Vegetarians and omnivores with diagnosed eating disorders exhibit no difference in symptomology: a retrospective clinical chart review.

PURPOSE: Past work suggests that vegetarianism is common in patients diagnosed with eating disorders (EDs), but the exact nature of this association is unclear, with reports conflicting as to whether vegetarianism is a risk factor for EDs, complicates ED treatment, or is wholly innocuous. Since vegetarianism has been on the rise, the need for current data on possible links with EDs is substantial. METHODS: We collected data on demographics, vegetarian status, ED diagnosis, current body mass index (BMI), highest and lowest BMI, Eating Attitudes Test, and Multifactorial Assessment of Eating Disorders Symptoms scores at intake in 124 patients (84.7% women, 90.3% white, Mage = 23.92 ± 9.16 years) admitted to an intensive outpatient ED program. RESULTS: We first compared omnivores (n = 72, 58.1%), meat-reducers (n = 27, 21.8%), vegetarians (n = 20, 16.1%), and vegans (n = 5, 4.0%) and found no significant differences in any demographic or outcome variable, with the exception that vegetarians reported significantly lower highest-ever BMI compared to meat-reducers (p = 0.03). To mirror past chart reviews, we then compared the combined groups of meat avoiders (n = 52, 41.9%) to the omnivores (n = 72, 58.1%) and found no significant differences in demographics or ED symptoms (all ps > 0.05). CONCLUSION: Overall, data support that meat restriction does not imply greater ED severity. LEVEL OF EVIDENCE: Level V, descriptive study, retrospective chart review.

Rapid response is predictive of treatment outcomes in a transdiagnostic intensive outpatient eating disorder sample: a replication of prior research in a real-world setting.

OBJECTIVE: There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample. METHOD: The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD)Duration = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients' medical charts. RESULTS: In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not. CONCLUSIONS: Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation. LEVEL OF EVIDENCE: Level IV, uncontrolled intervention.

Heart rate variability as a biobehavioral marker of diverse psychopathologies: A review and argument for an "ideal range".

Heart rate variability (HRV), a measure of the variability in intervals between subsequent heart beats, is now widely considered an index of emotion regulatory capacity and the ability to adapt flexibly to changing environmental demands. Abnormalities in HRV are implicated in a host of psychopathologies, making it a potentially powerful transdiagnostic biobehavioral change mechanism in treatment interventions. While most mental illnesses are associated with low HRV, eating disorders have been linked to elevated HRV. We examined 62 research articles on HRV in psychopathology to test the hypothesis that there is an "ideal range" of HRV that predicts optimal functioning. Relationships between symptom severity and parameters that quantify HRV were examined graphically. More extreme time-domain HRV measures, both high and low, were associated with psychopathology, whereas healthy controls displayed mid-range values. Findings preliminarily support the hypothesis that there is an "ideal range" of HRV that could be targeted in biofeedback interventions.

Confirmatory factor analysis of the EDE-Q in vegans and omnivores: Support for the brief three factor model.

The factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q) has proven difficult to replicate, including in vegans, whose eating behaviors differ from omnivores in important ways. We sought to assess fit of data from vegans and omnivores with the most recently proposed brief three-factor model of the EDE-Q, which retains only seven of the original 28 EDE-Q items. We examined fit indices of the EDE-Q brief three-factor model in vegans (i.e., individuals refraining from all animal products, n = 318) and omnivores (i.e., individuals not restricting intake of animal products, n = 200) in single-group confirmatory factor analyses (CFA). Configural and metric invariance across the two groups was examined in multi-group CFA. Data from omnivores exhibited good model fit. Fit in vegans was slightly worse, but still adequate and superior to alternative models. Findings from multi-group CFA supported configural, but not metric invariance across the two groups. We document satisfactory fit of data from vegans and omnivores with the EDE-Q brief three-factor model, suggesting that it is better suited for quantifying disordered eating than the original four-factor, full three-factor, or alternative two-, full one-, and brief one-factor versions, including in individuals who abstain from animal products.

Practitioners' perspectives on ethical issues within the treatment of eating disorders: Results from a concept mapping study.

