Screening For Eating Disorders Research Articles

Specific Dietary Practices In Female Athletes And Their Association With Disordered Eating

PURPOSE: Health and weight management benefits may influence athletes’ decisions regarding specific dietary practices. Eating disorders/disordered eating (ED/DE) are highly prevalent in the athletic population. The purpose of this study was to determine if following specific diets correlated with a greater likelihood of responding positively to ED/DE screening tools compared to not adhering to a diet. METHODS: 1000 female athletes (15-30 yrs) were asked to complete a comprehensive health and wellness survey. Athletes were asked to specify their diet and completed 3 ED/DE screening tools: the Brief Eating Disorder in Athletes Questionnaire, the Eating Disorder Screen for Primary Care, and self-reported current or past history of ED/DE. We hypothesized that athletes adhering to specific diets were more likely to score positively on ED/DE screening tools than those not following a diet. The most common diets were included in the analyses: vegan, vegetarian, pescatarian, gluten free, low carbohydrate, low dairy, and ≥2 diets. Athletes following diets for health issues (e.g. Celiac disease) were excluded. Descriptive statistics were calculated for all study measures and Chi-square testing was performed to assess relationships between athletes’ dietary practices and their responses to ED/DE screening tools. RESULTS:234 of 1000 female athletes reported adherence to specific diets; 766 reported no diet adherence. 69 of the 234 athletes were excluded due to medically-related dietary practices or vague dietary descriptions. 133 athletes reported following 1 of the diets and 32 athletes reported following ≥2 diets. Of the diet-adherent athletes, 67.9% responded positively to ≥1 of the 3 ED/DE screening tools. Athletes practicing vegetarian, vegan, low carbohydrate, low dairy, or ≥2 diets were more likely to respond positively to ≥1 ED/DE screening tool vs. athletes without dietary restrictions (70.0%, 77.8%, 79.5%, 60.0%, and 65.6%, respectively vs. 41.8%; p≤0.048). CONCLUSION: Specific diet adherence in female athletes is associated with greater likelihood of positive screening for ED/DE using survey self-report. Health practitioners should consider further ED/DE questioning of athletes reporting specific diet adherence in order to enhance nutritional knowledge and help treat and prevent ED/DE.

Specific Dietary Practices In Female Athletes And Their Association With Disordered Eating

PURPOSE: Health and weight management benefits may influence athletes’ decisions regarding specific dietary practices. Eating disorders/disordered eating (ED/DE) are highly prevalent in the athletic population. The purpose of this study was to determine if following specific diets correlated with a greater likelihood of responding positively to ED/DE screening tools compared to not adhering to a diet. METHODS: 1000 female athletes (15-30 yrs) were asked to complete a comprehensive health and wellness survey. Athletes were asked to specify their diet and completed 3 ED/DE screening tools: the Brief Eating Disorder in Athletes Questionnaire, the Eating Disorder Screen for Primary Care, and self-reported current or past history of ED/DE. We hypothesized that athletes adhering to specific diets were more likely to score positively on ED/DE screening tools than those not following a diet. The most common diets were included in the analyses: vegan, vegetarian, pescatarian, gluten free, low carbohydrate, low dairy, and ≥2 diets. Athletes following diets for health issues (e.g. Celiac disease) were excluded. Descriptive statistics were calculated for all study measures and Chi-square testing was performed to assess relationships between athletes’ dietary practices and their responses to ED/DE screening tools. RESULTS:234 of 1000 female athletes reported adherence to specific diets; 766 reported no diet adherence. 69 of the 234 athletes were excluded due to medically-related dietary practices or vague dietary descriptions. 133 athletes reported following 1 of the diets and 32 athletes reported following ≥2 diets. Of the diet-adherent athletes, 67.9% responded positively to ≥1 of the 3 ED/DE screening tools. Athletes practicing vegetarian, vegan, low carbohydrate, low dairy, or ≥2 diets were more likely to respond positively to ≥1 ED/DE screening tool vs. athletes without dietary restrictions (70.0%, 77.8%, 79.5%, 60.0%, and 65.6%, respectively vs. 41.8%; p≤0.048). CONCLUSION: Specific diet adherence in female athletes is associated with greater likelihood of positive screening for ED/DE using survey self-report. Health practitioners should consider further ED/DE questioning of athletes reporting specific diet adherence in order to enhance nutritional knowledge and help treat and prevent ED/DE.

