Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 61: (i) Sociocultural Factors (n = 2); (ii) Social Media (n = 3); (iii) Weight Stigma, Part 5 (n = 2); (iv) DE, Part 5 (n = 2); and (v) ARFID, Part 5 (n = 2)
Colleagues (N now = 1221 in 48 countries),
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list.
REQUEST FOR RESEARCH PARTICIPATION AND/OR ASSISTANCE RECRUITING
English-speaking/reading Adults Living in Australia
from [our own] Ms. Chantal Delaquis, University of Bordeaux (France)
for, as part of her doctoral studies, an investigation entitled:
What's on Your Plate? Unraveling Contributors to [Disordered] Eating Behaviour
Received yesterday (California time), 2 September 2024, via an email from our own Ms. Chantal Delaquis (France).
ML NOTE 1: As noted below, Ms. Delaquis and Drs. Jayanthi Raman and Sylvie Berthoz and I would appreciate if you would participate in this research, if eligible, and/or pass this along to anyone who might be eligible and/or clinicians, physicians, nurse practitioners, etc., who work with people who might be eligible.
[Ms. Delaquis writes; bold in the original:]
I am currently collaborating with the University of Newcastle (Australia) on a survey study, and I would appreciate if you could disseminate the following information about our study, entitled: What's on Your Plate? Unraveling Contributors to Eating Behaviour.
Drs. Jayanthi Raman, Sylvie Berthoz and I would appreciate if you would participate in this research, if eligible, and/or pass this along to anyone who might be eligible and/or clinicians, physicians, nurse practitioners, etc., who work with people who might be eligible. Participation in this study is entirely voluntary. The research is part of my doctoral studies at the University of Bordeaux supervised by Dr. Sylvie Berthoz from the EcoPsy research team, in collaboration with Dr. Jay Raman from the Three Squares Lab at the University of Newcastle.
My colleagues and I are conducting a study to investigate the connections between eating behaviour, like binging, purging and food restriction, and psychological factors such as perfectionism, self-esteem, flexibility, and emotion regulation. We will create networks that show how these factors are connected in people with and without these eating behaviours. This will help us to understand which psychological factors differentiate people who struggle with certain eating behaviours and those who do not, with the long-term goal of identifying key symptoms to target in eating disorder treatment across the spectrum of disordered eating behaviour.
To participate in this survey, please see the eligibility criteria below:
a) More than 18 years old
b) Have proficient English speaking and reading ability
c) Living in Australia
d) Not pregnant or breastfeeding
e) Interested in helping us to better understand the role of psychological factors like perfectionism, self-esteem, flexibility and emotions in eating behaviour
If you agree to participate, you will be asked to complete an anonymous survey, which includes demographic questions (e.g., age, sex, height and weight, ethnicity, eating behaviour, medical and psychiatric diagnoses, eating disorder treatment), questions about your eating behaviour, emotions, attachment style, perfectionism, self-esteem, your ability to be flexible in your thinking, and mood. We have also included optional open-ended questions for people who have experienced treatment for an eating disorder, to give you the opportunity to elaborate, in your own words, on your experience with this treatment if you wish to do so.
This survey will have approximately 30–45 minutes to complete.
To participate, please click on the following link: https://uninewcastle.questionpro.com.au/t/ARpYEZRvIw
Your participation in this study is completely voluntary, and you may refuse to answer any questions or stop your participation at any time. After completing the survey, you will be compensated for your time with a $15 AUD gift voucher. At the end of the main survey, you will be provided with a link to a separate questionnaire that collects your email address so that we can send you the voucher. This email address will not be linked to your survey responses.
If you have any questions or concerns, please don't hesitate to contact the principal investigator, Jay Raman at: Jay.Raman@newcastle.edu.au
We are more than happy to provide you with any additional information you may need. Thank you for considering this invitation and for your potential contribution to this important research!