OBJECTIVE: Treating patients with eating disorders (EDs) is associated with an array of ethical concerns, including balancing patients' health and autonomy, access to care, and use of harm-reduction versus recovery-oriented treatment models. The primary aim of the current study is to gain a better understanding of ethical issues faced by ED practitioners by using a concept mapping, or Q-sort, approach. METHOD: A total of 12 practitioners completed the brainstorming phase and generated statements regarding ethical issues they faced while treating patients with EDs. A subsequent 38 practitioners completed a sorting task, where they created and labeled piles, into which they grouped each statement. Of those 38 participants, 30 rated both the frequency with which they encountered each ethical issue and its impact on patient care. RESULTS: A total of six clusters emerged: Insufficient Level of Care, Lack of Evidence-Based Practice, Insurance Barriers, Family Involvement, Patient Autonomy, and Limited Access to Expertise. Lack of Evidence-Based Practice, Insurance Barriers, and Insufficient Level of Care was the most frequent problem faced by ED practitioners, whereas Insurance Barriers and Patient Autonomy had the greatest impact. DISCUSSION: Findings outline frequent and impactful areas of ethical concern that arise when treating patients diagnosed with EDs. Practitioners most commonly reported that patient- and insurance-driven factors limited patient access to appropriate care. Regulations supporting the provision of evidence-based care should be emphasized in public health policy and advocacy efforts, given their impact in limiting the delivery of adequate patient care.

Factor structure of the Eating Disorder Examination - Questionnaire among heterosexual and sexual minority males.

Eating disorder (ED) pathology is increasingly recognized among males; however, presentations within males differ from traditional descriptions of ED pathology in females. Additionally, experiences of ED pathology differ between sexual minority (SM) and heterosexual males. These differences suggest that existing ED assessments, which are primarily based on female samples, do not adequately capture ED pathology in SM and heterosexual males. The Eating Disorder Examination-Questionnaire (EDE-Q) is a commonly used assessment of ED pathology; however, at present the factor structure of this instrument in SM and heterosexual males is unclear. This study aimed to determine the most appropriate factor structure of the EDE-Q by evaluating proposed factor structures in a large, non-clinical sample consisting of heterosexual and SM men. Additionally, this study examined differences in the factor structures and severities of ED pathology between SM and heterosexual males. Confirmatory Factor Analyses examining existing factor structures of the EDE-Q indicated that the brief three-factor model was the best fitting model for both heterosexual and SM males. Subsequent comparisons of factor scores between groups indicated that SM males in our sample experienced higher levels of dietary restraint, overvaluation of shape and weight, and body dissatisfaction than heterosexual males. Results provide preliminary support for the use of the brief three-factor model of the EDE-Q when assessing ED pathology among SM and heterosexual males in non-clinical research settings.

What does the ORTO-15 measure? Assessing the construct validity of a common orthorexia nervosa questionnaire in a meat avoiding sample.

Orthorexia nervosa (ON) is a proposed diagnostic category that captures a pathological need to eat healthfully. The ORTO-15 is a self-report measure ostensibly designed to assess ON, but its suitability for capturing symptoms of pathology has been questioned. Vegans differ from omnivores in their focus on health and present with similar or lowered endorsement of eating behaviors symptoms, making them an ideal group to assess the construct validity of the ORTO-15. We tested the hypothesis that the ORTO-15 captures normative, rather than pathological, health focus. In total, 106 omnivores, 34 meat reducers, 50 lacto-ovo-vegetarians, and 191 vegans completed the ORTO-15 to quantify the presence and severity of ON and the Eating Disorder Examination Questionnaire (EDE-Q) as an established measure of eating pathology. More than 75% of respondents met criteria for a diagnosis of ON per established ORTO-15 cutoffs. Respondents above the 2.50 EDEQ cutoff (suggesting the likely presence of an eating disorder) did not differ in ORTO-15 scores from those scoring below the cutoff. There was a univariate main effect of meat avoidance type on the EDE-Q global scale (p < .01), with vegans endorsing fewer symptoms on the EDE-Q than semi-vegetarians (post-hoc p < .05). Vegans were more likely to meet the clinical ON cutoff of 40 on the ORTO-15 compared to omnivores (omnibus p < .01; post-hoc p = .01). Based on the ORTO-15, vegans' scores should be indicative of pathological eating behavior, but EDE-Q scores instead indicate the lowest levels in this group. The ORTO-15 is able to differentiate between types of meat avoiders, but given the difference in health focus between groups, the scale may be tapping into a construct other than pathological eating beliefs and behaviors.

