Indicated, Internet-based Prevention for Women With Anorexia Nervosa Symptoms: A Randomised Controlled Efficacy Trial (Preprint)

BACKGROUND While preventive interventions for eating disorders in general have shown promise, interventions specifically targeting individuals at risk for anorexia nervosa have not been evaluated. OBJECTIVE To determine the efficacy of a guided, indicated, Internet-based prevention program for women at risk for anorexia nervosa (AN). METHODS Randomized, controlled efficacy trial for women at risk for AN. Assessments at baseline (pre), post-intervention (10 weeks after baseline), 6-, and 12-month follow-up (FU). 168 women with low body weight (17.5≤BMI≤19) and high weight concerns, or with normal body weight 19<BMI≤25, high weight concerns and high restrained eating were recruited from three German universities as well as online, and randomized to Student Bodies-AN (SB-AN) or a waiting list control group (CG). Exclusion criteria were current DSM-IV full-syndrome AN, bulimia nervosa or binge eating disorder, serious medical or mental problems, such as current substance abuse, acute or chronic organic or schizophrenic psychosis, severe suicidal ideation or behaviour, no Internet access. Interventions: 1. Cognitive-behavioural, guided, Internet-based prevention program (SB-AN) over 10 weeks (IG); 2. Waiting list control condition (CG). Primary outcomes were clinically significant changes in attitudes and behaviours of disordered eating, and change in BMI in the underweight group of participants at 12-month follow-up. Secondary outcomes are new onset of eating disorders, symptoms of disordered eating, and associated psychopathology. RESULTS Data were available at post-intervention for N=137 women, and for N=116 women at 12-month FU. At 12-month FU, IGs participants showed larger decreases in EDE Total scores (79% vs. 57%) compared to the CG, and underweight IG participants also showed larger clinically relevant increases in BMI (49% vs. 32%) compared with underweight CG participants, but these differences were not significant. In addition, at post-intervention and 12-month follow-up, we found a significant increase in continuously measured BMI for underweight participants and significant improvements in attitudes and behaviours of disordered eating (e.g., restrained eating, weight and shape concerns). At all time points, rates of newly emerging ED onset cases were (non-significantly) lower in the IG compared with the CG and reductions in DSM-5-based ED syndromes were (non-significantly) higher in the IG compared with the CG. CONCLUSIONS SB-AN is the first preventive intervention shown to significantly reduce specific risk factors and symptoms for AN and shows promise for reducing full-syndrome AN onset. CLINICALTRIAL ISRCTN70380261

Traditional versus developmental measures of weight suppression: Exploring their relationships with bulimic psychopathology

Objective: Weight suppression (WS) is related to a wide variety of eating disorder characteristics. However, individuals with eating disorders usually reach their highest premorbid weight while still developing physically. Therefore, a more sensitive index of individual differences in highest premorbid weight may be one that compares highest premorbid z-BMI to current z-BMI (called developmental weight suppression (DWS) here). Method: We compared the relationships between traditional weight suppression (TWS) and DWS and a wide variety of measures related to bulimic psychopathology in 91 females (M age, 25.2; 60.5% White), with clinical or sub-clinical bulimia nervosa. Results: TWS and DWS were correlated (r = .40). TWS was significantly related to only one of 23 outcome variables whereas DWS showed significant or near-significant relationships to 14 outcomes. DWS showed consistent positive relations with behavioral outcomes (e.g., binge eating) but consistent negative relations with cognitive/affective outcomes (e.g., weight concerns). Conclusions: Findings indicated a much more consistent relationship between the novel DWS measure and bulimic characteristics than with the traditional weight suppression measure. DWS showed both positive and negative relations with bulimic symptoms, though these findings require replication to confirm their validity. Consistent evidence indicated that the two WS measures served as mutual suppressor variables.

