Management of eating disorders for people with higher weight: clinical practice guideline.

INTRODUCTION: The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population. AIM: The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. METHODS: The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience. RECOMMENDATIONS: Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed. CONCLUSIONS: This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

The objective of this project was to develop recommendations and clinical considerations to guide clinicians in the management of people experiencing eating disorders who also have higher weight. A Guideline Development Group was formed containing members with academic and/or clinical expertise and people with a lived experience of eating disorder. The guideline was not only informed by reviews of the scientific literature but also clinical expertise and lived expertise. This guideline has undergone extensive review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical, academic and/or lived expertise. The guideline outlines a set of recommendations for clinical practice including the strong recommendation for psychological treatment to be offered as the first treatment for an eating disorder in people who are of higher weight. Considerations in clinical practice including weight stigma, care by professionals from disparate disciplines, and cultural considerations are also discussed. The Guideline Development Group acknowledges a lack of available research evidence specific to people experiencing an eating disorder who are also of higher weight and consequently some recommendations relied on consensus of group members taking into account the expert reviews. The Group also identified areas where additional research is necessary such as research evaluating weigh-neutral and other more recent approached in the field.

Intuitive Eating Scale-2: psychometric properties and clinical norms among individuals seeking treatment for an eating disorder in private practice.

PURPOSE: Intuitive Eating (IE) is an approach to eating designed to facilitate a positive relationship with food. Its use in clinical settings and in the community is rapidly growing in popularity. The Intuitive Eating Scale 2 (IES-2) is a widely used measure that indexes intuitive eating motivations and behaviour, however evidence of its validity in populations with clinical eating disorders remains scarce. The objective of the proposed study was thus to evaluate the factor structure of the IES-2 in a large sample of individuals seeking treatment for eating disorders in private practice. METHODS: Data collected from 569 women and men aged 12-68 years seeking treatment for an eating disorder in one of eight specialist private outpatient eating disorder clinics were examined using confirmatory factor analysis (CFA). Relationships between IES-2 scores and measures of psychopathology were also examined. RESULTS: Results were relatively consistent with the purported four-factor structure of the IES-2. The measure displayed strong construct validity and good internal consistency. Scores on the IES-2 were inversely associated with scores of depression, anxiety, and disordered eating, providing evidence for divergent validity of the measure. Clinical norms are provided for anorexia nervosa (AN) spectrum disorders and bulimia nervosa (BN) spectrum disorders, as well as for the clinical sample as a whole. CONCLUSION: Findings suggest that the IES-2 may be an appropriate measure for evaluating behaviours relating to IE in community outpatient eating disorder settings, and provide further evidence for the association between IE and positive health outcomes. LEVEL OF EVIDENCE: III, evidence obtained from well-designed cohort or case-control analytic studies.

The relationship between social media use and disordered eating in young adolescents.

BACKGROUND: The relationship between social media (SM) use and disordered eating (DE) has not been adequately explored in young adolescents. METHODS: Data from 996 Grade 7 and 8 adolescents (n = 534 girls; M age = 13.08) was investigated. DE cognitions (Eating Disorder Examination-Questionnaire [EDE-Q]), DE behaviors (Project Eating Among Teens), and SM use measures related to Facebook, Instagram, Snapchat, and Tumblr were completed. RESULTS: DE behaviors were reported by 51.7% of girls and 45.0% of boys, with strict exercise and meal skipping the most common. A total of 75.4% of girls and 69.9% of boys had at least one SM account where Instagram was the most common, used by 68.1% of girls and 61.7% of boys. Global EDE-Q scores were significantly higher for girls and boys with each type of SM account, except for Facebook and Instagram for girls. A greater number of SM accounts was associated with higher DE scores for both cognitions and behaviors. Girls with Snapchat and Tumblr accounts and boys with Snapchat, Facebook and Instagram were significantly more likely to have both DE behaviors and over-evaluation of shape and weight in the clinical range. Greater daily time spent using Instagram was associated with significantly higher Global EDE-Q scores and DE behaviors for girls, while this pattern was also found for Snapchat usage and DE behaviors for girls. CONCLUSIONS: A clear pattern of association was found between SM usage and DE cognitions and behaviors with this exploratory study confirming that these relationships occur at younger-age than previously investigated.