Targeting acceptance in the management of food craving: The mediating roles of eating styles and thought suppression.

Food craving is now widely considered to be a cognitively motivated state. Acceptance-based treatments are effective in reducing the adverse impact of food cravings on consumption, via a hypothesized decrease in experiential avoidance. The mechanisms that drive the success of acceptance-based management of craving remain to be empirically tested. This study examined the role of eating styles and thought suppression as mediators in the relationship between experiential avoidance and craving. Participants (n = 298, 51.5% female) completed the Food Craving Acceptance and Awareness Questionnaire (FAAQ), the Dutch Eating Behavior Questionnaire (DEBQ), the White Bear Suppression Inventory (WBSI; a measure of thought suppression), and the reduced version of the Food Craving Questionnaire- Trait (FCQ-T-r). Scores on the FAAQ were inversely associated with scores on the FCQ-T-r, DEBQ, and WBSI; FCQ-T-r scores were positively correlated with scores on the DEBQ and WBSI (all p < 0.001). The total indirect effect of acceptance on craving through the hypothesized mediators was significantly different from zero. Controlling for eating styles and thought suppression, acceptance remained a significant predictor of craving. Results thus provide initial evidence that eating styles and thought suppression mediate the relationship between food-specific experiential avoidance and food craving. Findings lay the foundation for future study of the proximal antecedents of food cravings and lend preliminary support for targeting thought suppression and eating styles in acceptance-based approaches to the management of craving.

Confirmatory factor analysis of the Eating Disorder Examination-Questionnaire: A comparison of five factor solutions across vegan and omnivore participants.

OBJECTIVE: The Eating Disorder Examination-Questionnaire (EDE-Q) is a valid and reliable measure of eating-related pathology, but its factor structure has proven difficult to replicate. Given differences in dietary patterns in vegans compared to omnivores, proper measurement of eating disorder symptoms is especially important in studies of animal product avoiders. METHOD: This study compared goodness-of-fit of five alternative models of the EDE-Q in vegans (i.e., individuals refraining from all animal products, n = 318) and omnivores (i.e., individuals not restricting intake of animal products, n = 200). Confirmatory factor analyses were used to compare fit indices of the original four-factor model of the EDE-Q, along with alternative three-, two-, full one-, and brief one-factor models. RESULTS: No model provided adequate fit of the data in either sample of respondents. The fit of the brief one-factor model was the closest to acceptable in omnivores, but did not perform as well in vegans. Indicators of fit were comparable in vegans and omnivores across all other models. DISCUSSION: Our data confirm difficulties in replicating the proposed factor structure of the EDE-Q, including in vegans. More research is needed to determine the suitability of the EDE-Q for quantifying eating behaviors, including in those abstaining from animal products.

Early signs of cardiovascular dysregulation in young adult binge drinkers.

Binge drinking is widespread on American college campuses, but its effects on the cardiovascular system are poorly understood. This study sought evidence of preclinical cardiovascular changes in binge drinking young adults (n = 24) compared to nondrinking (n = 24) and social drinking (n = 23) peers during baseline, paced sighing (0.033 Hz), and paced breathing (0.1 Hz) tasks. Binge drinkers showed consistent but often statistically nonsignificant evidence of greater sympathetic activation and reduced baroreflex sensitivity. Interestingly, the structure of group-averaged baseline heart rate spectra was considerably different between groups in the low frequency range (0.05-0.15 Hz). In particular, the binge drinking group-averaged spectra showed several spectral peaks not evident in the other groups, possibly indicating two functionally distinct subranges (0.05-0.08 and 0.08-0.15 Hz) that reflect vascular tone baroreflex activity and heart rate baroreflex activity, respectively. Vascular tone baroreflex gain and power in two peaks in the 0.05-0.08 Hz range were associated with years of drinking in the binge drinking group. Vascular dysfunction may be an early indicator of drinking-related change in the cardiovascular system.