Chantal Delaquis, PhD student | Dr. Sylvie Berthoz, PhD supervisor, co-leader of EcoPsy team | Dr. Jay Raman, Head of the Three Squares Lab
EVERYTHING IS ADVOCACY REQUEST from
our own Dr. Marcella Radunz (Australia) and colleagues for
UNPUBLISHED DATA from dissertations, theses, conference presentations, reports, etc., pertaining to
Help-Seeking for Eating Disorders
for an ongoing Meta-Analysis
PLEASE RESPOND by Monday, September 16, 2024
Received yesterday (California time) via an everything-is-advocacy email from our own Dr. Marcela Radunz (Australia).
ML NOTE 2: Dr. Radunz and her colleagues and I would appreciate it if you would pass this request along to any and all researchers who might have unpublished data regarding help-seeking for eating disorders.
ML NOTE 3: Drs. Laura Hart (Australia), Sian McLean (Australia), and Anne O’Shea (Australia) are also members of this Group.
I am reaching out to you as I am currently working with Drs. Kathina Ali, Laura Hart, Sian McLean, Anne O’Shea and Dan Fassnacht on a systematic review and meta-analysis of help-seeking rates in the eating disorders.
I am wondering if you would be able to kindly share in your upcoming newsletter a request for unpublished data from colleagues across the globe. We hope that by incorporating both peer reviewed and unpublished data/reports we help reduce our concerns of publication bias.
[Here is the post; bold-for-emphasis added by ML]
Researchers are conducting a review on help-seeking rates for eating disorders and are reaching out to capture any unpublished data or reports. If you believe you have a study which meets the following criteria, please email by Monday, 16th September: bewell@usc.edu.au
(1) Observational study (i.e., cross-sectional, case-control, or cohort studies) with the inclusion of a community sample (including tertiary student samples) of help-seekers and non-help seekers. Trials in clinical populations reporting non-engagement of participants (e.g., participants who are recruited into a clinical trial but do not start the intervention or stop the intervention before completion) are not considered.
(2) Assessment of current eating disorder status using a standardised screening measure (e.g., Eating Disorder Examination-Questionnaire, EDE-Q) or using objective standard criteria (e.g., Eating Disorder Examination interview, EDE).
(3) The study needs to report the number (or percentage) of participants who had sought help or had received treatment for eating disorder concerns which is defined as “Any help received from a medical or mental health professional qualified to treat eating disorders (e.g., a general practitioner or physician, psychiatrist, psychologist or allied health professional) with the explicit purpose of alleviating or changing the symptoms of an eating disorder”.
Dr Marcela Radunz | PhD (Clin Psych), B. Psych (Hons) | Research Associate (Clinical Psychology) |College of Education, Psychology, and Social Work, Flinders University | Email: marcela.radunz@flinders.edu.au
Research Publication Categories in This Newsletter
(i) Sociocultural Factors (n = 2); (ii) Social Media (n = 3); (iii) Weight Stigma, Part 5 (n = 2); (iv) Disordered Eating, Part 5 (n = 2); and (v) ARFID, Part 5 (n = 2)
CONGRATULATIONS to our own
Dr. Kate Mulgrew (Australia) and colleagues for publication of the Families and Eating Disorders article in #1.
Drs. Amanda Raffoul (USA) and S. Bryn Austin (USA) and colleagues for publication of the Social Media research article in #4.
Drs. Eva Kemps (Australia) and Ivanka Prichard (Australia) and colleague for publication of the Social Media research article in #5.
Drs. Jason Nagata (USA) and Kyle Ganson (Canada) and colleagues for publication of the Disordered Eating research article in #8
Drs. Lauren Breithaupt (USA), Helen Burton-Murray (USA), Kamryn Eddy (USA), and Jennifer Thomas (USA) and colleagues for publication of the ARFID research article in #10.