Validation of the clinical perfectionism questionnaire in an eating disorder sample: A bifactor approach.

OBJECTIVE: Clinical perfectionism is involved in the etiology and maintenance of eating disorders. Limited research has examined the factor structure of the Clinical Perfectionism Questionnaire (CPQ) in clinical eating disorder samples. The aim of this research was to examine the validity and reliability of the CPQ in a mixed eating disorder sample. METHOD: Patients (N = 211) with an eating disorder completed the CPQ at pretreatment. A bifactor model was tested that included a general clinical perfectionism factor and two group factors; overevaluation of striving and concern over mistakes. The unique contributions that general and group factors make to the prediction of eating disorder symptoms were also investigated. Unidimensional, correlated two-factor, and bifactor models were tested using confirmatory factor analysis. RESULTS: A bifactor structure for a revised 10-item version of the CPQ provided the best fit, with a strong and reliable general clinical perfectionism factor. The general clinical perfectionism factor and the overevaluation of striving group factor explained reliable variance in the CPQ, and but only the general factor predicted eating disorder symptoms. DISCUSSION: The results suggested that a total score is generally appropriate for assessing clinical perfectionism in a clinical eating disorder sample.

Enhanced cognitive behavioral therapy for eating disorders adapted for a group setting.

OBJECTIVE: This randomized control trial is an evaluation of the effectiveness of enhanced cognitive behavioral treatment (CBT-E) for eating disorders adapted for a group setting. The study aimed to examine the effects of group CBT-E on eating disorder psychopathology and additional maintaining pathology. METHOD: A transdiagnostic sample of individuals with eating disorders with a BMI ≥ 18 kg/m2 (N = 40) were randomized to an immediate-start or delayed-start condition so as to compare therapeutic effects of group CBT-E with a waitlist control. Global Eating Disorder Examination Questionnaire (EDE-Q) scores, BMI, and measures of Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were measured across the 8-week control period, throughout the group treatment and at 3-months post-treatment. RESULTS: Over 70% of those who entered the trial completed treatment. The first eight weeks of group CBT-E were more effective at reducing Global EDE-Q scores than no treatment (waitlist control). By post-treatment, good outcome (a Global EDE-Q within 1 SD of Australian community norms plus BMI ≥ 18.5) was achieved by 67.9% of treatment completers and 66.7% of the total sample. Symptom abstinence within the previous month was reported by 14.3% of treatment completers and 10.3% of the total sample. Significant reductions in Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were also observed. DISCUSSION: This study demonstrated that a group version of CBT-E can be effective at reducing eating disorder psychopathology in a transdiagnostic sample of individuals with eating disorders. Group CBT-E could provide a means of increasing availability of evidence-based treatment for eating disorders.

High incidence of obesity co-morbidities in young children: a cross-sectional study.

AIM: The prevalence of overweight and obesity in children is a public health problem because of future morbidity. However, the prevalence of medical complications in overweight and obese primary school children in Australia is not well documented. As part of the larger, prospective cohort Growth and Development Study, this report aimed to identify the medical complications of obesity in a population-based community sample of primary school-aged children. METHODS: Two groups of primary school children were studied: a random community sample of overweight/obese children (not seeking treatment) and a matched community sample of normal weight children. Demographics, medical history, family history and symptoms of complications of overweight were collected. Children had a physical examination, oral glucose tolerance tests with insulins, fasting lipid profiles and liver function tests. RESULTS: Data from 283 children are presented (6.1-13.4 years, mean 9.8 years). There were no differences in birth data, family composition, parental age or socio-economic status between groups. Overweight and obese children were more likely to complain of musculoskeletal pain, depression, anxiety and bullying, and had more adverse examination findings than control children. They also had more abnormal investigations: overweight children: impaired glucose tolerance (IGT) 1.3%, hyperinsulinism 19.5%, dyslipidaemia 63.8%, raised alanine transaminase (ALT) 9.0%; obese children: IGT 5.3%, hyperinsulinism 38.9%, dyslipidaemia 73.7%, raised ALT 31.6%. CONCLUSION: Overweight and obese primary school-aged children have significant medical complications of their weight status. Overweight children, in addition to obese children, should be screened for complications. A secondary finding is a high proportion of normal weight children with lipid levels outside desirable healthy ranges.

