Perceptions and experiences with eating disorder treatment in the first year of COVID-19: A longitudinal qualitative analysis.

OBJECTIVE: The COVID-19 pandemic created significant challenges in accessing and receiving treatment for individuals with eating disorders (EDs). The purpose of this study is to explore perceptions of and experiences with ED treatment during the first year of the pandemic among individuals with past and self-reported EDs in the United States. METHODS: Online surveys were administered to adults (N = 510) with a past or current self-reported ED at 13 timepoints between April 2020 and May 2021. Using longitudinal qualitative analysis, 5651 free-text responses were examined to capture experiences with ED treatment and generate inferences of change over time. RESULTS: We categorized results into four sequential, temporal quarters and identified patterns that explained participants' perceptions of facilitators, barriers, and experiences with ED treatment over time: Quarter 1. Treatment Disruption and Reorienting Recovery; Quarter 2. Accumulating COVID-19 Stress and Virtual Treatment Woes; Quarter 3. A Continuation of Inadequate Care; and Quarter 4. Ongoing Adaptation and Adjustment to Uncertainty. Participant experiences were marked by numerous barriers to accessing care, challenges adjusting to virtual treatment, unmet treatment needs, and beginning acceptance of telehealth. DISCUSSION: Our findings present a timeline to help evaluate challenges related to navigating the switch to virtual care which created significant disruption to ED recovery. Participants spent much of the first year trying to adjust to unemployment, loss of insurance, and lack of access to in-person treatment. Future research should identify additional strategies to improve the receipt and experience of care for EDs. PUBLIC SIGNIFICANCE: Our findings suggest that individuals with eating disorders were significantly challenged by accumulating COVID-19 stress, worsening symptomatology, and limited access to effective treatment during the first year of the pandemic. This knowledge can guide clinicians, treatment centers, and policy makers in addressing the behavioral health needs of individuals impacted by disordered eating amidst emergent public health crises.

Course and predictors of eating disorder symptoms, anxiety symptoms, and pandemic-related eating disorder concerns among adults with eating disorders during the first year of the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic and public health mitigation measures have negatively impacted individuals with eating disorders (ED). We evaluated changes in and predictors of ED symptoms, pandemic-related ED concerns, and anxiety symptoms across the first 12 months of the COVID-19 pandemic among individuals with self-reported EDs in the United States (US), Sweden (SE), and the Netherlands (NL). METHOD: Participants in the US (N = 510), SE (N = 982), and NL (N = 510) completed an online survey assessing ED symptoms (binge eating, restriction, compensatory behaviors, and anxiety about being unable to exercise), general anxiety symptoms, and pandemic-related ED concerns about accessing food, lack of structure and social support, being in a triggering environment, and food and treatment costs. In the US and NL, respondents completed surveys beginning April 2020 and continuing monthly for a year. In SE, respondents completed baseline surveys in May 2020, a six-month follow-up around December 2020, and a 12-month follow-up in May 2021. RESULTS: Three patterns emerged: (1) a curvilinear course with the highest level of symptoms at baseline, declining through November 2020, and increasing through the rest of the year; (2) a linear declining course over time; and (3) a stable course with no changes. Worries about COVID-19 infection, lockdown, concerns about lack of structure and social support, and concerns about accessing food consistent with one's recovery meal plan predicted increases in ED symptoms. DISCUSSION: ED symptoms tracked with pandemic-related concerns in people with EDs. Conceptualizing predictors of symptoms may inform therapy and public health resources that reduce the impact of pandemics on mental health. PUBLIC SIGNIFICANCE: Our findings suggest that the COVID-19 pandemic had negative impacts on people with eating disorders, including amplification of mental health symptoms and stressors around peak periods of infection and COVID-19 restrictions. These findings inform medical providers, policy-makers, and community-based supports about the information and resource needs of this group to ensure efficient dissemination in future public health emergencies and during the ongoing COVID-19 pandemic.

Longer-term impact of COVID-19 among individuals with self-reported eating disorders in the United States, the Netherlands, and Sweden.

