Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 42: (i) Recognition of EDs; (ii) DE, Pt. 4 (n = 2); (iii) EDs & Neurodiverg; (iv) Big Picture; (v) Psychometrics; (vi) Weight Stigma, Pt. 3 (n = 2); and (vii) Nature of EDs, Pt. 1 (n = 2)
Colleagues (N now = 1199 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.
POSITIVE BODY IMAGE | PREVENTION | ADVOCACY-IN-ACTION PODCAST
Appearance Matters Podcast
Episode 89: The Body Confidence Book by Professor Phillippa Diedrichs
[our own] Dr. Nadia Craddock (England) talks with [our own] Dr. Phillippa Diedrichs
ML NOTE 1: In regard to the Appearance Matters Podcast, the senior producer is our own Bolder Model and Force-To-Be-Reckoned-With, Dr. Nadia Craddock (England). Her co-hosts and co-producers (all in England) are Ms. Bruna Costa, our own Dr. Maia Thornton, and Ms. Abbi Matthews.
ML NOTE 2: If I were asked to list the world’s top 10 prevention experts in our field(s)—using as criteria breadth/depth of knowledge, extent of hands-on experience, versatility of skills, mutiplicity of important collaborations and connections, and involvement in national and international advocacy—our own Dr. Phillippa Diedrichs (England) would definitely be one of them.
Link to the podcast episode (#89, ~41.5 min) here: TheBCBook
Episode Description: A slightly different kind of episode on the show this month. Nadia speaks with Professor Phillippa Diedrichs about her new book for teenagers: The Body Confidence Book!! A mixture of personal stories, science, statistics, and tips and actions for young people curious to learn ways to improve their body image.
To buy the book: BuyBCBook
To learn more about Professor Phillippa Diedrichs: Dr. Diedrichs
RECOVERY/SUPPORT, and EATING DISORDERS/TREATMENT LITERACY
[our own] Ms. Rachelle Heinemann's (USA)
Understanding Disordered Eating Podcast - Episode #133:
GLP(s) [Glucagon-Like Peptide-1 (GLP-1) agonists such as Ozempic]
with Kim Dennis MD, CES (USA)
Received 27 June 2024 via an everything-is-advocacy post to the Academy for Eating Disorders’ Main Discussion list by our own Ms. Rachel Heinemann, LMHC, LPC, CEDS (USA).
ML NOTE 3: All episodes in our own Ms. Rachel Heinemann's (USA) podcast series can be found at: https://www.rachelleheinemann.com/podcast.
Episode 133: GLP(s) with Kim Dennis, MD, CES (USA)
Listen (~48.5 min) at: GLPwDr.Kim
[From the AED Post] For those of you who missed the plenary at ICED* or would like more of a follow up to the conversation about GLP's, Dr. Kim Dennis kindly joined me in doing so. I know many of us have had continued conversations and I welcome more of it from our community!
[From the Podcast website] The world is absolutely obsessed with GLP medications, and the more we know, the better we can make informed decisions—without all the drama, please. But honestly, conversations around Ozempic, Wegovy, and other GLP medications can get super heated with not nearly enough facts to back them up.
In this episode, I’m chatting with Dr. Kim Dennis about the science and controversy of GLP medications.
Kim Dennis, MD, is a board-certified psychiatrist, eating disorders specialist and board-certified in addiction medicine. She specializes in treating eating disorders, addiction, trauma, and complex co-occurring psychiatric disorders. Dr. Dennis also brings lived experience to her work as a physician with long-term recovery from ED, addiction, and developmental trauma.
She is the co-founder, Chief Medical Officer, and CEO of SunCloud Health. Dr. Dennis is also on faculty at the University of Illinois Chicago as a clinical assistant professor in the Department of Psychiatry. She obtained her medical degree from the University of Chicago, Pritzker School of Medicine, and completed her psychiatry residency training at the University of Chicago Hospitals, where she served as Chief Resident.
She believes in and maintains a holistic perspective in psychiatry, incorporating biological, psycho-social, and spiritual approaches into individually tailored, weight-neutral treatments for each patient.
She serves as a board member for the Eating Disorders Coalition and Galen Mental Health, a member of NEDA’s Clinical Advisory Council, a member of the American Association of Pediatrics Eating Disorders and “Obesity” Workgroup, and past co-chair of AED’s Substance-Related and Addictive Disorders SIG.
In this episode, we’re talking about:
The challenges faced by patients who feel like they've "failed" eating disorder treatment and the impact of treatment not tailored to individual needs.
The reinforcement of feelings of failure by healthcare systems and insurance companies.
