED cognitions in pregnancy and their weight and shape concern scores remained high during pregnancy. Women with past ED were also more likely than controls to have some ED behaviors and/or concerns about weight gain during pregnancy. Conclusions Women with a recent ED continued to have some ED symptoms in pregnancy, albeit fewer compared to before pregnancy. Although at a lower level, women with a past history of ED also had ED symptoms in pregnancy. Screening for ED symptoms during pregnancy may provide a useful opportunity for engagement in treatment and to reduce behaviors that might be detrimental to the foetus.

Eating disorders in elite female distance runners: Effects of nationality and running environment

Objectives To compare UK and Kenyan athletes and to examine the influence of nationality and involvement in elite distance running on the presence of eating disorders, eating disorder psychopathology and menstrual dysfunction, in young women. Design Independent groups, with nationality and running status as independent variables. Methods Elite female distance runners were identified based on their performances in track, road and cross-country events. Questionnaire packs were sent to UK athletes and Kenyan athletes were approached at race meetings or a training camp. In all, 82 UK and 75 Kenyan athletes participated (70% and 90% of those invited) along with 97 and 101 non-athlete, age-matched controls from the two countries. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and assessments of dieting, mental health, self-esteem and menstrual function. Results UK women had significantly higher levels of eating disorder psychopathology and more probable present and past eating disorders than enyan women. Overall, 19.5% of the UK runners had a probable present or past eating disorder, confirming the results of our earlier study (Hulley & Hill, 2001). Kenyan runners had the lowest proportion of probable cases compared with all other groups and the least eating disorder psychopathology. Athletic participation was associated with less regular menstrual periods, regardless of nationality. Conclusion These findings confirm that participation in distance running at an elite level does not in itself predispose to an eating disorder. Eating disorder risk is better represented as a combination of cultural values, elite sporting environment and person variables.