State-wide university implementation of an online platform for eating disorders screening and intervention.

The Internet-based Healthy Body Image (HBI) Program platform uses online screening to identify individuals at low risk for, high risk for, or with an eating disorder (ED) and then directs users to tailored, evidence-based online/mobile interventions or referral to in-person care to address individuals' risk/clinical status. We examined findings from the first state-wide deployment of HBI over the course of 3 years in Missouri public universities, sponsored by the Missouri Eating Disorders Council and the Missouri Mental Health Foundation. First, the screen was completed 2,454 times, with an average of 2.5% of the undergraduate student body on each campus taking the screen. Second, ED risk level in the participating students was high-over 56% of students screened were identified as being at high risk for ED onset or having a clinical/subclinical ED. Third, uptake for the HBI online/mobile interventions ranged from 44-51%, with higher rates of uptake in the high-risk compared with low-risk group. Fourth, results showed that, for students with a clinical/subclinical ED, use of the clinical mobile application Student Bodies-Eating Disorders intervention resulted in significantly decreased restrictive eating and binge eating. Neither vomiting nor diet pill/laxative use was found to decrease, but reports of these behaviors were very low. This is the first deployment of a comprehensive online platform for screening and delivering tailored interventions to a population of individuals with varying ED risk and symptom profiles in an organized care setting. Implications for future research and sustaining and broadening the reach of HBI are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

URINARY INCONTINENCE IS MORE COMMON IN ADOLESCENT FEMALE ATHLETES WITH LOW ENERGY AVAILABILITY

BACKGROUND: Female Athlete Triad (Triad), an interrelated syndrome of low energy availability (EA), menstrual irregularity, and low bone mineral density. A broader, more comprehensive term was recently introduced by the International Olympic Committee: ‘Relative Energy Deficiency in Sport’ (RED-S). RED-S includes Triad, but also highlights the multiplicity of complex health and performance consequences of low EA and emphasizes that male athletes are also affected. The syndrome RED-S refers to impaired physiological function caused by relative energy deficiency including menstrual function, metabolism, bone health, immunity, protein synthesis, and cardiovascular health. Low EA has independent negative effects on reproductive function and gonadal steroid production. Urinary incontinence (UI) has many risk factors, including estrogen deficiency (which can be caused by low EA), depression, and participation in high-impact activities. A high prevalence of UI has been reported in female athletes participating in a variety of different sports. To date, research evaluating low energy availability as an independent risk factor for UI has been limited, particularly in a young female athlete population. The purpose of this study was to evaluate the association of UI and low EA in adolescent female athletes. METHODS: 1000 female athletes (ages 15–30 years) presenting to a sports medicine clinic completed a 476 question survey covering topics related to relative energy deficiency in sport (RED-S), including female athlete triad risk factors and athletic activity. For the purpose of this study, data was extracted from responses by subjects between 15–19 years of age. Low EA was defined as meeting = 1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed through a modified form of the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence (ICIQ-UI Short Form). Descriptive statistics are expressed as mean ± standard deviation and associations between EA status and UI queries were assessed by chi-squared analysis (cut off for statistical significance was defined as: p<0.05). RESULTS: Of those who completed the survey, 70.8% were adolescents between 15 and 19 years of age. UI during athletic activities was reported by 14.4% of these athletes. Of those reporting UI, UI was significantly more common in those with low EA than those with adequate EA (54.9% vs. 45.1%, p=0.003). Age was not associated with UI in this subset (p=0.83). The median onset of UI was 1–2 years prior to completing the survey and the median frequency of UI over the previous year was reported as weekly. There was no significant correlation between the presence of menstrual dysfunction and UI (p=0.104). CONCLUSIONS: Our findings demonstrate that UI is a common problem among adolescent female athletes, occurring in 14.4% of 15-19 year old female athletes surveyed in this study. UI is more prevalent in adolescent female athletes with low EA in comparison to female athletes with adequate EA. These findings are consistent with those previously observed in studies involving older populations of adult female athletes with eating disorders, where UI was more prevalent in those with low EA in comparison to controls with adequate EA. These findings suggest a potential place for genitourinary disorders in the constellation of impaired physiologic functions considered associated with low EA in athletes/RED-S, and offers a window into a commonly overlooked clinical problem impacting young female athletes.