Sociocultural Factors
1. Prince, T., Mulgrew, K. E., Driver, C., Loza, J., & Hermens, D. F. (2024). Appearance-related cyberbullying and its association with the desire to alter physical appearance among adolescent females. Journal of Eating Disorders, 12, 125. https://doi.org/10.1186/s40337-024-01083-z
Full text available for download at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01083-z#citeas
ABSTRACT. Cyberbullying is associated with various mental health concerns in adolescents, including body dissatisfaction and disordered eating behaviours. However, there is a significant research gap concerning the unique effects of appearance-related cyberbullying (ARC) on adolescent mental health. This study examined the prevalence and psychological consequences of ARC among middle to late adolescent females (aged 14–19 years, Mage = 15.98, N = 336). Participants completed an online survey regarding their experiences of ARC, body image variables, and eating disorder symptomology.
Findings indicate the widespread occurrence of ARC among adolescent females, with body shape and size emerging as predominant targets. Experiences of ARC-victimisation positively correlated with increased concerns about body shape, body shame, and eating disorder symptomology. Conversely, experiences of ARC-victimisation were negatively correlated with body esteem and body appreciation. Finally, appearance-related cybervictimisation was significantly associated with adolescent females’ desire to pursue appearance alterations through methods such as dieting and exercising, altering self-presentation, and undergoing cosmetic procedures due to perceived experiences of ARC.
These findings highlight the urgent need for preventative measures, such as age-appropriate social media policies and health promotion programs that encourage positive online behaviour, and strategies to address the impacts of ARC to protect the mental well-being of adolescent females.
Plain English Summary: Cyberbullying directed towards appearance is a serious problem for many adolescent females. Our study examined how often this type of cyberbullying happens online and its impact on females aged 14–19. We found that many adolescent females experience appearance-related cyberbullying, where they are teased or insulted about their body shape, weight, or physical features. These experiences make them more likely to feel bad about their bodies, leading to harmful behaviours like extreme dieting or considering cosmetic surgery. These findings highlight the urgent need for action from schools, parents, and social media platforms to prevent this form of cyberbullying and support those affected.
2. Troscianko, E. T., Riestra-Camacho, R., & Carney, J. (2024). Ethics-testing an eating disorder recovery memoir: A pre-publication experiment. Journal of Eating Disorders, 12, 114. https://doi.org/10.1186/s40337-024-01060-6
Full text available for download at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01060-6
ABSTRACT. Background: Narratives (including memoirs and novels) about eating disorders (EDs) are typically published with the intention to benefit readers, but survey evidence suggests that reading such narratives with an active ED may more often be harmful than helpful. To reduce the probability of inadvertent harm and learn more about how narrative reading and EDs interact, a pre-publication study was designed to determine whether or not a recovery memoir should be published.
Methods: 64 participants with a self-reported ED read either the experimental text (The Hungry Anorexic [HA]) or a control text (Ten Zen Questions [TZ]) over a roughly two-week period. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) one week before and two weeks after reading, and answered three recurring open-ended questions at regular timepoints during and after the reading.
Computational analysis of the free-text responses assessed text/response similarity and response characteristics on emotional, sensory, and action-effector dimensions. Both rating-scale and free-text data were analysed using mixed ANOVAs to test for effects of time and condition, and the university ethics board was notified in advance of the quantitative threshold for harmful effects that would prohibit the ED memoir from being published.
Results: On the two quantitative measures, there was an effect of time but not of condition: Significant improvement was found in both groups on the EDE-Q (with a medium-to-large effect size) and the ANSOCQ (with a very large effect size). In an ANCOVA analysis, no significant mediating effects were found for age, education, duration of professional support for the ED, or pre/post-reading BMI change. For the free-text responses, linguistic similarity measures indicated that HA responses most closely matched the text of HA, with the same being true for TZ.
