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The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (20 November 2021) | Viewed by 57116

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Special Issue Editors

Dr. Kirrilly Pursey

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Guest Editor

School of Health Sciences, College of Medicine, Health and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
Interests: disordered eating; addictive eating; paediatric nutrition
Special Issues, Collections and Topics in MDPI journals

Dr. Susan Hart

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Guest Editor

The Boden Colloboration of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
Interests: nutrition; eating disorders

Special Issue Information

Dear Colleagues,

Disordered eating encompasses a broad range of unhealthy eating attitudes and behaviours that can affect physical, mental and psychosocial health. The prevalence of disordered eating is increasing globally, highlighting the need for appropriate and effective treatments as well as prevention and health promotion approaches.

The aim of this Special Issue, “The Spectrum of Disordered Eating Attitudes and Behaviours: From Prevention to Treatment”, is to highlight emerging evidence across a broad scope of disordered eating, spanning from restrictive to overeating attitudes and behaviours and subclinical to diagnosable conditions, with a special focus on nutrition and dietetic management.

This special issue will provide health care professionals and researchers with emerging evidence around the identification, prevention, and treatment options to assist in improving the health outcomes and wellbeing of people affected by disordered eating behaviours.

Dr. Kirrilly Pursey
Dr. Susan Hart
Guest Editors

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Keywords

Feeding and eating disorders
Disordered eating
Eating disorders
Eating behaviours
Eating attitudes
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Food addiction
Refeeding
Nutrition
Treatment
Prevention

Published Papers (10 papers)

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Research

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11 pages, 298 KiB

Open AccessArticle

Psychosocial Factors in Adolescence and Risk of Development of Eating Disorders

by Fernando Mora, Miguel A. Alvarez-Mon, Sonia Fernandez-Rojo, Miguel A. Ortega, Miriam P. Felix-Alcantara, Isabel Morales-Gil, Alberto Rodriguez-Quiroga, Melchor Alvarez-Mon and Javier Quintero

Nutrients 2022, 14(7), 1481; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14071481 - 01 Apr 2022

Cited by 7 | Viewed by 3887

Abstract

Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg’s self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878–0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables ‘number of meals’ (p < 0.01), ‘dieting’ (p < 0.01), and ‘drug consumption to lose weight’ (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

17 pages, 1309 KiB

Open AccessArticle

Dietary Behavior and Risk of Orthorexia in Women with Celiac Disease

by Karolina Kujawowicz, Iwona Mirończuk-Chodakowska and Anna Maria Witkowska

Nutrients 2022, 14(4), 904; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14040904 - 21 Feb 2022

Cited by 10 | Viewed by 2688

Abstract

Evidence points to a link between celiac disease and eating disorders. Although with the current limited knowledge, orthorexia cannot be formally recognized as an eating disorder, some features are similar. This study is the first to examine individuals with celiac disease in terms of the prevalence of risk of orthorexia. Participants were 123 females diagnosed with celiac disease. The standardized ORTO-15 questionnaire was used to assess the risk of orthorexia. In this study, eating habits and physical activity were assessed. The effect of celiac disease on diet was self-assessed on a 5-point scale. Taking a score of 40 on the ORTO-15 test as the cut-off point, a risk of orthorexia was found in 71% of individuals with celiac disease, but only in 32% when the cut-off point was set at 35. There was a positive correlation between age and ORTO-15 test scores (rho = 0.30). In the group with orthorexia risk, meals were more often self-prepared (94%) compared to those without risk of orthorexia (78%) (p = 0.006). Individuals at risk for orthorexia were less likely to pay attention to the caloric content of food (46%) relative to those without risk of orthorexia (69%) (p = 0.001). For 64% of those at risk for orthorexia vs. 8% without risk had the thought of food that worried them (p = 0.001). Given the survey instrument for assessing the prevalence of orthorexia and the overlap between eating behaviors in celiac disease and orthorexia, the prevalence of orthorexia in celiac disease cannot be clearly established. Therefore, future research should focus on using other research tools to confirm the presence of orthorexia in celiac disease. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

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12 pages, 1126 KiB

Open AccessFeature PaperArticle

Eating Disorder Day Programs: Is There a Best Format?

by Ertimiss Eshkevari, Isabella Ferraro, Andrew McGregor and Tracey Wade

Nutrients 2022, 14(4), 879; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14040879 - 19 Feb 2022