The difference between discussions around GLP medications for type 2 diabetes vs weight loss, and the complexities of these conversations.
The importance of discerning the context of GLP medication use.
The lack of sufficient screening for eating disorder risks among those prescribed GLP medications.
The limited and short-term research on the impact of GLP medications on eating disorder symptoms.
How GLP meds can slow down impulsive responses, allowing individuals more time and autonomy over their eating decisions.
How some studies show improvements in eating disorder symptoms, not just reductions in binge eating, although more research is needed.
The lack of comprehensive research on GLP meds' impact on eating disorders and the apparent disinterest from pharmaceutical companies in exploring this further.
The financial incentives for companies to focus on weight loss rather than eating disorder recovery.
Mixed reactions from the eating disorder community about using GLP meds to reduce food noise and binge eating.
The difficulty many Americans, especially those from marginalized communities, face in accessing eating disorder care.
Comparing the stigma around GLP meds for eating disorders to the stigma around Suboxone for opioid use disorder, stressing the need for less judgment and more open dialogue.
The nuanced, patient-centered care and informed consent, acknowledging the unknowns and individual differences in responses to treatment.
The need for healthcare professionals to be aware of their biases and ensure they are not imposing their views on patients, but rather supporting patient autonomy.
Research Publication Categories in This Newsletter
(i) Awareness/Recognition of EDs; (ii) Disordered Eating, Part 4 (n = 2); (iii) Eating Disorders and Neurodivergence; (iv) The Big(ger) Picture; (v) Psychometrics; (vi) Weight Stigma, Part 3 (n = 2); and (vii) Nature/Correlates of Eating Disorders, Part 1 (n = 2)
CONGRATULATIONS to our own
Dr. Margaret Sala (USA) and colleagues for publication of the Recognition of Eating Disorders research article in #1.
Dr. Jake Linardon (Australia) and colleagues for publication of the Disordered Eating research article in #3.
Dr. Matthew Fuller-Tyszkiewicz (Australia) and colleagues for publication of the Eating Disorders and Neurodivergence review article in #4.
Drs. Shiri Sadeh-Sharvit (USA) and Ellen Fitzsimmons-Craft (USA) and colleagues for publication of the Big(ger) Picture article in #5.
Drs. Emma Haycraft (England) and Carolyn Plateau (England) and colleague for publication of the Psychometrics research article in #6.
Dr. David Sánchez-Carracedo (Catalonia/Spain) and colleagues for publication of the Weight Stigma research article in #7.
Drs. Andreas Birgegård (Sweden) and Cynthia Bulik (USA/Sweden) and colleagues for publication of the Nature of Eating Disorders research article in #9.
Awareness/Recognition/Identification of Eating Disorders
1. Sala, M., Coll, S. & Flamer, R. (2024). Gender stereotypes in eating disorder recognition. Eating and Weight Disorders, 29, 45. https://doi.org/10.1007/s40519-024-01672-6
Full text available for download at: https://link.springer.com/article/10.1007/s40519-024-01672-6
ABSTRACT. Purpose: Eating disorder (ED) awareness is low. We assessed if ED symptom recognition, perceived need for treatment, perceived distress, perceived acceptability, and perceived prevalence differed depending on the gender of the individual with the ED.
Methods: 276 community participants were randomly assigned to one of three gender conditions (female, male, and non-binary), read three vignettes describing three different individuals with ED symptoms [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)], and then answered a series of questions related to participants ED symptom recognition, perceived need for treatment, perceived distress associated with having ED symptoms, perceived acceptability (e.g., the extent to which it may not be too bad to have an ED), and perceived prevalence. Mixed ANOVAs and chi-square analyses were conducted to examine differences between groups.
Results: There were no significant main effects of gender condition across the outcome variables. There were main effects of ED type for problem recognition, perceived need for treatment, perceived level of distress, and perceived prevalence, with participants being more likely to recognize a problem in the AN and BN vignettes than the BED vignettes, refer for treatment and rate a higher perceived level of distress in then AN vignette than the BN and BED vignettes, and perceive a higher prevalence rate in the BN vignette than the AN vignette. There was a significant gender by condition interaction for perceived prevalence, with participants rating a higher prevalence of AN in women and non-binary individuals than men and a higher prevalence of BN in women than non-binary individuals and men.
Conclusion: These results highlight the importance of education on EDs and awareness that EDs can occur in any individual, regardless of their gender identification. Level of evidence: Level I, experimental study with randomization.