OBJECTIVE: We assessed eating disorder (ED) illness status, symptomatology, treatment access, anxiety, and depression in the first year of the COVID-19 pandemic among individuals with a pre-existing ED in the United States (US), the Netherlands (NL), and Sweden (SE). METHODS: Participants completed online surveys in April-July 2020, at the early stage of the pandemic, and one year later. At one-year follow-up, we added questions addressing retrospective changes in ED symptoms, treatment, and anxiety/depression since the start of the COVID-19 pandemic. We present descriptive statistics and assess change in ED symptomatology, treatment, and anxiety/depression among those with an active or lingering ED. RESULTS: Participants (US n = 132; NL n = 219; SE n = 702) were mostly young and female with a history of anorexia nervosa (>60% in all three countries). Across countries, respondents reported impact of COVID-19 on ED symptoms at both time points, with improvement in US and NL at one-year follow-up, and stable but less impact on ED symptoms in SE. Furthermore, at one-year follow-up, roughly half of those in treatment reported reduced treatment access and quality, and the majority of the sample reported increased anxiety and depressive mood since the start of the pandemic. DISCUSSION: Our findings suggest that the self-perceived impact of COVID-19 changed over time but remained concerning even one year after the start of the pandemic. Clinicians, community organizations, and policy makers are encouraged to address potentially changing treatment needs in the face of public health emergency events. PUBLIC SIGNIFICANCE: Our findings suggest that the impact of COVID-19 on individuals with eating disorders decreased over time but remained concerning even one year after the start of the pandemic and that the impact differed across countries. Clinicians, community organizations, and policy makers are encouraged to incorporate this knowledge to address potentially changing treatment needs in the face of public health emergency events.

Roux-en-Y Gastric Bypass Is Associated With Increased Hazard for De Novo Alcohol-related Complications and Liver Disease.

GOAL: The goal of this study was to determine if bariatric surgeries are associated with de novo alcohol-related complications. BACKGROUND: Bariatric surgery is associated with an increased risk of alcohol use disorders. The effect of bariatric surgeries on other alcohol-related outcomes, including liver disease, is understudied. MATERIALS AND METHODS: Using the IMS PharMetrics database, we performed a cohort study of adults undergoing bariatric surgery or cholecystectomy, excluding patients with an alcohol-related diagnosis within 1 year before surgery. The primary outcome was any alcohol-related diagnosis after surgery. We fit a multivariable Cox proportional hazards model to determine independent associations between bariatric surgeries [Roux-en-Y gastric bypass (RYGB); adjustable gastric band; sleeve gastrectomy] versus cholecystectomy and the development of de novo alcohol-related outcomes. We further fit complication-specific models for each alcohol-related diagnosis. RESULTS: RYGB was significantly associated with an increased hazard of any de novo alcohol-related diagnosis [adjusted hazard ratio (AHR)=1.51, 95% confidence interval (CI): 1.40-1.62], while adjustable gastric band (AHR=0.55, 95% CI: 0.48-0.63) and sleeve gastrectomy (AHR=0.77, 95% CI: 0.64-0.91) had decreased hazards. RYGB was associated with a 2- to 3-fold higher hazard for alcoholic hepatitis (AHR=1.98, 95% CI: 1.17-3.33), abuse (AHR=2.05, 95% CI: 1.88-2.24), and poisoning (3.14, 95% CI: 1.80-5.49). CONCLUSIONS: RYGB was associated with higher hazards of developing de novo alcohol-related hepatitis, abuse, and poisoning compared with a control group. Patients without a history of alcohol use disorder should still be counseled on the increased risk of alcohol use and alcohol-related complications, including alcohol-related liver disease, following RYGB, and should be monitored long term for the development of alcohol-related complications.

Addressing eating disorders in primary care: Understanding screening recommendations and opportunities to improve care.