Cited by 3 | Viewed by 3354

Abstract

The use of a Day Program (DP) format (i.e., intensive daily treatment with no overnight admission) has been shown to be an effective treatment for eating disorders (EDs). The disadvantages, however, include higher cost than outpatient treatment (including costs of meals and staff), greater disruption to patients’ lives, and the use of a highly structured and strict schedule that may interrupt the development of patients’ autonomy in taking responsibility for their recovery. This study investigated whether reducing costs of a DP and the disruption to patients’ lives, and increasing opportunity to develop autonomy, impacted clinical outcomes. Three sequential DP formats were compared in the current study: Format 1 was the most expensive (provision of supported dinners three times/week and extended staff hours); Format 2 included only one dinner/week and provision of a take-home meal. Both formats gave greater support to patients who were not progressing well (i.e., extended admission and extensive support from staff when experiencing feelings of suicidality or self-harm). Format 3 did not provide this greater support but established pre-determined admission lengths and required the patient to step out of the program temporarily when feeling suicidal. Fifty-six patients were included in the analyses: 45% were underweight (body mass index (BMI) < 18.5), 96.4% were female, 63% were given a primary diagnosis of anorexia nervosa (or atypical anorexia nervosa), and mean age was 25.57 years. Clinical outcomes were assessed using self-reported measures of disordered eating, psychosocial impairment, and negative mood, but BMI was recorded by staff. Over admission, 4- and 8-week post-admission, and discharge there were no significant differences between any of the clinical outcomes across the three formats. We can tentatively conclude that decreasing costs and increasing the opportunities for autonomy did not negatively impact patient outcomes, but future research should seek to replicate these results in other and larger populations that allow conclusions to be drawn for different eating disorder diagnostic groups. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

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17 pages, 341 KiB

Open AccessArticle

Polish Adaptation of the Dutch Eating Behaviour Questionnaire (DEBQ): The Role of Eating Style in Explaining Food Intake—A Cross-Sectional Study

by Aleksandra Małachowska, Marzena Jeżewska-Zychowicz and Jerzy Gębski

Nutrients 2021, 13(12), 4486; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13124486 - 15 Dec 2021

Cited by 13 | Viewed by 4248

Abstract

Knowledge of associations between emotional, external, and restrained eating with food choices is still limited due to the inconsistent results of the previous research. The aim of the study was to adopt the Dutch Eating Behavior Questionnaire (DEBQ) and then to examine the relationship between emotional, external, and restrained eating styles and dietary patterns distinguished on the basis of intake of fruit and vegetables (fresh and processed separately), fruit and/or vegetable unsweetened juices, sweets and salty snacks, and the adequacy of fruit and vegetable intake. The cross-sectional study was conducted in 2020, in a sample of 1000 Polish adults. The questionnaire consisted of the Dutch Eating Behavior Questionnaire, questions on selected food groups intake, and metrics. DEBQ structure was tested using both exploratory and confirmatory factor analysis (EFA, CFA) and structural equation modelling (SEM), while multi-group analysis was used to test measurement invariance. Logistic regression was applied to investigate the association between eating styles and dietary patterns, identified with the use of K-means cluster analysis. EFA, CFA and SEM revealed a three-factor, 29-item tool with satisfactory psychometric parameters. Restrained eating (ResEat) and external eating (ExtEat) were found to decrease chances of low intake of both favorable (fruit, vegetables, and unsweetened juices) and unfavorable (sweets and salty snacks) foods and increased the chances of their moderate intake. ResEat increased the probability of the high intake of favorable and moderate or high intake of unfavorable foods. ResEat and ExtEat were predisposed to adequate intake of fruit and vegetables while emotional eating had the opposite effect. Gender, education, and BMI were also found to determine food intake. Our results provide evidence that both eating styles and sociodemographic characteristics should be taken into account while explaining food intake as they may favor healthy and unhealthy eating in different ways. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

13 pages, 2871 KiB

Open AccessArticle

Why Do Women with Eating Disorders Decline Treatment? A Qualitative Study of Barriers to Specialized Eating Disorder Treatment

by Sofie T. Andersen, Thea Linkhorst, Frederik A. Gildberg and Magnus Sjögren

Nutrients 2021, 13(11), 4033; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13114033 - 11 Nov 2021