In a word-norm analysis, text condition significantly affected six emotional, sensory, and action-effector variables (interoception, olfaction, gustatory, mouth, torso, and hand/arm), mean scores for all of which were higher in HA responses than TZ responses. Close reading of readers’ responses explored two potential mechanisms for the positive effects of time but not condition: engagement with the during-reading prompts as part of the experimental setup and engagement with the texts’ dialogical form.
Conclusions: The ED memoir was found not to yield measurably harmful effects for readers with an ED, and will therefore be published. The finding that significant improvement on both quantitative measures was observed irrespective of text condition suggests that positive effects may be attributable to linguistic characteristics shared by the two texts or to elements of the reading and/or reflective processes scaffolded by both. The quantitative results and the free-text testimony have implications for our understanding of bibliotherapy, “triggering”, and the practicalities of responsible publishing.
Plain English summary: This paper reports on an experiment designed to decide whether a memoir about recovery from an eating disorder (ED) should be published. Previous research suggested that reading books about EDs may have strongly negative effects, especially for individuals with an ED.
In this experiment, 64 participants were randomly assigned to read either the memoir under investigation, The Hungry Anorexic (HA), or a book unrelated to EDs, Ten Zen Questions (TZ). Participants completed two questionnaires before and after reading the book over roughly two weeks: the Eating Disorder Examination Questionnaire (EDE-Q), a common measure of eating disorder severity, and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), used to assess attitudes to illness and recovery. Participants also answered three recurring open-ended questions at timepoints during and after their reading.
The book would not be published if EDE-Q scores of participants in the HA group worsened significantly, and worsened more than those of participants in the TZ group. Scores on both measures improved significantly between pre- and post-reading for both groups, so the memoir will be published. The positive effects may be due to a feature shared by the two books or a feature of the reading process independent of the books themselves.
Social Media
3. You, S., & Kwon, M. (2024). Self-objectification of bodies in social networking sites: Mental and behavioral health problems of young female adults. Health Care for Women International. Advance online publication. https://doi.org/10.1080/07399332.2024.2392530
Email address for correspondence: skyou@hufs.ac.kr
ABSTRACT. Social network sites (SNS) are becoming a popular means of “digital leisure” among young adults. Several problematic consequences of extensive SNS use have been reported including objectifying bodies on SNS. Thus, in this study, we aimed to understand the specific pathway between young female adults’ SNS use and mental and behavioral problems using the objectification theory framework.
We conducted structural equation modeling of data from 507 Korean female undergraduates to elucidate the relationships between SNS use and self-esteem, depression, abnormal eating, and exercise dependence, and the mediation effects of body surveillance and body shame.
A significant direct relationship between SNS use and problematic consequences was found only between SNS use and exercise dependence. Mediation effects of body surveillance and body shame were confirmed in all four relationships. In this study, the researchers expand the objectification theory’s applicability to SNS platforms and identify a potential mechanism of consequent adverse outcomes, providing useful empirical evidence for preventive educational measures.
4. Raffoul, A., Monique Santoso, M., Junjie Lu, J., Valeria Duran, V., & Austin, S. B. (2024). Diet pills and deception: A content analysis of weight-loss, muscle-building, and cleanse and detox supplements videos on TikTok. Eating Behaviors, 55. Advance online publication. https://doi.org/10.1016/j.eatbeh.2024.101911
Full text available for download at: https://www.sciencedirect.com/science/article/pii/S1471015324000709
ABSTRACT. The promotion of harmful dieting-related products, including weight-loss, muscle-building, and cleanse/detox supplements, is pervasive across TikTok. Use of these products has been associated with eating pathology, and in some instances, increased risk of an eating disorder diagnosis.
To inform eating disorders prevention and public health intervention, a content analysis was conducted to analyze the promotional features of the most viewed videos as of June 2022 in the U.S. across popular dieting product-related hashtags (#dietpills, #preworkout, #detox) (N = 233 videos). Investigators watched and coded videos using a codebook that captured details about featured individuals, product claims and details, and other video elements (e.g., language, use of popular music). Descriptive statistics were obtained to analyze trends within and across product hashtags.