Ethical concerns regarding animal use mediate the relationship between variety of pets owned in childhood and vegetarianism in adulthood.

Plant-based and vegetarian diets have been shown to have diverse health and environmental benefits and also serve to reduce farmed animal exploitation. It is therefore worthwhile to gain a better understanding of the factors that play a role in the decision to refrain from animal products. Past studies have shown that childhood pet ownership predicts the likelihood of adherence to a vegetarian diet in adulthood. Building on this research, we tested the hypothesis that the number of different types of pets owned in childhood is positively associated with degree of restriction of animal products in adulthood, and that this relationship is mediated by pro-animal attitudes. A self-selected convenience sample of 325 participants (77.2% female; mean age = 30.23 ± 12.5) reported on their vegetarian status and completed the Animal Advocacy Scale and Child Pet Ownership Questionnaire. The number of different pets owned in childhood was positively correlated with degree of vegetarianism in adulthood (p < 0.001), but was no longer a significant predictor when controlling for moral opposition to animal exploitation. A significant Sobel test (z = 4.36; p < 0.001) confirmed the presence of full mediation. Findings support the hypothesis that individuals who owned a greater variety of pets in childhood endorse more concerns regarding animal use. This, in turn, appears to predict the decision to refrain from animal products in adulthood. The possibility that an enhanced ability to generalize empathy from companion to laboratory, farm, and wildlife animals underlies this relationship should be examined in future research.

Eating and health behaviors in vegans compared to omnivores: Dispelling common myths.

Studies comparing eating behaviors in individuals avoiding meat and other animal products to omnivores have produced largely inconclusive findings, in part due to a failure to obtain sufficiently large samples of vegan participants to make meaningful comparisons. This study examined eating and health behaviors in a large community sample of dietary vegans ("vegans"), compared to omnivores. Participants (n = 578, 80.4% female) completed an online questionnaire assessing a range of eating- and other health-related attitudes and behaviors. Vegans (62.0%, n = 358) and omnivores (38.1%, n = 220) were comparable in terms of demographics. Vegans scored significantly lower than omnivores the Eating Disorder Examination - Questionnaire (multivariate p < 0.001), a measure of pathological eating behavior. They also were more likely to consider themselves "healthy" (p < 0.001) and to prepare food at home (p < 0.001). Vegans more frequently consumed fruits, vegetables, nuts, beans and grains (all p < 0.001), and less frequently consumed caffeinated soft drinks (p < 0.001). There were no significant differences between vegans and omnivores on measures of eating styles, body mass index, smoking or exercise behaviors, or problems related to alcohol consumption. Effect sizes for comparisons on eating-related measures were generally small, with ηp2 ranging from <0.01 to 0.05; the size of effects for comparisons on measures of other health behaviors ranged from small to medium (Φ = 0.09 to 0.33 and ηp2 < 0.01 to 0.42). Taken together, findings suggest that ultimately, vegans do not differ much from omnivores in their eating attitudes and behaviors, and when they do, differences indicate slightly healthier attitudes and behaviors towards food. Similarly, vegans closely resembled omnivores in non-eating related health behaviors.

The effects of sighing on the cardiovascular system.

Elicitation of high-amplitude oscillations in the cardiovascular system may serve to dampen psychophysiological reactivity to emotional and cognitive loading. Prior work has used paced breathing to impose clinically valuable high-amplitude ∼ 0.1 Hz oscillations. In this study, we investigated whether rhythmical sighing could likewise produce high-amplitude cardiovascular oscillations in the very low frequency range (0.003-0.05 Hz). ECG, respiration, skin conductance, and beat-to-beat blood pressure were collected in 24 healthy participants during baseline, 0.1 Hz paced breathing, and 0.02 Hz paced sighing (1 sigh every 50s, with normal breathing interspersed). Results showed that each sigh elicited a strong, well-defined reaction in the cardiovascular system. This reaction did not habituate when participants repeatedly sighed for 8.5 min. The result was a high-amplitude 0.02 Hz oscillation in multiple cardiovascular parameters. Thus, paced sighing is a reliable method for imposing very low frequency oscillations in the cardiovascular system, which has research and clinical implications that warrant further study.