Disordered Eating, Part 4 of (now) 5
2. Malik, R. Z., Hassan, S. M. U., & Tariq, I. (2024). Depression, self-esteem, and disordered eating among Pakistani adolescent girls: The mediating role of appearance comparison and internalization of appearance ideals. Child and Adolescent Social Work Journal. Advance online publication. https://doi.org/10.1007/s10560-024-00972-1
Full text available for download at: https://link.springer.com/article/10.1007/s10560-024-00972-1#citeas
ABSTRACT. Although the link of depression and self-esteem with disordered eating is well reported in literature, there is insufficient insight into the underlying processes that inform the relationship. The present study examined the mediating effects of comparison of appearance and internalization of appearance ideals in the relationship of depression and self-esteem with disordered eating.
The study sample comprised of 381 school-going adolescent girls, aged 13 to 18, from Islamabad, Pakistan. As part of the study, participants were required to complete several measures, including the Eating Disorder Examination Questionnaire—Short Form, Depression Anxiety Stress Scale 21, Rosenberg Self-Esteem Scale, Physical Appearance Comparison Scale—Revised, and Sociocultural Attitudes Toward Appearance Questionnaire—4.
Findings revealed significant relationships between depression, self-esteem, comparison of appearance, internalization of appearance ideals, and disordered eating. Path analyses indicated that comparison of appearance and internalization of appearance ideals partially serially mediated the relationship between depression and disordered eating. Additionally, these two mediators were found to fully serially mediate the relationship between self-esteem and disordered eating.
This study implicates the importance of considering depression and self-esteem in predicting disordered eating. Furthermore, findings posited that comparison of appearance and internalization of appearance ideals posed as potential risk factors in aggravating disordered eating. This study extends an opportunity for clinicians and community workers to initiate projects of social welfare such as awareness programs to address eating-related pathologies in educational as well as community settings, specifically amongst the adolescent population.
3. Moffitt, R. L., Dwyer, B. K., Scarce, P. R., & Linardon, J. (2024). Effortless perfectionism and its relationship with body dissatisfaction, and pathological eating and exercise: the mediating role of self-kindness and self-criticism. Clinical Psychologist. Advance online publication. https://doi.org/10.1080/13284207.2024.2371324
Full text available for download, perhaps for a limited time, at: https://tinyurl.com/w6bjsm3s
Email address for correspondence at: r.moffitt@deakin.edu.au
ABSTRACT. Objective: The current study investigated the interrelationships between effortless perfectionism (a desire to appear perfect without outward displays of effort) and body dissatisfaction, pathological eating, and pathological exercise. In addition, the mediating role of self-kindness and self-criticism in these relationships was explored. Method: Using a cross-sectional design, undergraduate students (N = 497) were asked to complete a battery of questionnaires assessing these key variables.
Results: Effortless perfectionism was indirectly positively associated with more severe body dissatisfaction and pathological eating/exercise, via higher levels of self-criticism (controlling for self-kindness). By contrast, after controlling for self-criticism, self-kindness did not mediate the relationships between effortless perfectionism and body dissatisfaction, pathological eating, or pathological exercise
Conclusions: Self-criticism uniquely emerged as a mediating mechanism; the desire for effortless perfection was associated with higher self-criticism, which in turn was linked with worsened symptomatology. By contrast, self-kindness did not emerge as a unique mediating mechanism in this context. Longitudinal research would be useful to establish the effect of situational context, and possible reciprocal relationships between self-kindness and self-criticism over time.
Eating Disorders and Neurodivergence
4. Norton, B., Sheen, J., Burns, L., Enticott, P. G., Fuller-Tyszkiewicz, M., & Kirkovski, M. (2024). Overlap of eating disorders and neurodivergence: The role of inhibitory control. BMC Psychiatry, 24, 454. https://doi.org/10.1186/s12888-024-05837-6
Full text available for download at: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05837-6
ABSTRACT. Background: Difficulties with inhibitory control have been identified in eating disorders (EDs) and neurodevelopmental disorders (NDs; including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder), and there appear to be parallels between the expression of these impairments. It is theorised that impairments in inhibitory control within NDs may represent a unique vulnerability for eating disorders (EDs), and this same mechanism may contribute to poorer treatment outcomes. This review seeks to determine the state of the literature concerning the role of inhibitory control in the overlap of EDs and neurodivergence.
Method: A scoping review was conducted to summarise extant research, and to identify gaps in the existing knowledge base. Scopus, Medline, PsycInfo, Embase, and ProQuest were systematically searched. Studies were included if the study measured traits of ADHD or autism, and symptoms of ED, and required participants to complete a performance task measure of inhibitory control. Where studies included a cohort with both an ND and ED, these results had to be reported separately from cohorts with a singular diagnosis. Studies were required to be published in English, within the last 10 years.
