Eating disorder traits in obese children and adolescents.

The aim of the present study was to investigate the prevalence of eating disorder (ED) traits among obese children and adolescents. The Swedish version of the Eating Disorder Inventory for Children, consisting of 11 subscales, was administered to 150 obese patients during an extensive investigation of causes and risk factors in obesity at the Karolinska University Hospital at Huddinge. Patients aged 17-18 years (N=24) had a mean body mass index (BMI) of 40.7, SD 5.31, and patients aged 8-16 (N=126) had a mean body mass index standard deviation score (BMI SDS) of 6.18, SD 1.69. These patients were compared with 201 girls with a diagnosed ED from the COEAT project and with a control group of schoolchildren. The comparison between obese girls and boys showed that adolescent obese girls scored higher than obese boys on Drive for Thinness, Bulimia and Body Dissatisfaction. They also scored higher on Ineffectiveness, Interoceptive Awareness and Impulse Regulation. Obese girls were close to the girls with an ED on six of the subscales. Obese boys had a lower score of Asceticism than boys in the control group. The conclusion is that psychological traits associated with disordered eating appear among obese patients, particularly among the girls. However, these patients rarely satisfy any diagnostic criteria for ED during childhood or adolescence. Since obesity treatment currently assumes rational behavior, i.e. no EDs, it is important to discover ED traits at an early age in order to adapt treatment accordingly.

Clinical onset and diagnosis of eating disorders in premenarcheal girls is preceded by inadequate weight gain and growth retardation.

AIM: To study growth and weight changes before the presentation of an eating disorder (ED) with premenarcheal onset. METHODS: Growth charts from the school health services were obtained for 45 girls assessed during the period 1990-2000 at Uppsala University Children's Hospital. Measurements of weight and height from the charts and at presentation were recalculated into standard deviation scores (SDS). RESULTS: At their maximal weight the girls were 12.5 +/- 1.7 (mean +/- SE) y old. They were then lighter, shorter and leaner than the general population mean, as evidenced by SDS below zero for weight (-0.43 +/- 1.08; mean +/- SD), height (-0.45 +/- 1.01) and body mass index (BMI) (-0.35 +/- 1.07). At presentation approximately 1 y later they had lost 5.8 +/- 4.3 kg and were considerably underweight (weight SDS -2.27 +/- 1.33) and further stunted (height SDS -0.76 +/- 0.97). The point on the growth curves with the highest SDS for weight was observed at 8.5 +/- 1.4 y of age. The girls were then heavier (weight SDS 0.35 +/- 0.93) and less lean (BMI SDS 0.42 +/- 0.97) than the population average. A tendency to track down through weight and height curves before the onset of weight loss was thus observed. Total weight deficit was as much as 31 +/- 10% of expected body weight. Analyses of weight and height deficits indicated that two-thirds of the weight deficit and 60% of the height deficit was generated before the onset of weight loss. CONCLUSION: Girls with eating disorders presenting before menarche may have a long history of poor weight gain and growth retardation before the onset of weight loss. This is in contrast to older girls, who commonly start weight loss at an above-average weight without prior poor weight gain. Since the psychopathology of ED in young girls may be different and less evident compared with older teenagers it is important to be aware that poor weight gain and growth retardation may be associated with early-onset ED.

Psychometric properties of Eating Disorder Inventory for Children (EDI-C) in Swedish girls with and without a known eating disorder.

OBJECTIVE: To evaluate the Swedish version of the Eating Disorder Inventory (EDI-C) for the internal consistency, factor structure and ability to discriminate between adolescent girls with and without a known eating disorder (ED). METHODS: Completely answered EDI-C questionnaires were available from 201 girls diagnosed with an ED and from 2073 schoolgirls. The girls were adolescents attending grade 7-12. RESULTS: Internal consistency was 0.70-0.91 for the ED group. Eleven factors with eigenvalue > 2.2 explained 56% of the variance and showed satisfying correspondence to the proposed constructs of EDI-C. A discriminant analysis classified 85.6% of the cases correctly. The three most important discriminating subscales were Drive for Thinness, Asceticism and Body Dissatisfaction. All subscales except Maturity Fears showed significantly higher mean values for the ED group. CONCLUSIONS: The results indicate that the psychometric properties of EDI-C are comparable to the properties of EDI-2. EDI-C should be preferred for adolescents since its statements suit this age group.