Results of disseminating an online screen for eating disorders across the U.S.: Reach, respondent characteristics, and unmet treatment need.

The treatment gap between those who need and those who receive care for eating disorders is wide. Scaling a validated, online screener that makes individuals aware of the significance of their symptoms/behaviors is a crucial first step for increasing access to care. The objective of the current study was to determine the reach of disseminating an online eating disorder screener in partnership with the National Eating Disorders Association (NEDA), as well to examine the probable eating disorder diagnostic and risk breakdown of adult respondents. We also assessed receipt of any treatment. Participants completed a validated eating disorder screen on the NEDA website over 6 months in 2017. Of 71,362 respondents, 91.0% were female, 57.7% 18-24 years, 89.6% non-Hispanic, and 84.7% White. Most (86.3%) screened positive for an eating disorder. In addition, 10.2% screened as high risk for the development of an eating disorder, and only 3.4% as not at risk. Of those screening positive for an eating disorder, 85.9% had never received treatment and only 3.0% were currently in treatment. The NEDA online screen may represent an important eating disorder detection tool, as it was completed by >71,000 adult respondents over just 6 months, the majority of whom screened positive for a clinical/subclinical eating disorder. The extremely high percentage of individuals screening positive for an eating disorder who reported not being in treatment suggests a wide treatment gap and the need to offer accessible, affordable, evidence-based intervention options, directly linked with screening.

Gender Differences in Eating Disorder Risk among NCAA Division I Cross Country and Track Student-Athletes.

Purpose This study compared gender differences in eating disorder risk among NCAA Division I cross country and track distance running student-athletes. Methods Six hundred thirty-eight male and female student-athletes competing at distances of 800m or greater completed the Eating Disorder Screen for Primary Care (ESP). Scores on the ESP were used as the risk of eating disorders. Results Females screened positive at higher rates for risk of eating disorders than males on the ESP at a cutoff of 2 (sensitivity 90-100%, specificity 71%) with rates of 45.95% ± 3.03 and 13.66% ± 1.80, respectively. Females were also screened positive at higher rates than males at a stricter cutoff of 3 (sensitivity 81%, specificity 92%), with rates of 21.69% ± 2.50 compared to 4.64% ± 1.10, respectively. Conclusion This study highlights that, among distance runners, both males and females are at risk of eating disorders, with females being at higher risk. It also emphasizes the need for screening for risk of eating disorders in this population.

Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?

The low-FODMAP diet has emerged as an option for the treatment of irritable bowel syndrome (IBS). This diet is very restrictive, and compliance is usually low. Preliminary findings suggest an association between eating disorders (EDs) and the risk of developing IBS. The aim of this study was to assess the correlation between compliance with a low-FODMAP diet and the risk of ED behaviours among patients with IBS. A single-centre prospective study was carried out among 233 IBS patients (79.8% females) at University College London Hospital, who commenced a low FODMAPs group programme for IBS (Rome III or IV). Self-reported diet adherence at the end of the 6-week programme was measured. At baseline, and at the 6-week follow-up visit, participants completed the validated IBS-Symptom Severity Score, the SCOFF ED screening questionnaire and the Hospital Anxiety and Depression Scale. Adherence with a low-FODMAP diet was found in 95 (41%) patients. Overall, 54 (23%) patients were classified to be at risk for ED behaviour. Adherence was 57% in the ED group (31/54) versus 35% in the non-ED group (64/179); P<0.05. Adherence with a low-FODMAP diet was highest (51%) in the IBS with diarrhoea subtype and lowest (10%) in IBS with constipation. There was no significant correlation between IBS-Symptom Severity Score and either adherence (P=0.39) or ED behaviour (P=0.28). In this IBS cohort, greater adherence to a low-FODMAP diet is associated with ED behaviour. The implications of our study are important in clinical practice for a clinician to have a high index of suspicion of EDs in IBS patients when a high level of low-FODMAP diet achieved.