OBJECTIVE: For the first time in its history, the United States Preventive Services Task Force (USPSTF) published a recommendation on screening for eating disorders among adolescents and adults in primary care. The current manuscript provides an overview of the USPSTF recommendation, screening principles, and suggestions for clinical and research efforts. METHOD: The USPSTF based their recommendations on a rigorous systematic review of the evidence on routine screening for eating disorders. Eligible studies included studies of screening test accuracy and controlled trials of screening or interventions for eating disorders in screen-detected or previously untreated eating disorders. The current manuscript briefly summarizes the results of this evidence review which are published in full elsewhere and focuses on providing interpretation of the recommendations by clarifying the scope and methodology of the USPSTF. RESULTS: Fifty-seven studies were included in the evidence review. Seventeen studies evaluated screening test accuracy and 40 trials evaluated interventions among populations with previously untreated eating disorders. No studies directly assessed the benefits and harms of screening. The evidence review highlights important gaps in our knowledge regarding eating disorders in primary care. The authors provide recommendations for future studies in light of these evidence gaps and propose specific clinical strategies to improve care for those with eating disorders who present to primary care. DISCUSSION: Primary care can play an important role in the early detection of eating disorders, but data are needed to more fully understand the potential benefits and harms of routine screening in this setting. PUBLIC SIGNIFICANCE: There are gaps in the evidence regarding the benefits and harms of eating disorder screening in primary care. Future studies are needed to improve certainty about the net benefit of screening. Of particular importance are studies that compare routine screening to usual care (no screening). Current providers may benefit from tailored eating disorders education and training, practical tools, and integration of mental health services in primary care.

Screen-detected disordered eating and related traits in a large population sample of females in mainland China: China Health and Nutrition Survey.

OBJECTIVE: We describe the prevalence and sociodemographic factors associated with screen-detected disordered eating and related traits in a population-based sample of women in China. We also explored prevalence trends over time. METHOD: A total of 4,218 females aged 12-50 were sampled from 15 provinces as part of the China Health and Nutrition Survey (CHNS) in 2015. The SCOFF questionnaire screened for disordered eating and the selected questions from the Eating Disorders Examination-Questionnaire measured dietary restraint, shape concerns, and weight concerns. Body mass index (BMI) was measured and sociodemographic factors captured urban/rural residence, age, ethnicity, income, education, marital status, and occupational status. We calculated the prevalence of screen-detected disordered eating and related traits broadly and across several dimensions and compared prevalence estimates to 2009 and 2011 reports. RESULTS: We detected 296 individuals who screened positive for disordered eating on the SCOFF (prevalence = 7.04%). Positive screens were associated with urban residence (p = .002) and higher education levels (p < .001). Scores on restraint, shape concerns, and weight concerns were all higher for individuals in urban versus village locations (all p's < .001), and with higher BMI (p < .001) for shape and weight concerns. The prevalence of screen-detected disordered eating increased numerically across 2009, 2011, and 2015. DISCUSSION: The prevalence of screen-detected disordered eating in mainland China was comparable to other populations worldwide obtained from a recent meta-analysis. The distribution of disordered eating and related traits varied by several sociodemographic factors, which include age, BMI, urban/rural residence, education, and income, suggesting important directions for case detection and intervention in China.

Identifying research priorities for the study of atypical anorexia nervosa: A Delphi study.

OBJECTIVE: Individuals meeting all criteria for anorexia nervosa (AN) except that weight falls within or above the normal range despite significant weight loss are categorized as having atypical AN (AAN). Existing research has provided mixed evidence concerning the diagnostic demarcation of AN and AAN. The aim of the present study was to identify research priorities for furthering the understanding of AN and AAN as diagnostic entities. METHOD: Employing the Delphi methodology, experts in the field were invited to suggest research questions that need to be explored in the demarcation of AN from AAN. This yielded 24 research areas, that were presented in subsequent rounds where panelists were asked to prioritize areas of primary interest. RESULTS: Fifty-three panelists completed all three Delphi rounds. Consensus was only reached on three items considered to be of primary interest: medical, neurobiological, and neurological factors; epidemiology and natural course; and treatment response in AAN compared to AN. In contrast, questions of premorbid weight and determining the need for and nature of a body mass index cutoff differentiating between AAN and AN were seen as being of low priority. DISCUSSION: These findings reveal a relatively low degree of consensus on the demarcation of AN from AAN in the field of eating disorders. A reason could be that the definition and use of the AAN category vary in research and clinical practice. In order to achieve further diagnostic clarity, research on the demarcation of AAN and AN should focus on the identified prioritized research areas.

Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ~1,000 individuals in the United States and the Netherlands.