A total of 78 #dietpills, 86 #preworkout, and 69 #detox videos met study criteria. Videos promoting weight-loss and cleanse/detox products overwhelmingly featured feminine-presenting (70.5 % and 71 %, respectively) and thin (35.9 % and 44.9 %) individuals, while #preworkout video subjects were mostly masculine-presenting (73.3 %) and muscular (61.6 %). Most did not disclose their credentials (93.6 %) nor identify whether the promotion of the product was sponsored by the retailer (95.7 %). The vast majority of videos (97 %) did not provide any scientific evidence to support health- and appearance-related claims.
The most popular videos promoting dieting-related supplements on TikTok overwhelmingly make unsubstantiated health claims, posing substantial risks for social media users who are vulnerable to their usage and associated health risks, including engagement in disordered eating.
5. Beos, N., Kemps, E., & Prichard, I. (2024). Relationships between social media, body image, physical activity, and anabolic-androgenic steroid use in men: A systematic review. Psychology of Men & Masculinities. Advance online publication. https://doi.org/10.1037/men0000487
Email address for correspondence: ivanka.prichard@flinders.edu.au
ABSTRACT. Research suggests that social media use is linked to greater body image concerns and appearance-altering behaviors (e.g., physical activity, anabolic-androgenic steroid use) in men; however, no review has collated these results specifically for men. Thus, the current systematic review examined the relationships between social media and body image (e.g., body satisfaction, internalization of the muscular ideal, self-objectification), physical activity, and anabolic-androgenic steroid use in men.
Six electronic databases were searched. Included studies (N = 60) isolated the male data and reported at least one analysis of the relationship between social media and either body image, physical activity, and/or anabolic-androgenic steroid use. Studies looked at either general social media use, appearance-related social media behaviors, or exposure to social media content.
Overall, while some forms of social media (namely, appearance-related) were linked to body image and appearance-altering behaviors, findings were mixed. This was attributed to the diversity and appropriateness of outcome measures for use with men and the type of social media (e.g., time spent on social media, selfie behaviors) used. However, it was clear that appearance-related social media use is related to a more negative body image and greater odds of anabolic-androgenic steroid use in men. Future research should continue to investigate the impacts of social media on men and choose appropriate measures for this demographic.
Impact Statement: Social media use is negatively associated with body image/appearance-altering behaviors in men. Results are mixed due to the variety of measures used and low percentage of men in samples. Future research should focus on appearance-related social media, with more experimental, longitudinal, and qualitative research recommended.
Weight Stigma, Part 5 of Many
6. Pearl, R. L., Friedman Donze, L., Rosas, L. G., Agurs-Collins, T., Breland, J. Y., Byker Shanks, C., Stowers, K. C., Johnson, S., Lee, B. Y., Martin, M. Y., Mujuru, P., Odoms-Young, A., Panza, E., Pronk, N., Calicutt, K., Nadglowski, J., Nece, P. M., Tedder, M., Chow, L., Krishnamurti, H., . . . Stanford, F. C. (2024). Ending weight stigma to advance health equity. American Journal of Preventive Medicine. Advance online publication. https://doi.org/10.1016/j.amepre.2024.06.021
Email address for correspondence: lisa.pearl@ufl.edu
ABSTRACT. None
7. Barnes, R.D., & Lawson, J. L. (2024). Weight stigma and binge eating related to poorer perceptions of healthcare provider interaction quality in a community-based sample. Journal of Eating Disorders, 12, 128. https://doi.org/10.1186/s40337-024-01093-x
Full text available for download at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01093-x#citeas
ABSTRACT. Background: Weight stigma refers to the social rejection, discrimination, and ideological devaluation of individuals because of body size and is a direct result of weight bias and anti-fat attitudes. Individuals with higher weight may be less likely to seek healthcare due to weight stigma, and if or when they do present for care, medical providers with weight bias may fail to provide high quality care. Little, however, is known about the intersectionality of weight stigma and perceptions of healthcare interactions as experienced by individuals who also binge eat.