Impulsivity and affect reactivity prospectively predict disordered eating attitudes in adolescents: a 6-year longitudinal study.

Eating disorders (EDs) are associated with significant psychological and physical comorbidities, and adolescence is a particularly high-risk time for the development of EDs. Impulsivity (i.e., acting with little conscious judgment or forethought) and affect reactivity (i.e., changes in negative affect in response to a stressor) are hypothesized to contribute to the development of binge/purge ED pathology. The current study is the first to examine the prospective relationships between impulsivity and affect reactivity as predictors of the development of ED attitudes in adolescents over time. Two hundred six adolescents participated in a longitudinal study examining the development of psychopathology. ED attitudes were assessed via the College Eating Disorders Screen annually for 6years. Baseline impulsivity and affect reactivity were also assessed. Affect reactivity, impulsivity, and their interaction were examined as baseline predictors of changes in ED attitudes over time using latent growth modeling. Results of latent growth modeling indicated that ED attitudes increased over time. The interaction between impulsivity and affect reactivity significantly predicted the slope of ED attitudes, such that the relationship between impulsivity and ED attitudes was strongest for those with elevated levels of affect reactivity. Findings suggest that greater levels of affect reactivity and impulsivity are key risk factors for the development of ED attitudes in adolescents. Subsequent research should examine the relation between affect reactivity and impulsivity in predicting objectively measured ED behaviors, in addition to ED attitudes. Further investigation may implicate affect reactivity and impulsivity as important targets for early intervention to prevent onset of ED symptoms in adolescents.

Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Non-conforming Adults: Comparative Levels and a Proposed Mediational Model.

In this study we sought to compare eating disorder attitudes and behaviors, and proneness to an eating disorder (“ED proneness”), between gay men, lesbian women, and transgender and gender non-conforming (TGNC) adults. A further aim was to identify and compare risk and protective factors, and examine a mediational model based on the interpersonal theory of eating disorders (IPT-ED), whereby the association between interpersonal factors and ED proneness would be mediated by psychological constructs pertaining to the self and negative affect. Data was obtained from a larger national study of health risk and protective factors among sexual minority and gender diverse populations. The sample included 97 gay men, 82 lesbian women, and 138 TGNC adults. Participants completed the National College Health Assessment, Eating Disorders Screen for Primary Care, Patient Health Questionnaire Depression scale, Generalized Anxiety Disorder 7 scale, Self-Compassion Scale-Short Form, Negative Social Exchange subscale of the Multidimensional Health Profile, Interpersonal Needs Questionnaire, and Perceived Stigma Scale. There was a significant difference between groups in ED proneness, with lesbian women (66.7%) having a significantly higher percentage than gay men (47.6%). There was also a significant difference between groups in weight-based self-worth, with the lowest percentage in gay men (63%) and the highest percentage in lesbian women (82%), as well as dissatisfaction with eating patterns, with the highest percentage in TGNC adults (69.8%) and the lowest percentage in gay men (47.7%). There was a low percentage of inappropriate compensatory behaviors, with no significant difference between groups. Logistic regression analyses showed that the predictor variables of ED proneness were depression, perceived stigma, and self-compassion in gay men; depression in lesbian women; and self-compassion in the TGNC adults. Mediation analyses showed that thwarted belongingness (i.e., an unmet to belong) and perceived stigma had an indirect association with ED proneness that was mediated by self-compassion and depression (for perceived stigma alone) in gay men, depression in lesbian women, and self-compassion in TGNC adults. The interpersonal theory of eating disorders therefore extends to sexual minority and gender diverse populations; however, the results suggest a broadening of theoretical models and intervention programs to include the role of stigma and self-compassion.

