Beyond Binge Eating: The Impact of Implicit Biases in Healthcare on Youth with Disordered Eating and Obesity.

(1) Background: Obesity and eating disorders (ED) can coexist resulting in worse health outcomes. Youth with ED are more likely to have obesity relative to peers with a healthy weight. Pediatric providers deliver first-line care to children and youth of all sizes and body shapes from infancy to adolescents. As healthcare providers (HCPs), we bring biases into our practice. Learning to recognize and address these biases is needed to provide the best care for youth with obesity. (2) Purpose: This paper aims to summarize the literature regarding the prevalence of ED beyond binge eating in youth with obesity and discuss how the intersection of weight, gender, and racial biases impact the assessment, diagnosis, and treatment of ED. We provide recommendations for practice and considerations for research and policy. (3) Conclusions: The assessment and treatment of ED and disordered eating behaviors (DEBs) in youth with obesity is complex and requires a holistic approach. This approach begins with identifying and understanding how one's implicit biases impact care. Providing care from a patient-centers lens, which considers how the intersection of multiple stigmatized identities increases the risk for DEBs in youth with obesity may improve long-term health outcomes.

Everyday discrimination as a predictor of maladaptive and adaptive eating: Findings from EAT 2018.

Various types of stressors are associated with maladaptive eating, but how the stressor of everyday discrimination (e.g., less respect, poorer service) relates to maladaptive eating and adaptive eating remains unclear. We examined everyday discrimination as a predictor of maladaptive and adaptive eating. Data were collected in a population-based study, Eating and Activity over Time (N = 1410, ages 18-30). Everyday discrimination was categorized as none, low, moderate, or high. Outcomes included maladaptive eating (i.e., overeating and binge eating) and adaptive eating (i.e., intuitive eating and mindful eating). Modified Poisson regressions estimated the prevalence ratios (PRs) for overeating and binge eating associated with everyday discrimination. Linear regressions estimated associations between everyday discrimination and intuitive and mindful eating scores. After adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were each associated with a significantly greater prevalence of binge eating (PR = 2.2, [95% CI = 1.3-3.7] and PR = 3.1, [95% CI = 2.0-4.7], respectively) and lower intuitive (ß = -0.4, [95% CI = -0.7, -0.2] and ß = -0.5 [95% CI = -0.8, -0.3], respectively), and mindful eating scores (ß = -0.3, [95% CI = -0.6, -0.1] and ß = -0.5 [95% CI = -0.8, -0.3], respectively) compared to young adults with no discriminatory experience. Public health efforts to prevent maladaptive eating and encourage the adoption of adaptive eating should consider the potential contribution of everyday discrimination and the need to advocate for equity and inclusion.

"Making weight" during military service is related to binge eating and eating pathology for veterans later in life.

PURPOSE: "Making weight" behaviors are unhealthy weight control strategies intended to reduce weight in an effort to meet weight requirements. This study aimed to examine a brief measure of making weight and to investigate the relationship between making weight and weight, binge eating, and eating pathology later in life. METHODS: Participants were veterans [N = 120, mean age 61.7, mean body mass index (BMI) 38.0, 89.2% male, 74.2% Caucasian] who were overweight/obese and seeking weight management treatment. Participants completed the making weight inventory (MWI), a measure of making weight behaviors engaged in during military service, and validated measures of eating behavior. Analyses compared participants who engaged in at least one making weight behavior (MWI+) versus those who did not (MWI-). RESULTS: The MWI had good internal consistency. One-third of participants were MWI+ and two-thirds were MWI-. The most frequently reported behavior was excessive exercise, reported in one-quarter of the sample, followed by fasting/skipping meals, sauna/rubber suit, laxatives, diuretics, and vomiting. MWI+ participants were significantly more likely to be in a younger cohort of veterans, to be an ethnic/racial minority, and to engage in current maladaptive eating behaviors, including binge eating, vomiting, emotional eating, food addiction, and night eating, compared to the MWI- group. Groups did not differ on BMI. CONCLUSIONS: One-third of veterans who were overweight/obese screened positive for engaging in making weight behaviors during military service. Findings provide evidence that efforts to "make weight" are related to binge eating and eating pathology later in life. Future research and clinical efforts should address how to best eliminate unhealthy weight control strategies in military service while also supporting healthy weight management efforts.

The eating disorders medicine cabinet revisited: a clinician's guide to appetite suppressants and diuretics.