Methods: Community-based adults completed online self-report questionnaires regarding generalized weight stigma (Attitudes Towards Obese Persons1), healthcare interaction quality (Patient Perceptions of Healthcare Provider Interaction Quality; PPH), and disordered eating (Eating Disorder Examination-Questionnaire) via Amazon’s Mechanical Turk platform. For this cross-sectional study, participants were categorized by the presence and absence of regular binge episodes. Pearson’s correlations, T-tests, ANOVA/ANCOVA, and a multivariate regression were used to examine relationships among demographic variables, weight stigma, disordered eating, and the PPH.
Results: Participants (N = 648) primarily identified as female (65.4%) and White, non-Hispanic (72.7%). Participants’ average age and body mass index (BMI) were 37.5 (SD = 12.3) years old and 27.3 (SD = 6.9) kg/m2, respectively. Higher healthcare provider interaction quality ratings (PPH) were significantly related to lower BMI (r(648) = -0.098, p = 0.012), less weight stigma (r(648) = 0.149, p < 0.001), and identifying as a woman (t(514) = 2.09, p = 0.037, Cohen’s d = 0.165) or White, non-Hispanic (t(646)=-2.73, p = 0.007, Cohen’s d=-0.240).
Participants reporting regular binge eating endorsed significantly worse perceptions of healthcare provider quality than those who did not, even after accounting for BMI, F(1, 645) = 8.42, p = 0.004, η2 = 0.013. A multivariate linear regression examining the PPH as dependent, and weight stigma and binge eating as independent, variable/s, was significant even after accounting for covariates (sex, race, BMI), F(95, 640) = 7.13, p < 0.001, R2 = 0.053 (small effect).
Conclusions: More negative experiences with healthcare providers was associated with worse weight stigma, higher BMI, regular binge eating and overall disordered eating, and for participants identifying as male or a Person of Color. These data have implications for non-clinical community populations and are particularly important as experiencing poorer quality of interactions with healthcare providers may decrease individuals’ likelihood of seeking needed care for both disordered eating and health-related concerns.
Plain English summary: Weight stigma refers to the discrimination towards individuals because of body size. Individuals who identify as a Person of Color and who experience binge eating may experience additional discrimination, resulting in barriers to receiving healthcare. To examine these relationships, a community-based sample (N = 648) completed health- and eating-related questionnaires online.
Participants who had higher weight rated their perceptions of their interactions with healthcare providers as lower quality. People of Color and men reported lower quality of perceptions of their healthcare provider interactions compared to White, non-Hispanic and female participants, respectively. Participants reporting less weight stigma also reported more positive interactions with their healthcare providers. Participants who reported regular binge eating episodes reported worse quality of interactions with their healthcare providers compared to those who did not report regular binge eating, regardless of their weight.
Participants endorsing more stigmatizing views of individuals with higher weight and those reporting regular binge eating were more likely to report poorer perceived quality of interactions with healthcare providers, regardless of their weight, race/ethnicity, or sex. These findings are of particular importance as experiencing poor quality interactions with healthcare providers may be a barrier to receiving needed healthcare.
Disordered Eating, Part 5 of 5
8. White, C., Pang, N., Nagata, J. M., Zaitsoff, S., & Ganson, K. T. (2024). Losing, gaining, or staying the same: How do different weight change attempts relate to muscle dysmorphia and eating disorder symptoms across genders? Eating Disorders: The Journal of Treatment & Prevention. Advance online publication. https://doi.org/10.1080/10640266.2024.2391208
Email address for correspondence: kyle.ganson@utoronto.ca
ABSTRACT. Adolescents and young adults are at heightened risk for eating disorder (ED) and muscle dysmorphia (MD) symptoms; yet, these symptoms and their relationships to harmful behaviors may also vary by gender. Thus, this study examined: 1) the prevalence of attempts to lose, gain, or maintain the same weight across gender identities, 2) purposes of weight change attempts, and 3) relationships between weight change attempts and ED and MD symptoms across cisgender men, women, and transgender and gender expansive (TGE) youth.