Prevalence and correlates of a positive screen for eating disorders among Syrian refugees.

The objective of this cross-sectional study was to examine the prevalence and correlates of a positive screen for eating disorders (EDs) in a sample of Syrian refugees living in North Lebanon. The study was conducted on a convenience sample of 450 (84.67% women and 15.33% men) refugees, aged between 18 and 45years. The prevalence of a positive screen for ED was 5.79%. Bivariate analyses revealed that female gender (p=0.02), presence of medical conditions (p=0.01), old occurrence of major stressful life event (p<0.01), and positive primary care post-traumatic stress disorder screen (p<0.01) were associated with the positive sick, control, one stone, fat, food tool. Multiple logistic regression analyses showed that subjects screened with post-traumatic stress disorder had a three times higher risk of having a positive screen for ED (odds ratio=3.2; 95% confidence interval [1.32, 7.78]). Early detection of ED and related factors may help identify refugees who would benefit from interventions to improve mental health.

A systematic digital approach to implementation and dissemination of eating disorders interventions to large populations identified through online screening: implications for post-traumatic stress.

We describe an approach to implementation and dissemination that focuses on changing outcomes variables within a large, defined population and attempts to provide cost-effective opportunities and resources-which might include the provision of both digital and traditional interventions-to address individual needs and interests. We present a case example of how aspects of this model are being applied to increase reach, engagement and outcomes for individuals who complete a national eating disorders screen, and are likely to have an eating disorder but who are not in treatment. We then describe how this model can apply to post-traumatic stress (PTS) and conclude with a discussion of limitations and issues with the model. The National Eating Disorders Association (NEDA) provides online screening for eating disorders. From February 2017 through March 2018, over 200,000 individuals completed the NEDA screen. Of these, 96% screened positive or at risk for an eating disorder, and most of those who screened positive for a clinical/subclinical eating disorder were not currently in treatment. Less than 10% engaged in self-help or guided self-help online digital program, or expressed interest in calling a helpline for referral to treatment. A systematic digital approach to implementation and dissemination has the potential to increase the number of individuals who benefit from interventions in defined populations. Uptake rates need to be improved.

Increased prevalence of eating disorders as a biopsychosocial implication of food allergy.

IntroductionThe study evaluates the impact of biopsychosocial factors involved in food allergy (FA) on the prevalence of eating disorders (ED). For the 5-year follow-up studies, 75 participants (aged 1–14 years) with early-onset FA and 81 healthy peers were included.MethodParticipants were diagnosed with FA using antibody/cytokine content immunoassay tests. Medical history, including BMI z-scores, was completed using data obtained in response to a validated allergic questionnaire that incorporated the SCOFF and EAT-8 screening questionnaires for ED. FA was confirmed if total IgE was elevated, specific sIgE to food allergens exceeded 0.7 kUA/L and if manifestations were observed. Screening for ED was considered positive if two or more SCOFF and EAT-8 items were confirmed.ResultsIn the FA+ group, 50% of female participants and 6.7% of their healthy female peers reported ED. An ED+ result was more frequent in FA+ individuals than in their healthy peers (p = 0.046) although the association is weak. In the FA+/ED+ group, 25.3% of the participants were underweight, and 14.7% were overweight compared to their peers where this reached respectively 4.2% and 2.8% (p<0.005). 74% of the FA+/ED+ individuals reported elimination diet implementation and only 15% declared it was medically consulted. The prevalence of ED in the FA+ male group was consistently correlated with lack of confidence in FA issues (r = 0.5424) and in the FA+ female group with applied medical procedures (r = 0.7069; p<0.005).ConclusionThese findings suggest that participants with FA especially struggling with lack of confidence in FA issues and those following an uncontrolled, restrictive elimination diet are more prone to food aversion and ED than their healthy peers. Applied procedures are necessary, and their neglect is associated with FA deterioration; however, the possibility of ED and biopsychosocial implications development should not be underestimated.

Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis.

We aimed to identify the risk of eating disorders (ED) in women with polycystic ovary syndrome (PCOS) compared to controls. We performed a systematic review and meta-analysis of studies that included women with well-defined PCOS and controls and used validated ED screening/diagnostic tools to measure mean ED score, prevalence of abnormal ED scores, and/or prevalence of specific ED diagnoses such as bulimia nervosa and binge eating disorder. Eight studies, including 470 women with PCOS and 390 controls, met inclusion criteria for the systematic review. Meta-analysis of seven of those studies found that the odds of an abnormal ED score (OR 3.05; 95% CI 1.33, 6.99; four studies) and the odds of any ED diagnosis (OR 3.87; 95% CI 1.43, 10.49; four studies) were higher in women with PCOS compared to controls. Our study suggests that women with PCOS are at increased odds of having abnormal ED scores and specific ED diagnoses. Given the potential implications of an ED on weight management strategies, our findings support routine screening for ED in this population. Level I,systematic reviewand meta-analysis.

Associations between healthcare use and disordered eating among female veterans.

Individuals with eating disorders (EDs) have considerable medical and psychiatric comorbidity as well as increased healthcare use and associated costs. However, EDs remain largely undetected and understudied among veteran populations, and EDs are not routinely screened for or treated in Veterans Affairs (VA) medical settings. Research elucidating the links between disordered eating and VA and non-VA healthcare use is needed to inform policy and practice for ED screening and treatment. Data regarding probable EDs and VA and non-VA healthcare use was obtained through a mail survey of 198 female veterans receiving care from VA. A total of 21 participants (10.6%) met probable criteria for subthreshold anorexia nervosa, bulimia nervosa, or binge-eating disorder. Negative binomial regression models revealed that female veterans with EDs reported higher frequency of VA mental healthcare use and substance use disorder treatment, above and beyond the association of comorbid PTSD and depression symptoms. These findings confirm the high probability that female veterans with EDs are utilizing significant VA mental health resources. Screening for EDs may be particularly important in VA medical and mental health settings.

Military sexual trauma is associated with eating disorders, while combat exposure is not.

There are strong associations among trauma and eating disorders. However, while trauma and eating disorders are more common among veterans than other populations, there is little information on how military-specific stressors affect eating disorder risk. This study's objective was to determine whether military sexual trauma and combat exposure were independent predictors of eating disorders among women veterans, a high-risk group. Participants were women age 18-70, using VA medical center services, without psychotic disorders or suicidal ideation (N = 407). We estimated a cross-sectional logistic regression model to predict eating disorders (anorexia, bulimia, binge eating disorder) as a function of military sexual trauma and combat exposure, adjusting for demographic variables. Sixty-six percent of participants reported military sexual trauma, 32% reported combat exposure, and 15% met eating disorder criteria. Mean age was 49 years (SD = 13); 40% were veterans of color. Women reporting military sexual trauma had twice the odds of an eating disorder compared to women who did not (odds ratio [OR]: 2.03; 95% CI [1.03-3.98]). Combat exposure was not associated with eating disorders. Asian race (OR: 3.36; 95% CI [1.26-8.97]) and age (OR: 1.03; 95% CI [1.01-1.06]) were associated with eating disorders. The high rates of military sexual trauma and eating disorders highlight a need for continued work. Results suggest that it may be useful to focus on women reporting military sexual trauma when implementing eating disorder screening and treatment programs. Given associations among trauma, eating disorders, obesity, and mortality, such efforts could greatly improve veteran health. (PsycINFO Database Record