Cited by 4 | Viewed by 4420

Abstract

Despite the fact that eating disorders (EDs) are conditions that are potentially life-threatening, many people decline treatment. The aim of this study was to investigate why women decline specialized ED treatment, including their viewpoints on treatment services. Eighteen semi-structured qualitative interviews were conducted with women who had declined inpatient or outpatient specialized ED treatment. A thematic analysis revealed five main themes: (1) Disagreement on treatment needs, (2) rigid standard procedures, (3) failure to listen, (4) deprivation of identity, and (5) mistrust and fear. The women had declined ED treatment because they believed that treatment was only focused on nutritional rehabilitation and that it failed to address their self-identified needs. From their perspectives treatment was characterized by rigid standard procedures that could not be adapted to their individual situations and preferences. They felt that the therapists failed to listen to them, and they felt deprived of identity and reduced to an ED instead of a real person. This investigation is one of the first of its kind to provide clues as to how treatment could be moderated to better meet the needs of women who decline specialized ED treatment. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

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17 pages, 619 KiB

Open AccessArticle

Outcomes of a Cluster Randomized Controlled Trial of the SoMe Social Media Literacy Program for Improving Body Image-Related Outcomes in Adolescent Boys and Girls

by Chloe S. Gordon, Hannah K. Jarman, Rachel F. Rodgers, Siân A. McLean, Amy Slater, Matthew Fuller-Tyszkiewicz and Susan J. Paxton

Nutrients 2021, 13(11), 3825; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13113825 - 27 Oct 2021

Cited by 14 | Viewed by 8532

Abstract

Although the negative effect of social media use among youth on body image and eating concerns has been established, few classroom-based resources that can decrease these effects through targeting social media literacy skills have been developed. This study aimed to test the efficacy of SoMe, a social media literacy body image, dieting, and wellbeing program for adolescents, through a cluster randomized controlled trial. Participants (n = 892; M_age = 12.77, SD = 0.74; range 11–15; 49.5% male) were randomized by school (n = 8) to receive either weekly SoMe (n = 483) or control sessions (lessons as usual; n = 409) over 4 weeks in their classroom. Participants completed surveys at four timepoints (baseline, 1-week post-intervention, and 6- and 12-month follow-up) assessing body dissatisfaction, dietary restraint, strategies to increase muscles (primary outcomes), self-esteem and depressive symptoms (secondary outcomes), and internalization of appearance ideals and appearance comparison (exploratory outcomes). Modest positive intervention effects were found in dietary restraint and depressive symptoms at 6-month follow-up in girls but few positive effects emerged for boys. The findings provide only preliminary support for a social media literacy intervention, but suggest the usefulness of both identifying those who benefit most from a universally delivered intervention and the need to refine the intervention to maximize intervention effects. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

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Review

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31 pages, 1071 KiB

Open AccessReview

Stigmatization toward People with Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder: A Scoping Review

by Lisa Brelet, Valentin Flaudias, Michel Désert, Sébastien Guillaume, Pierre-Michel Llorca and Yves Boirie

Nutrients 2021, 13(8), 2834; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13082834 - 18 Aug 2021

Cited by 27 | Viewed by 14339

Abstract

Research about stigmatization in eating disorders (EDs) has highlighted stereotypes, prejudices, and discrimination against people with EDs, as well as their harmful effects on them, including self-stigma and a difficult recovery process. Whereas a recent review focused on the consequences of ED stigma, our work aimed to provide a broader synthesis of ED stigma, including its consequences, but also its content and distribution. More precisely, we focused on three EDs—namely, anorexia nervosa, bulimia nervosa, and binge eating disorder. Based on a systematic search of four major databases in psychology, the present scoping review includes 46 studies published between 2004 and 2021. We did not conduct any quality assessment of the studies included, because our aim was to provide a wide-ranging overview of these topics instead of an appraisal of evidence answering a precise research question. The review confirmed the existence of a common ED stigma: all individuals affected by EDs reviewed here were perceived as responsible for their situation, and elicited negative emotions and social distance. However, our review also depicted a specific stigma content associated with each ED. In addition, the demographic characteristics of the stigmatizing individuals had a notable influence on the extent of ED stigma: men, young adults, and low-income individuals appeared to be the most stigmatizing toward individuals with EDs. It is important to note that ED stigma had a negative effect on individuals’ eating disorders, psychological wellbeing, and treatment-seeking behavior. There is an urgent need for further research on the adverse effects of ED stigma and its prevention. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

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Other

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22 pages, 700 KiB

Open AccessSystematic Review

The Relationship between Addictive Eating and Dietary Intake: A Systematic Review

by Kirrilly M. Pursey, Janelle Skinner, Mark Leary and Tracy Burrows

Nutrients 2022, 14(1), 164; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14010164 - 30 Dec 2021