940 adolescents and young adults (57.4% cisgender women, 33.8% cisgender men, 8.8% TGE) completed questionnaires about weight change attempts, ED and MD symptoms. Women and TGE individuals attempted to lose weight more often than men, while men attempted to gain weight more often. All genders endorsed weight loss and gain attempts for different purposes. Weight loss attempts related to ED symptoms and appearance intolerance, whereas weight gain attempts related to MD symptoms across genders.
In women, all weight change attempts related to greater functional impairment due to exercise. Findings highlight the need for tailored interventions to address desires to change one’s body and underscore the harmful effects of weight change attempts across genders.
ML NOTE 4: In regard to the Power et al. (2024) study described below in #9 — and in regard to the always important, always tricky issues of risk factor determination, correlation, causality, and research design — see the Wikipedia page on Mendelian randomization (https://en.wikipedia.org/wiki/Mendelian_randomization) for an introduction AND MAKE SURE TO READ CAREFULLY the section on the 3 fundamental assumptions that have to be verified before this approach can be applied.
9. Power, G. M., Warne, N., Bould, H., Casanova, F., Jones, S. E., Richardson, T. G., Tyrrell, J., Davey Smith, G., & Heron, J. (2024). The role of body image dissatisfaction in the relationship between body size and disordered eating and self-harm: Complimentary Mendelian randomization and mediation analyses. Molecular Psychiatry. Advance online publication. https://doi.org/10.1038/s41380-024-02676-5
Full text available for download at: https://www.nature.com/articles/s41380-024-02676-5#citeas
ABSTRACT. Disordered eating and self-harm commonly co-occur in young people suggesting potential for shared underlying causes. Body image dissatisfaction (BID) has been recognised as a psychological correlate of body size, associated with both disordered eating and self-harm. However, the investigation into etiological pathways early in the lifecourse to provide detail on how body size and BID may foster disordered eating and self-harm remains largely unexplored.
Employing data from two large population-based cohorts, the UK Biobank and the Avon Longitudinal Study of Parents And Children (ALSPAC), we conducted bidirectional Mendelian randomization (MR) to determine the causal direction of effect between genetically predicted prepubertal body size and two measures of BID indicating (i) desire to be smaller, and (ii) desire to be larger. We then used multivariable regression followed by counterfactual mediation analyses. Bidirectional MR indicated robust evidence that increased genetically predicted prepubertal body size increased desire to be smaller and decreased desire to be larger.
Evidence for the reverse causal direction was negligible. These findings remained very similar across sensitivity analyses. In females and males, multivariable regression analyses demonstrated that being overweight increased the risk of disordered eating (risk ratio (RR), 95% confidence interval (CI): 1.19, 1.01 to 1.40 and 1.98, 1.28 to 3.05, respectively) and self-harm (RR, 95% CI: 1.35, 1.04 to 1.77 and 1.55, 0.86 to 2.81, respectively), while being underweight was protective against disordered eating (RR, 95% CI: 0.57, 0.40 to 0.81 and 0.81, 0.38 to 1.73, respectively).
There was weak evidence of an increase in the risk of self-harm among underweight individuals. Mediation analyses indicated that the relationship between being overweight and subsequent disordered eating was largely mediated by the desire to be smaller.
Our research carries important public health implications, suggesting distinct risk profiles for self-harm and disordered eating in relation to weight and body image. In addition, a better understanding of genetically predicted prepubertal BID may be valuable in the prevention and treatment of disordered eating and self-harm in adolescence.