Low Energy Availability Associated With Lower BMD And Bone Stress Injury Site In Female Athletes

Low energy availability (LEA) is a risk factor for impaired bone health and bone stress injury (BSI). Additionally, those with BSI at trabecular-rich bone sites are at higher risk for low BMD vs. those with BSI at only cortical-rich sites. PURPOSE: To evaluate the association of LEA with BMD and site of BSI in female athletes. METHODS: 1000 female athletes (ages 15-30 years) presenting to a sports medicine clinic completed a 400+ question survey covering topics related to relative energy deficiency in sport (RED-S), including female athlete triad risk factors and athletic activity. Comprehensive chart review was completed to identify athletes with history of BSI and available dual energy x-ray absorptiometry (DXA). LEA was defined as meeting ≥ 1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or high score on the Eating Disorder Screen for Primary Care (ESP). Athletes with BSI of the pelvis, femoral neck, sacrum, and/or calcaneus were categorized into the trabecular-rich BSI group; all others were categorized into the cortical-rich BSI group. Associations between EA status, BSI location, and DXA were assessed by chi-squared or t-test analysis (p<0.05). RESULTS: Of the 1000 patients surveyed, 126 had a history of both BSI and available DXA. Of these patients, 53.2% had LEA. Patients with LEA had lower BMD Z-scores than those with normal EA at the lumbar spine (-0.92±1.06 vs. -0.49±0.98, p=0.022), total hip (-0.27±0.75 vs. 0.29±0.77, p=0.009), and femoral neck (-0.34±0.87 vs. 0.23±0.97, p=0.028). Patients with ≥ 1 trabecular BSI accounted for 21.4% of the sample. In the trabecular-rich BSI group, 70.4% had LEA, while 48.5% of those in the cortical-rich group had LEA (p=0.043). Additionally, those with trabecular-rich BSI had lower BMD than the cortical-rich BSI group at the lumbar spine (-1.19±1.10 vs. -0.58±0.99, p=0.015), but not at other sites assessed by DXA. CONCLUSIONS: Our findings support the well-established relationship between LEA and impaired BMD. We also found that trabecular-rich BSI is associated with low EA and independently associated with low BMD. Therefore, trabecular BSI may serve as a clinical indicator for further bone health evaluation and assessment for LEA, including ED/DE.

Correlates of suicidal ideation in college women with eating disorders.

To identify the correlates of suicidal ideation (SI) in a large sample of college women with eating disorders (EDs). A total of 690 female college students from 28 US colleges who screened positive for an ED, with the exception of anorexia nervosa, were assessed for SI. Univariate logistic regression analyses were performed to determine independent correlates of SI. Measures included: ED psychopathology, ED behaviors (i.e., binge eating, vomiting, laxatives, compulsive exercise), current co-morbid psychopathology (i.e., depression, anxiety, insomnia), weight/shape concerns, ED-related clinical impairment, and body mass index (BMI). All significant variables were included in a backward binary multivariate logistic regression model to determine which variables were most strongly associated with SI. A total of 25.6% of the sample reported SI. All variables examined were significantly independently associated with SI, with the exception of compulsive exercise. Depression, anxiety, and vomiting remained as significant correlates of SI in the multivariate logistic regression model. ED screening on college campuses should assess for suicidality, and prevention and treatment efforts should target vomiting and co-morbid depression and anxiety symptoms to reduce risk of SI for high-risk individuals.