OBJECTIVE: We evaluated the early impact of COVID-19 on people with self-reported eating disorders. METHOD: Participants in the United States (US, N = 511) and the Netherlands (NL, N = 510), recruited through ongoing studies and social media, completed an online survey that included both quantitative measures and free-text responses assessing the impact of COVID-19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well-being. RESULTS: Results revealed strong and wide-ranging effects on eating disorder concerns and illness behaviors that were consistent with eating disorder type. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge-eating disorder (US 30% of sample; NL 15%) reported increases in their binge-eating episodes and urges to binge. Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of COVID-19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations of this treatment modality for this population were raised. Individuals with past histories of eating disorders noted concerns about relapse related to COVID-19 circumstances. Encouragingly, respondents also noted positive effects including greater connection with family, more time for self-care, and motivation to recover. DISCUSSIONS: COVID-19 is associated with increased anxiety and poses specific disorder-related challenges for individuals with eating disorders that require attention by healthcare professionals and carers.

Weight suppression and weight elevation are associated with eating disorder symptomatology in women age 50 and older: Results of the gender and body image study.

OBJECTIVE: Weight suppression (WS), the difference between highest past non-pregnancy weight and current weight, predicts negative outcomes in eating disorders, but the impact of WS and related weight constructs are understudied in nonclinical, midlife populations. We examined WS (current weight < highest weight) and weight elevation (WE), the opposite of WS (current weight > lowest weight) and their associations with eating psychopathology in women aged 50+. METHOD: Participants were a community-based sample (N = 1,776, Mage = 59) who completed demographic and eating psychopathology questions via online survey. WS, WE, and WS × WE were tested as predictors of outcome variables; BMI and medical conditions that affect weight were controlled for. RESULTS: Individuals that were higher on WS and WE were most likely to engage in current weight loss attempts, dieting in the past 5 years, and extreme lifetime restriction. Individuals with higher WS were more likely to experience binge eating, greater frequency of weight checking, overvaluation of shape and weight, and lifetime fasting. Individuals with higher WE were more likely to report negative life impacts of eating and dieting. Higher WS and WE each predicted higher levels of skipping meals over the lifetime. DISCUSSION: This novel study investigated WS in midlife women and introduced a new conceptualization of weight change (WE) that may be more relevant for aging populations given that women tend to gain weight with age. The findings implicate the utility of investigating both WS and WE as factors associated with eating psychopathology in midlife women.

CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa.

OBJECTIVE: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). METHOD: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. RESULTS: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. CONCLUSIONS: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.

Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial.

OBJECTIVE: We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout. METHOD: Participants (N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors. RESULTS: Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96). DISCUSSION: Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:569-577).

Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis.

BACKGROUND: The best treatment options for binge-eating disorder are unclear. PURPOSE: To summarize evidence about the benefits and harms of psychological and pharmacologic therapies for adults with binge-eating disorder. DATA SOURCES: English-language publications in EMBASE, the Cochrane Library, Academic OneFile, CINAHL, and ClinicalTrials.gov through 18 November 2015, and in MEDLINE through 12 May 2016. STUDY SELECTION: 9 waitlist-controlled psychological trials and 25 placebo-controlled trials that evaluated pharmacologic (n = 19) or combination (n = 6) treatment. All were randomized trials with low or medium risk of bias. DATA EXTRACTION: 2 reviewers independently extracted trial data, assessed risk of bias, and graded strength of evidence. DATA SYNTHESIS: Therapist-led cognitive behavioral therapy, lisdexamfetamine, and second-generation antidepressants (SGAs) decreased binge-eating frequency and increased binge-eating abstinence (relative risk, 4.95 [95% CI, 3.06 to 8.00], 2.61 [CI, 2.04 to 3.33], and 1.67 [CI, 1.24 to 2.26], respectively). Lisdexamfetamine (mean difference [MD], -6.50 [CI, -8.82 to -4.18]) and SGAs (MD, -3.84 [CI, -6.55 to -1.13]) reduced binge-eating-related obsessions and compulsions, and SGAs reduced symptoms of depression (MD, -1.97 [CI, -3.67 to -0.28]). Headache, gastrointestinal upset, sleep disturbance, and sympathetic nervous system arousal occurred more frequently with lisdexamfetamine than placebo (relative risk range, 1.63 to 4.28). Other forms of cognitive behavioral therapy and topiramate also increased abstinence and reduced binge-eating frequency and related psychopathology. Topiramate reduced weight and increased sympathetic nervous system arousal, and lisdexamfetamine reduced weight and appetite. LIMITATIONS: Most study participants were overweight or obese white women aged 20 to 40 years. Many treatments were examined only in single studies. Outcomes were measured inconsistently across trials and rarely assessed beyond end of treatment. CONCLUSION: Cognitive behavioral therapy, lisdexamfetamine, SGAs, and topiramate reduced binge eating and related psychopathology, and lisdexamfetamine and topiramate reduced weight in adults with binge-eating disorder. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Comparative Effectiveness of Treatments for Binge-Eating Disorder: Systematic Review and Network Meta-Analysis.