Cited by 14 | Viewed by 3313

Abstract

(1) Background: Research suggests that certain foods may have addictive effects; however, no reviews have systematically appraised studies in this area. The aims of this review were to determine the nutrients, foods and dietary patterns associated with addictive eating. (2) Methods: Published studies up to November 2020 were identified through searches of 6 electronic databases. Eligible studies included those in in children and adults that reported dietary intakes of individuals with ‘food addiction’. (3) Results: Fifteen studies (n = 12 in adults and n = 3 in children/adolescents with Yale Food Addiction Scale defined ‘food addiction’) were included. Foods commonly associated with addictive eating were those high in a combination of fat and refined carbohydrates. Generally, intakes of energy, carbohydrates and fats were significantly higher in individuals with addictive eating compared to those without. (4) Conclusions: Due to the heterogeneity in study methodologies and outcomes across included studies, it is difficult to conclude if any specific foods, nutrients or dietary patterns facilitate an addictive process. Further research is needed to elucidate potential associations. However, present addictive eating treatment approaches could incorporate individualised dietary advice targeting foods high in fat and refined carbohydrates. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

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21 pages, 1066 KiB

Open AccessSystematic Review

Beyond Refeeding: The Effect of Including a Dietitian in Eating Disorder Treatment. A Systematic Review

by Yive Yang, Janet Conti, Caitlin M. McMaster and Phillipa Hay

Nutrients 2021, 13(12), 4490; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13124490 - 15 Dec 2021

Cited by 6 | Viewed by 6368

Abstract

Eating disorders are potentially life-threatening mental health disorders that require management by a multidisciplinary team including medical, psychological and dietetic specialties. This review systematically evaluated the available literature to determine the effect of including a dietitian in outpatient eating disorder (ED) treatment, and to contribute to the understanding of a dietitian’s role in ED treatment. Six databases and Google Scholar were searched for articles that compared treatment outcomes for individuals receiving specialist dietetic treatment with outcomes for those receiving any comparative treatment. Studies needed to be controlled trials where outcomes were measured by a validated instrument (PROSPERO CRD42021224126). The searches returned 16,327 articles, of which 11 articles reporting on 10 studies were included. Two studies found that dietetic intervention significantly improved ED psychopathology, and three found that it did not. Three studies reported that dietetic input improved other psychopathological markers, and three reported that it did not. One consistent finding was that dietetic input improved body mass index/weight and nutritional intake, although only two and three studies reported on each outcome, respectively. A variety of instruments were used to measure each outcome type, making direct comparisons between studies difficult. Furthermore, there was no consistent definition of the dietetic components included, with many containing psychological components. Most studies included were also published over 20 years ago and are now out of date. Further research is needed to develop consistent dietetic guidelines and outcome measures; this would help to clearly define the role of each member of the multidisciplinary team, and particularly the role of dietitians, in ED treatment. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

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28 pages, 590 KiB

Open AccessSystematic Review

Disordered Eating among People with Schizophrenia Spectrum Disorders: A Systematic Review

by Anoop Sankaranarayanan, Karthika Johnson, Sanop J. Mammen, Helen E. Wilding, Deepali Vasani, Vijaya Murali, Deborah Mitchison, David J. Castle and Phillipa Hay

Nutrients 2021, 13(11), 3820; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13113820 - 27 Oct 2021

Cited by 19 | Viewed by 4237

Abstract

Disordered eating, or abnormal eating behaviours that do not meet the criteria for an independent eating disorder, have been reported among people with schizophrenia. We aimed to systemati-cally review literature on disordered eating among people with schizophrenia spectrum disorder (SSD). Seven databases were systematically searched for studies that described the prevalence and correlates of disordered eating among patients with SSD from January 1984 to 15 February 2021. Qualitative analysis was performed using the National Institutes of Health scales. Of 5504 records identified, 31 studies involving 471,159 subjects were included in the systematic review. The ma-jority of studies (17) rated fair on qualitative analysis and included more men, and participants in their 30s and 40s, on antipsychotics. The commonest limitations include lack of sample size or power calculations, poor sample description, not using valid tools, or not adjusting for con-founders. The reported rates were 4.4% to 45% for binge eating, 16.1% to 64%, for food craving, 27% to 60.6% for food addiction, and 4% to 30% for night eating. Positive associations were re-ported for binge eating with antipsychotic use and female gender, between food craving and weight gain, between food addiction and increased dietary intake, and between disordered eating and female gender, mood and psychotic symptoms. Reported rates for disordered eating among people with SSD are higher than those in the general population. We will discuss the clinical, treatment and research implications of our findings. Full article

(This article belongs to the Special Issue The Spectrum of Eating Disorder Attitudes and Behaviors: From Prevention to Treatment)

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