Avoidant/Restrictive Food Intake Disorder (ARFID), Part 5 of (now) 7
10. Stern, C. M., Graver, H., McPhersonn, I., Gydus, J., Kambanis, E., Breithaupt, L., Burton-Murray, H., Zayas, L., Eddy, K. T., Thomas, J. J., & Becker, K. R. (2024). Difficulties in emotion regulation in avoidant/restrictive food intake disorder. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24281
Email address for correspondence: krbecker@mgh.harvard.edu
ABSTRACT. Objective: Despite substantial research indicating difficulties with emotion regulation across eating disorder presentations, emotion regulation has yet to be studied in adults with avoidant/restrictive food intake disorder (ARFID). We hypothesized that (1) those with ARFID would report greater overall emotion regulation difficulties than nonclinical participants, and (2) those with ARFID would not differ from those with other eating disorders on the level of emotion regulation difficulty.
Methods: One hundred and thirty-seven adults (age 18–30) from an outpatient clinic with ARFID (n = 27), with other primarily restrictive eating disorders (e.g., anorexia nervosa; n = 34), and with binge/purge eating disorders (e.g., bulimia nervosa; n = 51), as well as nonclinical participants (n = 25) recruited via Amazon Mechanical Turk (MTurk) completed the Difficulties in Emotion Regulation Scale (DERS). We compared DERS scores across groups.
Results: In line with expectations, patients with ARFID scored significantly higher than nonclinical participants on the DERS Total (p = 0.01) with a large effect size (d = 0.87). Also as hypothesized, those with ARFID did not differ from those with other primarily restrictive (p = 0.99) or binge/purge disorders (p = 0.29) on DERS Total.
Discussion: Adults with ARFID appear to exhibit emotion regulation difficulties which are greater than nonclinical participants, and commensurate with other eating disorders. These findings highlight the possibility of emotion regulation difficulties as a maintenance mechanism for ARFID.
11. Fonseca, N. K. O., Curtarelli, V. D., Bertoletti, J., Azevedo, K., Cardinal, T. M., Moreira, J. D., & Antunes, L. C. (2024). Avoidant restrictive food intake disorder: Recent advances in neurobiology and treatment. Journal of Eating Disorders, 12, 74. https://doi.org/10.1186/s40337-024-01021-z
Full text available for download at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01021-z#citeas
ABSTRACT. Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. ARFID, before referred to as “selective eating disorder”, was introduced recently in the DSM-5 as a replacement for and expansion of the previous diagnosis. Individuals with ARFID may limit food variety and intake due to avoidance based on the sensory characteristics of the food or related to any adverse consequences of eating without the intention of losing weight and concerns of body image.
The limited understanding of avoidant and restrictive eating poses challenges to effective treatment and management, impacting directly on the growth and development of children and adolescents. The ARFID neurobiological concept has not yet been clearly defined to clinical practice for nutritionists, thereby hindering screening and impeding the development of treatment recommendations. This narrative review provide useful practical information to consult the pathophysiology, the neurobiology, the clinical features, the assessment and the treatment for healthcare professionals seeking to enhance their clinical knowledge and management of this disorder.
Plain English summary: Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. Individuals with ARFID exhibit limited food intake and variety, often due to a lack in eating, without the primary goal of weight loss.
The limited understanding of avoidant and restrictive eating poses challenges in terms of effective treatment and management, which directly impacts the growth and development of children and adolescents, as well as their nutrition and psychosocial well-being. ARFID is a relatively recent diagnostic classification, representing a burgeoning field of study. The identification of diagnostic criteria and the pursuit of new knowledge in this area have only recently begun. Consequently, assessment tools and treatment strategies are still in the process of development and validation.
This narrative review explored the neurobiological perspective of ARFID using the three-dimensional model, examined its etiology and risk factors, evaluated clinical screening and evaluation tools, discussed common clinical complications, and presented different types of nutritional, behavioural, and pharmacological interventions used in ARFID treatment.