Validation of the Eating Disorder Examination Questionnaire in Danish Eating Disorder Patients and Athletes

The Eating Disorder Examination Questionnaire (EDE-Q) is a gold standard questionnaire to identify eating disorder symptoms but has not yet been validated in Danish. The scale consists of four theoretical constructs of disordered eating: Restraint eating, Eating concerns, Shape concerns and Weight concerns. However, the four-factor structure has been difficult to replicate across cultures. This study aimed to examine the factor structure and psychometric properties of the EDE-Q in Danish. The study consisted of four samples (aged 15–70): Patients with anorexia, bulimia and unspecified eating disorders (n = 101), patients with symptoms of binge-eating disorder (n = 300), recreational athletes (n = 404), and elite athletes (n = 526). Depending on the analysis performed, participants had to complete the EDE-Q, the SCOFF questionnaire for eating disorders or the Binge Eating Disorders Questionnaire. In accordance with international research, we found no evidence for a four-factor structure in the EDE-Q among patients or among athletes. But our results showed significant, positive associations between EDE-Q and SCOFF, BED-Q and MDI in all samples. We conclude that the internal structure of EDE-Q is low, while construct validity is high, making EDE-Q useful as an instrument to identify individuals with eating disorder symptoms, including recreational, and elite athletes.

Effects of Calorie Labelling, Motivation and Habits on Coffee Shop Menu Choices

Objective: To examine effects of calorie labelling, motivation and habits on the calorie content of items selected from a coffee-shop menuboard. Methods: In one exploratory (n = 70) and one pre-registered (n = 300) laboratory study, participants viewed a hypothetical calorie-labelled or non calorie-labelled menuboard and selected their preferred item(s). Coffee shop drinking habits were measured using the Self-Report Habit Index, and motivation was assessed with three items asking about eating healthily, watching weight and reading calorie labels. Participants also estimated calories contained in various drinks.Results: Labelling did not significantly affect the total calorie content of items selected. However, as predicted, in the pre-registered study there was a trend toward moderation by motivation (p = .056) with less motivated participants showing relatively greater calorie selection when exposed to labelling. Participants with weaker habits took longer to select items (p =.002) but, contrary to predictions, were not more influenced by labelling. Higher motivation was associated with selecting fewer calories (p = .002), correctly recalling the presence/absence of labelling (p = .016) and better estimating calorie content (p &lt; .001). Overall, participants significantly underestimated calories in higher calorie drinks but overestimated calories in lower calorie drinks. Conclusions: The results highlight the importance of underlying habits and motivation for obesity interventions and are relevant for the UK’s recent introduction of selective mandatory calorie labelling. In some instances, labelling may actually increase intake among those less motivated by health and weight concerns, but further research is needed to substantiate this concern.

A review of risk factors associated with insulin omission for weight loss in type 1 diabetes

Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.

Perceived Weight Gain and Eating Disorder Symptoms among LGBTQ+ Adults during the COVID-19 Pandemic: A Convergent Mixed-Method Study

BackgroundIn this study, we seek to further explore the role of COVID-19 pandemic-related stress, social support, and resilience on self-reported eating disorder symptoms (using the EDE-QS) and perceived weight gain among lesbian, gay, bisexual, transgender and/or queer (LGBTQ+ adults) in the US context during the COVID-19 pandemic. MethodsEmploying a convergent mixed method design, we surveyed 411 individuals, and conducted qualitative semi-structured follow-up interviews with 43 LGBTQ+-identifying survey respondents. Using OLS regression and multinomial logistic regression, we modeled eating disorder symptoms and perceived weight gain among LGBTQ+ individuals (n=120) and cisgender and heterosexual-identifying women (n=230), to cisgender and heterosexual-identifying men (n=61). We also explored complementary interview narratives among LGBTQ+ people by employing selective coding strategies. ResultsStudy results suggest that LGBTQ+ individuals are likely experiencing uniquely high levels of pandemic-related stress, and secondly, that pandemic-related stress is associated with elevated eating disorder symptoms and higher risk of perceived weight gain. Nearly 1 in 3 participants reported eating disorder symptoms of potentially clinical significance. Social support, but not resilient coping, was found to be protective against increased eating disorder symptoms. Qualitative analyses revealed that LGBTQ+ individuals situated physical exercise constraints, challenging eating patterns, and weight concerns within their pandemic experiences. ConclusionsClinicians of diverse specialties should screen for eating disorder symptoms and actively engage patients in conversations about their COVID-19 related weight gain and eating behaviors, particularly with LGBTQ+-identifying adults.