Body dissatisfaction and the effects of perceptual exposure on body norms and ideals.

OBJECTIVE: Body dissatisfaction is of high prevalence among women all over the Western world. It is often suggested that sociocultural processes are the main cause of such widespread dissatisfaction. Here, we consider how perceptual effects may influence ideas of body normality and body ideals. METHOD: Women who varied on a measure of body dissatisfaction rated a range of bodies for how normal and ideal they looked. They were exposed to either thin or fat bodies, and then they rerated the bodies. RESULTS: Women's perceptions of body normality and ideal were easily malleable by exposure. In addition, greater body dissatisfaction and internalization of the thin Western ideal were related to (i) a smaller most normal and ideal body, (ii) a greater discrepancy between the most normal and most ideal-rated body, and (iii) a reduced effect of exposure to fat bodies. DISCUSSION: Reduced updating of perceptions of body normality and body ideals in response to experience may be one mechanism that maintains body dissatisfaction.

Increasing body mass index z-score is continuously associated with complications of overweight in children, even in the healthy weight range.

CONTEXT: Overweight/obesity in children is increasing. Incidence data for medical complications use arbitrary cutoff values for categories of overweight and obesity. Continuous relationships are seldom reported. OBJECTIVES: The objective of this study is to report relationships of child body mass index (BMI) z-score as a continuous variable with the medical complications of overweight. DESIGN: This study is a part of the larger, prospective cohort Growth and Development Study. SETTING: Children were recruited from the community through randomly selected primary schools. Overweight children seeking treatment were recruited through tertiary centers. PARTICIPANTS: Children aged 6-13 yr were community-recruited normal weight (n = 73), community-recruited overweight (n = 53), and overweight treatment-seeking (n = 51). Medical history, family history, and symptoms of complications of overweight were collected by interview, and physical examination was performed. Investigations included oral glucose tolerance tests, fasting lipids, and liver function tests. MAIN OUTCOME MEASURE: Adjusted regression was used to model each complication of obesity with age- and sex-specific child BMI z-scores entered as a continuous dependent variable. RESULTS: Adjusted logistic regression showed the proportion of children with musculoskeletal pain, obstructive sleep apnea symptoms, headaches, depression, anxiety, bullying, and acanthosis nigricans increased with child BMI z-score. Adjusted linear regression showed BMI z-score was significantly related to systolic and diastolic blood pressure, insulin during oral glucose tolerance test, total cholesterol, high-density lipoprotein, triglycerides, and alanine aminotransferase. CONCLUSION: Child's BMI z-score is independently related to complications of overweight and obesity in a linear or curvilinear fashion. Children's risks of most complications increase across the entire range of BMI values and are not defined by thresholds.

The influence of colonic temperature changes in anaesthetised rats on tail skin temperatures and repeated testing of tail-flick latencies.

Tail-flick (TF) response latencies were measured in pentobarbitone-anaesthetized rats and variations with time, body and tail temperatures and 5 tail stimuli positions analysed with a mixed model analysis of variance. Variation with time was not significant. Highly significant differences (P < 0.001) were found between tail-flick latencies (TFLs) for tail temperatures and stimulus position. The most proximal tail position showed significantly different relationships for TFL with time and body temperature from other positions. The method described allows multiple TFLs to be measured in 1 animal with the potential of reducing the total number of animals in an experiment. Tail stimuli positions from proximal to distal sites showed a variation in response from 4.3 sec (95% CI: 4.2, 4.4) to 6.7 sec (95% CI: 6.6, 6.9). Rat tail stimulus position should therefore be standardised to allow reproducible measures of TFL and body temperature maintained within normal limits. TFLs were found to be abnormal at body temperatures above 39 degrees C.