OBJECTIVE: This article explores the frequencies of use of alternative medications, available products, and their potential toxicities. METHOD: Survey data were gathered from 39 consecutive patients diagnosed with bulimia nervosa who were seeking treatment. A survey of area outlets (health food stores, pharmacies, grocery stores) was conducted to establish a database of available agents. Putative active ingredients were identified. MEDLINE literature searches, as well as reviews of specialized texts, were performed to identify the potential toxicities of the ingredients. RESULTS: Diet pill use was found in 64% of patients; 18 % reported use in the past month. The survey identified 167 products. Diuretic use was found in 31% of patients; 21% reported use in the past month. Twenty-five diuretic products were identified. DISCUSSION: Alternative medicines are frequently used in the population of patients seeking treatment for bulimia nervosa. An abundance of products are available with potentially significant toxicities.

Obesity and eating disorder prevention: an integrated approach?

This article provides a rationale for interventions aimed at the prevention of eating disorders and obesity, an overview of some of the questions and controversies currently facing the fields of eating disorder and obesity prevention, and a discussion of the potential for integrated prevention approaches that address the broad spectrum of weight-related disorders. A rationale for utilizing an integrated approach, the challenges inherent to developing such an approach, and suggestions for working toward integrated approaches aimed at preventing the broad spectrum of weight-related disorders are discussed.

Eating disorders: a review of the literature with emphasis on medical complications and clinical nutrition.

Eating disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder, and atypical eating disorder (eating disorder not otherwise specified or NOS), are estimated to occur in 5-10 million young and adult women and one million males in the United States. The etiology of eating disorders is complex and appears to include predisposing genetic factors and serotonin dysregulation, as well as psychological factors that include a history of trauma and childhood sexual abuse. Both anorexia nervosa and bulimia nervosa are medical conditions complicated by multiple neuroendocrine dysfunctions, nutritional deficiencies, and psychiatric diagnoses. Medical complications, specific nutritional deficiencies, and research involving the therapeutic use of inositol and zinc are reviewed.

An open trial of light therapy for women with seasonal affective disorder and comorbid bulimia nervosa.

OBJECTIVE: Many patients with seasonal affective disorder (SAD) have dysfunctional eating behaviors. Conversely, many women with bulimia nervosa have marked winter worsening of mood and bulimic symptoms. Controlled studies of light therapy in SAD and in bulimia nervosa have shown beneficial effects on mood and binge/purge symptoms. We explored the clinical use of light therapy in women with SAD who also had comorbid bulimia nervosa. METHOD: Twenty-two female patients diagnosed using DSM-IV criteria with both bulimia nervosa and major depressive disorder with a seasonal (winter) pattern were treated with an open design, 4-week trial of light therapy (10,000 lux fluorescent light box with an ultraviolet filter, 30 to 60 minutes per day in the early morning). Patients were assessed before and after treatment with depression scales and with binge/purge diaries. RESULTS: Light therapy resulted in significant improvement in mood, with a mean 56% reduction in 29-item Hamilton Rating Scale for Depression scores following treatment (p < .001). The frequency of binges and purges per week also significantly decreased (p < .001) from baseline by a mean of 46% and 36%, respectively. Two (9%) of 22 patients became abstinent of binge/ purge episodes, compared with 10 (45%) of 22 patients who met criteria for remission of depressive symptoms. The light therapy was well tolerated by patients. CONCLUSION: These results suggest that therapeutic effects of light therapy on mood and bulimic symptoms in patients with SAD and comorbid bulimia nervosa are sustained over at least 4 weeks. However, the low abstinence rate in bulimic symptoms indicates that light therapy may be most effectively used as an adjunctive treatment to medications and/or psychotherapy for bulimia nervosa.

[High-risk eating behavior in Mexican adolescents. Data on the student population in the Federal District]. / Conductas alimentarias de riesgo en adolescentes mexicanos. Datos en población estudiantil del Distrito Federal.

Data of the Drug and Alcohol Prevalence in Student Population of Mexico City Survey 1997 were used to achieve knowledge about the presence of risk eating behaviors, characteristic of eating disorders in the student population of Mexico city (N = 10,173). The sample was conformed by boys (47.9%) and girls (52.1%), with a mean age of 14.5 years (SD = 1.8). The identification of the differences between boys and girls, and age groups in two occurrence categories of risk eating behavior (ever and two or more times per week) were among the main objectives. An eleven items scale with three answering options about eating behavior during the last three months was used. The BMI-P distributed normally, with greater percentage of overweight, than underweight in both sexes. A greater percentage of risk eating behaviors were found among girls, excluding hard exercising and binge eating, as well as similar percentages of laxative and enema use in both sexes. The analysis held by age groups for risk eating behaviors showed significant differences in binge eating, self induced vomiting, pills and enemas use among boys, while girls showed differences in almost all of these practices, being the group of 18 and 19 years where the greater percentages were found.