Attribution of weight regain to emotional reasons amongst European adults with overweight and obesity who regained weight following a weight loss attempt

PurposeDespite the wide availability of effective weight loss programmes, maintenance of weight loss remains challenging. Difficulties in emotion regulation are associated with binge eating and may represent one barrier to long-term intervention effectiveness in obesity. The purpose of this study was to determine the relationship between emotion regulation difficulties and the extent of weight regain in a sample of adults who had lost, and then regained, weight, and to examine the characteristics associated with emotional difficulties.Methods2000 adults from three European countries (UK, Portugal, and Denmark) completed an online survey assessing self-reported weight loss and regain following their most recent weight loss attempt. They also completed a binge eating disorder screening questionnaire and, if they had regained weight, were asked if they attributed it to any emotional factors (a proxy for emotion regulation difficulties). Spearman’s correlations and logistic regression were used to assess the associations between emotion regulation, weight regain, and strategy use.ResultsEmotion regulation difficulties were associated with greater weight regain (N = 1594 who lost and regained weight). Attribution to emotional reasons was associated with younger age, female gender, loss of control and binge eating, lower perceptions of success at maintenance, using more dietary and self-regulatory strategies in weight loss, and fewer dietary strategies in maintenance.ConclusionsWeight-related emotion regulation difficulties are common amongst regainers and are associated with regaining more weight. Affected individuals are already making frequent use of behavioural strategies during weight loss, but do not apply these consistently beyond active attempts. Simply encouraging the use of more numerous strategies, without concurrently teaching emotion regulation skills, may not be an effective means to improving weight outcomes in this group.Level of evidenceLevel V, descriptive (cross-sectional) study.

Risk of Eating Disorders in Patients With Celiac Disease.

Several cases of eating disorders (EDs) have been reported in patients with celiac disease (CD), suggesting that ED could be a comorbidity associated with CD. Few epidemiological studies have, however, assessed this potential association. We aimed to evaluate the risk of EDs in individuals diagnosed with CD in comparison to healthy controls. A total of 98 cases and 98 controls matched for sex, age, and body mass index between 10 and 23 years old were studied. A questionnaire was completed on medical history and sociodemographic as well as anthropometric characteristics. Various ED screening self-reported tests were administered. A total of 61.2% of the study population were girls with a mean age of 15.3 ± 3.7 years old. Patients with CD scored nonsignificantly higher on all the ED screening tests than control participants. No differences were observed between study groups in terms of the frequency of individuals who exceeded the clinical cutoff identifying those at risk of ED. Patients with CD above 13 years old were associated with a 2.15-point increase in the Eating Attitude Test score compared with controls [β-coefficient = 2.15 SE 1.04; P = 0.04] after adjusting for various confounders. Although being a patient with CD was associated with a significantly higher Eating Attitude Test score in individuals older than 13 years old, no clear differences were observed between individuals with CD and controls in terms of risk of ED when other screening tests were used. More studies with larger samples and prospective designs are warranted to confirm these findings.

Screen for Disordered Eating: Improving the accuracy of eating disorder screening in primary care.

To develop a primary care eating disorder screen with greater accuracy and greater potential for generalizability, compared to existing screens. Cross-sectional survey to assess discriminative accuracy of a new screen, Screen for Disordered Eating (SDE), compared to Eating Disorders Screen for Primary Care (EDS-PC) and SCOFF screener, using prevalence rates of Binge Eating Disorder (BED), Bulimia Nervosa (BN), Anorexia Nervosa (AN), and Any Eating Disorder (AED), as measured by the Eating Disorder Examination Questionnaire (EDE-Q). The SDE correctly classified 87.2% (CI: 74.3%-95.2%) of BED cases, all cases of BN and AN, and 90.5% (CI: 80.4%-96.4%) of AED cases. Sensitivity estimates were higher than the SCOFF, which correctly identified 69.6% (CI: 54.2%-82.3%) of BED, 77.8% (CI: 40.0%-97.2%) of BN, 37.5% (CI: 8.52%-75.5%) of AN, and 66.1% (CI: 53%-77.7%) of AED. While the EDS-PC had slightly higher sensitivity than the SDE, the SDE had better specificity. The SDE outperformed the SCOFF in classifying true cases, the EDS-PC in classifying true non-cases, and the EDS-PC in distinguishing cases from non-cases. The SDE is the first screen, inclusive of BED, valid for detecting eating disorders in primary care. Findings have broad implications to address eating disorder screening in primary care settings.