Psychological and pharmacological interventions for binge-eating disorder have previously demonstrated efficacy (compared with placebo or waitlist control); thus, we aimed to expand that literature with a review of comparative effectiveness. We searched MEDLINE,® EMBASE,® Cochrane Library, Academic OneFile, CINAHL® for binge-eating disorder treatment articles and selected studies using predetermined inclusion and exclusion criteria. Data were sufficient for network meta-analysis comparing two pharmacological interventions; psychological interventions were analysed qualitatively. In all, 28 treatment comparisons were included in this review: one pharmacological comparison (second-generation antidepressants versus lisdexamfetamine) and 26 psychological comparisons. Only three statistically significant differences emerged: lisdexamfetamine was better at increasing binge abstinence than second-generation antidepressants; therapist-led cognitive behavioural therapy was better at reducing binge-eating frequency than behavioural weight loss, but behavioural weight loss was better at reducing weight. The majority of other treatment comparisons revealed few significant differences between groups. Thus, patients and clinicians can choose from several effective treatment options. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

The association between internet and television access and disordered eating in a Chinese sample.

OBJECTIVE: China has historically reported a low prevalence of eating disorders. However, the rapid social and economic development of this country as well as Western ideals widely disseminated by television and the Internet have led to distinct patterns of behavioral choices that could affect eating disorder risk. Thus, the current study explored the relation between disordered eating and media use. METHOD: Participants were females from the 2009 wave of the China Health and Nutrition Survey (N = 1,053). Descriptive statistics were obtained and logistic regression models, stratified by age (adolescents ages 12-17 years and adults ages 18-35 years), were used to evaluate the association of media use with disordered eating. RESULTS: In adolescents, 46.8% had access to the Internet and those with access averaged one hour per day each of Internet and television use. In adults, 41.4% had access to the Internet, and those with access averaged 1 h per day of Internet use and 2 h per day of television use. Internet access was significantly associated with a subjective belief of fatness (OR = 2.8, 95% CI: 1.6, 4.9) and worry over losing control over eating (OR = 4.8, 95% CI: 2.3, 9.8) only in adults. DISCUSSION: These findings help characterize the overall pattern of media use and report of eating disorder symptoms in a large sample of female Chinese adolescents and adults. That Internet access in adults was significantly associated with disordered eating cognitions might suggest that media access negatively influences these domains; however, more granular investigations are warranted.

The Intestinal Microbiome in Bariatric Surgery Patients.

With nearly 39% of the worldwide adult population classified as obese, much of the globe is facing a serious public health challenge. Increasing rates of obesity, coupled with the failure of many behavioural and pharmacological interventions, have contributed to a rise in popularity of bariatric surgery as a treatment for obesity. Surgery-mediated weight loss was initially thought to be a direct result of mechanical alterations causing restriction and calorie malabsorption. However, the mounting evidence suggests that indirect factors influence the accumulation and storage of fat in patients that have undergone this procedure. Given the established impact the intestinal microbiota has on adiposity, it is likely that this complex enteric microbial community contributes to surgery-mediated weight loss and maintenance of weight loss postsurgery. In this review, we discuss the physiological and psychological traits exhibited by bariatric surgery candidates that can be influenced by the intestinal microbiota. Additionally, we detail the studies that investigated the impact of bariatric surgery on the intestinal microbiota in humans and mouse models of this procedure.

Prevalence of screening-detected eating disorders in chinese females and exploratory associations with dietary practices.

