The need for future research into the assessment and monitoring of eating disorder risk in the context of obesity treatment.

In adolescents and adults, the co-occurrence of eating disorders and overweight or obesity is continuing to increase, and the prevalence of eating disorders is higher in people with higher weight compared to those with lower weight. People with an eating disorder with higher weight are more likely to present for weight loss than for eating disorder treatment. However, there are no clinical practice guidelines on how to screen, assess, and monitor eating disorder risk in the context of obesity treatment. In this article, we first summarize current challenges and knowledge gaps related to the identification and assessment of eating disorder risk and symptoms in people with higher weight seeking obesity treatment. Specifically, we discuss considerations relating to the validation of current self-report measures, dietary restraint, body dissatisfaction, binge eating, and how change in eating disorder risk can be measured in this setting. Second, we propose avenues for further research to guide the development and implementation of clinical and research protocols for the identification and assessment of eating disorders in people with higher weight in the context of obesity treatment. PUBLIC SIGNIFICANCE: The number of people with both eating disorders and higher weight is increasing. Currently, there is little guidance for clinicians and researchers about how to identify and monitor risk of eating disorders in people with higher weight. We present limitations of current research and suggest future avenues for research to enhance care for people living with higher weight with eating disorders.

Critical measurement issues in the assessment of social media influence on body image.

Progress towards understanding how social media impacts body image hinges on the use of appropriate measurement tools and methodologies. This review provides an overview of common (qualitative, self-report survey, lab-based experiments) and emerging (momentary assessment, computational) methodological approaches to the exploration of the impact of social media on body image. The potential of these methodologies is detailed, with examples illustrating current use as well as opportunities for expansion. A key theme from our review is that each methodology has provided insights for the body image research field, yet is insufficient in isolation to fully capture the nuance and complexity of social media experiences. Thus, in consideration of gaps in methodology, we emphasise the need for big picture thinking that leverages and combines the strengths of each of these methodologies to yield a more comprehensive, nuanced, and robust picture of the positive and negative impacts of social media.

The modelled cost-effectiveness of cognitive dissonance for the prevention of anorexia nervosa and bulimia nervosa in adolescent girls in Australia.

BACKGROUND: Eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN), are prevalent disorders that carry substantial economic and social burden. The aim of the current study was to evaluate the modelled population cost-effectiveness of cognitive dissonance (CD), a school-based preventive intervention for EDs, in the Australian health care context. METHOD: A population-based Markov model was developed to estimate the cost per disability adjusted life-year (DALY) averted by CD relative to no intervention. We modelled the cases of AN and BN that could be prevented over a 10-year time horizon in each study arm and the subsequent reduction in DALYs associated with this. The target population was 15-18 year old secondary school girls with high body-image concerns. This study only considered costs of the health sector providing services and not costs to individuals. Multivariate probabilistic and one-way sensitivity analyses were conducted to test model assumptions. RESULTS: Findings showed that the mean incremental cost-effectiveness ratio at base-case for the intervention was $103,980 per DALY averted with none of the uncertainty iterations falling below the threshold of AUD$50,000 per DALY averted. The evaluation was most sensitive to estimates of participant rates with higher rates associated with more favourable results. The intervention would become cost-effective (84% chance) if the effect of the intervention lasted up to 5 years. CONCLUSION: As modelled, school-based CD intervention is not a cost-effective preventive intervention for AN and BN. Given the burden of EDs, understanding how to improve participation rates is an important opportunity for future research.

Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases.

OBJECTIVE: To systematically review the literature on the proportion of community cases with a diagnosable eating disorder who seek eating disorder specific treatment. METHOD: CSA PsycInfo, Medline/PubMed and Scopus databases were searched for relevant articles that were written in English, published between January 1989 and January 2010, and satisfied three selection criteria: 1) recruited a representative sample of community cases; 2) used a standardized eating disorder screening instrument; 3) reported percentage of cases with eating disorders that sought appropriate (mental health or medical) treatment specifically for their eating disorder. Reference lists were also scanned for relevant articles. RESULTS: Of 200 articles identified, 14 met inclusion criteria, comprising 1581 participants with a diagnosable eating disorder. The pooled proportion seeking treatment was 23.2% (95% CI=16.6, 31.4), however this estimate was associated with significant variability. The proportion seeking treatment for weight loss ranged from 30% to 73%, indicating that individuals with eating disorders are much more likely to receive treatment for a perceived problem with weight. DISCUSSION: The literature provides a complex picture, as a minority receive appropriate mental health care, yet many receive treatment for weight loss. Significant gaps in the literature currently exist and future research needs to focus on treatment seeking in the young and elderly, males, and in countries outside of Australia and the United States. There is a need for interventions that assist community members, health professionals and treatment services to recognize eating disorders and understand their associated burden and the benefit of providing appropriate and timely treatment.

Eating disorders "mental health literacy" in low risk, high risk and symptomatic women: implications for health promotion programs.