Eating disorders and adolescents: an overview of a maladaptive behavior.

TOPIC: Eating disorders among the adolescent population are a serious health problem. The author provides an overview of anorexia nervosa and bulimia nervosa. PURPOSE: To present information on eating disorders that includes DSM-IV criteria and typical profiles of the client. Current hypotheses about the etiology of eating disorders, medical complications, treatment approaches, morbidity and mortality data research, and outcome research of treatment are reviewed. Research, treatment, and educational considerations for nursing care are discussed. SOURCES: Published literature, clinical experience. CONCLUSIONS: Advanced practice nurses are particularly suited for working with adolescents because of their holistic approach to client care. Inconsistencies and gaps in the knowledge base of eating disorders regarding incidence, etiology, treatment approaches, pharmacology, and outcome are areas for future nursing research.

Anorexia nerviosa y bulimia nerviosa: clínica y epidemiología de 90 casos / Anorexia nervosa and bulimia nervosa: clinical and epidemiology of 90 cases

En este estudio se analizan las características clínicas y epidemiológicas de 90 pacientes con diagnóstico de trastornos de la alimentación, atendidas en los servicios de endocrinología y psiquiatría del Hospital Clínico de la Universidad de Chile, entre 1990 y 1995. La muestra estaba compuesta por 84 mujeres y 6 hombres entre 13 y 33 años. El promedio de edad fue 20 años. 42 pacientes fueron diagnosticados con anorexia nerviosa, 25 como bulimia nerviosa y 23 como mixtos. El 52 por ciento de los pacientes había comenzado la enfermedad antes de los 15 años. Sólo el 23 por ciento de los pacientes consulta promariamente al psiquíatra. El tiempo de evolución entre la aparición de los síntomas y el tratamiento es de 2,4 años en promedio. Un tercio de los pacientes consulta luego de 3 o más años de evolución. 21 pacientes, el 23,3 por ciento reportó intentos de suicidio. El 91 por ciento refirió sentorse deprimido, al momento fr la entrevista

Eating disorders: current nutrition therapy and perceived needs in dietetics education and research.

OBJECTIVE: Research was conducted to obtain a profile of nutrition therapy currently in practice for patients with anorexia nervosa, bulimia nervosa, and anorexia/bulimia (mixed diagnosis) and to identify the areas of dietetics education and research regarding eating disorders that need more attention. DESIGN: A cross-sectional correlational survey was conducted by mailing a questionnaire composed of open- and closed-ended questions to US dietitians who work with patients who have eating disorders. SAMPLE: Of 199 dietitians selected from a list of 495 representing all geographic areas of the United States, 117 responded. The list was obtained from a national referral network for eating disorders. STATISTICAL ANALYSIS: chi 2 Analysis was completed on all closed-ended answers. Pearson's correlation coefficient with a value of P < .05 was considered significant. RESULTS: Nutrition therapy administered varied among dietitians treating inpatients, outpatients, and both. Three community groups were identified as most important to reach for prevention of eating disorders: junior high school students, coaches, and parents. Crucial areas of research were perceived by 94 dietitians to be comparative effectiveness of techniques of medical nutrition therapy (n = 55) and of techniques of prevention (n = 26) and increased understanding of etiology in relation to identification of high-risk groups and prevention (n = 21). Dietitians desired further information on multiple topics related to eating disorders. APPLICATION: Medical nutrition therapy for eating disorders is a specialization that requires education and training beyond the minimum required for dietetic registration. Some of the techniques required are unique to this specialization due, in part, to the psychological nature of the disorders. All dietitians, however, must be able to recognize and refer patients with eating disorders; these skills must be included in basic undergraduate programs and internships. This study supports the need for more research concerning the outcomes of nutrition therapy and the effectiveness of prevention programs.

Ipecac abuse in a sample of eating disordered outpatients.

Eight hundred fifty-one consecutive outpatients presenting at a suburban eating disorder clinic were evaluated for current or past ipecac abuse. A percentage (7.6%) of all subjects reported some use or experimentation with ipecac for purging; 4.7% had experimented with it briefly; 3.1% (8.8% of subjects meeting criteria for bulimia) had chronically abused ipecac; and 1.1% (1.5% of subjects meeting criteria for bulimia) were regularly abusing ipecac at the time of intake. Chronic ipecac abusers were more likely to have been hospitalized. Subjects who experimented briefly with ipecac had a longer duration of illness. Both chronic ipecac abusers and experimenters were more prone to abuse other substances for purging and to report alcohol abuse in an immediate family member.