OBJECTIVE: China is undergoing dramatic Westernization, hence may be able to provide unique insights into the role of sociocultural factors in disease. The purpose of this exploratory study was two-fold: to describe the prevalence of screening-detected eating disorders and disordered eating in China at the first occasion of assessment in the large-scale China Health and Nutrition Survey (CHNS) and to explore the associations between dietary practices and disordered eating. Regarding the first objective, participants are provincially representative and in subsequent waves will be followed longitudinally. METHOD: CHNS participants were recruited using multistage, cluster random sampling, beginning in 1989. In this study, participants comprised 259 female adolescents (12-17 years) and 979 women (18-35 years) who participated in the CHNS 2009 survey, which is the first CHNS survey to assess disordered eating. Dietary practice-disordered eating associations were investigated with logistic regression adjusting for age, body mass index, and urbanization. RESULTS: Of the participants, 6.3% (95% CI: 4.8, 8.2) of adults and 7.8% (95% CI: 5.0, 12.0) of adolescents had a screening-detected eating disorder. Dietary practices had non-significant associations with disordered eating at the general population level, except for protein consumption among women. There was evidence that skipping meals and a high-fat diet may confer risk. DISCUSSION: Screening-detected eating disorders in China are lower in prevalence than in developed countries. Dietary practices had fairly limited associations with disordered eating at the general population level; protein consumption, skipping meals, and a high-fat diet are candidate dietary practice exposures for disordered eating. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Characteristics of women with body size satisfaction at midlife: results of the Gender and Body Image (GABI) Study.

This study characterizes the profile of women (N = 1,789) ages 50 and over who report body size satisfaction on a figure rating scale. Satisfied women (12.2%) had a lower body mass index and reported fewer eating disorder symptoms, dieting behaviors, and weight and appearance dissatisfaction. Interestingly, satisfied women exercised more than dissatisfied women, and weight and shape still played a primary role in their self-evaluation. Weight monitoring and appearance-altering behaviors did not differ between groups. Body satisfaction was associated with better overall functioning. This end point appears to represent effortful body satisfaction rather than passive contentment.

Examining sex differences in the association between sedentary behavior and cognitive function in bariatric surgery patients.

BACKGROUND: Obesity is associated with cognitive impairment. A potential contributor to these deficits is sedentary behavior (SB), which is linked to poorer cognitive functioning in other populations. Little is known about the association between SB and cognitive function in bariatric surgery populations. OBJECTIVES: This cross-sectional study examined the association between SB and cognitive function in preoperative bariatric surgery patients, as well as possible sex differences in this relationship. SETTING: Data were collected at 2 health centers in the United States. METHODS: A total of 121 participants (43.2 ± 10.3 yr of age) scheduled for Roux-en-Y gastric bypass or sleeve gastrectomy completed the National Institute of Health (NIH) Toolbox for the Assessment of Neurological and Behavioral Function Cognition Domain, a computerized neuropsychological assessment battery. Participants wore a waist-mounted accelerometer for 7 consecutive days to measure SB and light-intensity physical activity (LPA). RESULTS: Pearson and partial correlations found no significant relationships between cognitive function and SB or LPA in the full sample. However, partial correlations controlling for LPA found that greater SB was associated with poorer performance on List Sorting Working Memory Test in women (r = -.28; P = .006), whereas there was a positive relationship between SB and Dimensional Change Card Sort for men (r = .51; P = .015; 95% CI [.25, .73]). CONCLUSIONS: These results showed that greater SB, independent of LPA, is associated with poorer working memory in women and better set shifting ability in men. Future studies should examine the possibility of domain-specific cognitive effects associated with SB in bariatric surgery samples and clarify possible sex differences.

Non-suicidal self-injury in eating disordered patients: a test of a conceptual model.

A theoretical model explaining the high co-occurrence of non-suicidal self-injury (NSSI) in eating disordered populations as resulting from childhood traumatic experiences, low self-esteem, psychopathology, dissociation, and body dissatisfaction was previously proposed but not empirically tested. The current study empirically evaluated the fit of this proposed model within a sample of 422 young adult females (mean age=21.60; S.D.=6.27) consecutively admitted to an inpatient treatment unit for eating disorders. Participants completed a packet of questionnaires within a week of admission. Structural equation modeling procedures showed the model provided a good fit to the data, accounting for 15% of the variance in NSSI. Childhood trauma appears to have an indirect relationship to NSSI that is likely to be expressed via relationships to low self-esteem, psychopathology, body dissatisfaction, and dissociation. It appears that dissociation and body dissatisfaction may be particularly salient factors to consider in both understanding and treating NSSI within an eating disordered population.