Attitudes and beliefs concerning the nature and treatment of bulimia nervosa (BN) were compared among young adult women at low risk of an eating disorder (n = 332), at high risk (n = 83), or already showing symptoms (n = 94). Participants completed a self-report questionnaire that included a measure of eating disorder symptoms. A vignette of a fictional person suffering from BN was presented, followed by a series of questions addressing the nature and treatment of the problem described. High-risk and symptomatic participants were more likely than low-risk participants to report that they would not approach anyone for advice or help, were they to have BN or a similar problem, because they would not want anyone to know. Symptomatic participants were more likely to believe that someone with BN would be discriminated against, more likely to consider bulimic behaviors to be acceptable, and more likely to view BN as being common among women in the community, than low-risk participants, participants in the high-risk group being intermediate on each of these questions. The findings suggest that the attitudes and beliefs of individuals with eating disorder symptoms differ systematically from those of individuals at high risk, but who do not yet have symptoms, and from those at low risk. They also indicate specific attitudes and beliefs that may need to be addressed in prevention and early intervention programs. The potential benefits of assessing individuals' attitudes and beliefs concerning the nature and treatment of eating-disordered behaviour and tailoring program content accordingly may be worthy of investigation.

Pathways to help-seeking in bulimia nervosa and binge eating problems: a concept mapping approach.

OBJECTIVE: To conduct an in-depth study, using concept mapping, of three factors related to help-seeking for bulimia nervosa and binge eating: problem recognition, barriers to help-seeking, and prompts to help-seeking. METHOD: Semistructured interviews were conducted to elicit information about help-seeking with 63 women (18-62 years) with past or present bulimic behaviors. RESULTS: Using Leximancer software, factors identified as associated with problem recognition were Changes in Behavior, Interference with Life Roles, Comments about Changes and Psychological Problems. Salient barriers to help-seeking were Fear of Stigma, Low Mental Health Literacy/Perception of Need, Shame, Fear of Change and Cost. Prompts to help-seeking were increased Symptom Severity, Psychological Distress, Interference with Life Roles, Health Problems, and Desire to Get Better. CONCLUSION: Results highlighted the need for awareness campaigns to reduce both self and perceived stigma by others towards bulimic behaviors, and the need to enhance awareness of available interventions for people ready to engage in treatment, to increase help-seeking.

Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys.

This research examined whether body dissatisfaction prospectively predicted depressive mood and low self-esteem in adolescent girls and boys 5 years later. Participants were early-adolescent girls (n = 440, Time 1 M age = 12.7 years) and boys (n = 366, Time 1 M age = 12.8 years) and midadolescent girls (n = 946, Time 1 M age = 15.8 years) and boys (n = 764, Time 1 M age = 15.9 years). After controlling for Time 1 of the relevant dependent variable, ethnicity, socioeconomic status, and body mass index, Time 1 body dissatisfaction was a unique predictor of Time 2 depressive mood and low self-esteem in early-adolescent girls (depressive mood: F = 4.80, p < .05; self-esteem: F = 9.64, p < .01) and midadolescent boys (depressive mood: F = 12.27, p < .001; self-esteem: F = 9.38, p < .01) but not in early-adolescent boys or midadolescent girls. These findings are consistent with the hypothesis that body dissatisfaction is a risk factor for depressive mood and low self-esteem in both girls and boys but in different phases of adolescence.

Prospective predictors of body dissatisfaction in adolescent girls and boys: a five-year longitudinal study.

This study investigated prospective risk factors for increases in body dissatisfaction in adolescent girls and boys in the Eating Among Teens Project. At the time of first assessment (Time 1), participants were a cohort of early adolescent girls (N=440) and boys (N=366) and a cohort of middle adolescent girls (N=946) and boys (N=764). Participants were followed up 5 years later (Time 2). Potential prospective risk factors examined included body mass index, socioeconomic status, ethnicity, parent dieting environment, peer environment, and psychological factors. Predictors of Time 2 body dissatisfaction were Time 1 body dissatisfaction, body mass index, socioeconomic status, being African American, friend dieting and teasing, self-esteem, and depression. However, the profile of predictors differed across the samples.

Development of the Children's Body Image Scale.

OBJECTIVE: The aim of this study was to develop a gender-appropriate pictorial scale to measure body image in young children based on a measurable index of adiposity. METHOD: Pictorial scales for boys and girls containing seven body pictures representing standard percentile curves for body mass index (BMI) for healthy children were developed. The Children's Body Image Scale (CBIS) was administered to 312 children aged between 7 and 12 years. RESULTS: Accuracy of body size perception, indicated by the correlation between actual and perceived BMI category figure, developed with age, girls acquiring accuracy earlier than boys. Whereas girls developed a good accuracy (r =.60, p <.001, 10-12 years), in boys, the correlation, though significant, was not strong (r =.35, p <.01, 10-12 years). There was a consistent bias towards underestimation of body size using this technique. There was a high frequency of body size dissatisfaction across all the age ranges, 48% girls and 36% boys wished to have a smaller body figure than their own, and only 10% of girls and 20% boys wished to have a larger body figure. Construct validity was assessed in a subset of 153 children in which additional measures of restrained eating (DEBQ-R) and body esteem were available. From the age of 8 years, the CBIS provides a good measure of body dissatisfaction. CONCLUSIONS: The CBIS provides a good measure of body size perception in girls and an adequate measure in boys aged 8 years and older. It also provides a good measure of body size dissatisfaction in children. Internalization of a thin body ideal takes place at a young age, many children desiring a BMI below the average norm.