Results: No studies explored the relationship between autism and EDs using behavioural measures of inhibitory control. Four studies exploring the relationship between ADHD and EDs using behavioural measures of inhibitory control met selection criteria. These studies showed a multifaceted relationship between these conditions, with differences emerging between domains of inhibitory control.
ADHD symptoms predicted poorer performance on measures of response inhibition in a non-clinical sample; this was not replicated in clinical samples, nor was there a significant association with EDs. Both ADHD and ED symptoms are associated with poor performance on attentional control measures; where these diagnoses were combined, performance was worse than for those with a singular diagnosis of ADHD. This was not replicated when compared to those with only ED diagnoses.
Conclusion: Impairments in attentional control may represent a unique vulnerability for the development of an ED and contribute to poor treatment outcomes. Further research is needed to explore the role of inhibitory control in EDs, ADHD and autism, including the use of both self-report and behavioural measures to capture the domains of inhibitory control.
The Big(ger) Picture: Digital Mental Health Technologies and the Training of Psychologists
ML NOTE 4: The senior author of the article described below in #9, distinguished scientist-practitioner-mentor Dr. C. Barr Taylor (USA) — and one of the founders and leading lights of the prevention field/movement, and a friend and source of inspiration to me and so many of us in this Group — passed away on 3 December 2023. He was one of the first 20 members of this Newsletter Group.
5. Ruzek, J. I., Sadeh-Sharvit, S., Bunge, E. L., Sheperis, D. S., Fitzsimmons-Craft, E., Guinn, V., Joseph, R., Cameron, E., & Taylor, C. B. (2024). Training the psychologist of the future in the use of digital mental health technologies. Professional Psychology: Research and Practice. Advance online publication. https://doi.org/10.1037/pro0000567
Email address for correspondence: jruzek@paloaltou.edu
ABSTRACT. The pandemic forced virtually all mental health professionals to use some form of digital technology, yet few receive any training in digital mental health tools (DMHT). Therapists and students in all mental health treatment settings should be trained to routinely include DMHT in their practice. In this article, we describe why DMHT will play an increasingly important part in clinical mental health practice and discuss how we train psychologists and counselors in our eClinic to learn the basics of incorporating digital technologies into the care they provide.
More specifically, we describe the three basic components of the training: (a) an asynchronous onboarding program; (b) a didactic curriculum, implemented via monthly core skill development seminars led by experts in digital mental health practice; and (c) ongoing weekly supervision by licensed supervisors. The eClinic training approach described is a work in progress, and we expect to adjust it to follow the evolution of digital tools for mental health assessment and treatment.
Impact Statement: The present article suggests that, despite the fact that digital mental health interventions are playing an increasingly important part in clinical mental health practice, few mental health providers have received any kind of formal training related to digital therapeutics. It argues that the training of psychologists and other mental health professionals should routinely include the development of knowledge and skills related to the delivery of digital interventions and gives an example of the design of a training program
Psychometrics: Sociocultural Influences on Exercise Behaviours in Adolescents Questionnaire
6. Reynolds, K. A., Haycraft, E., & Plateau, C. R. (2024). Development and psychometric assessment of the Sociocultural Influences on Exercise Behaviours in Adolescents Questionnaire. Psychology & Health. Advance online publication. https://doi.org/10.1080/08870446.2024.2372644
Full text available for download, perhaps for only a limited time, at: https://www.tandfonline.com/doi/full/10.1080/08870446.2024.2372644
Email address for correspondence: C.R.Plateau@lboro.ac.uk
ABSTRACT. Objectives: This research aimed to construct and psychometrically test a measure of multiple sociocultural dimensions (i.e. family, peers, media) theoretically associated with exercise behaviours/attitudes in adolescents; the Sociocultural Influences on Exercise Behaviours in Adolescents Questionnaire (SIEBAQ).
Methods and measurement: Part 1 of this study focused on measure construction and psychometric testing, involving item generation and exploratory factor analysis (EFA) to refine the item pool, with 905 adolescents (Mage 13.66 years (SD = 0.94); girls = 442). Part 2 sought to explore the convergent validity of the SIEBAQ (n = 846; n = 414 girls).
Results: EFA resulted in a 47-item measure with a nine-factor structure (including social media modelling, parent exercise expectations, peer co-participation; α = 0.72-0.92). Correlations revealed weak-moderate significant relationships between the SIEBAQ and related constructs (e.g. compulsive exercise, sociocultural attitudes towards appearance). Regression analyses with the SIEBAQ identified social media modelling of exercise as a significant predictor of compulsive exercise in boys and girls. Proving exercise ability to significant others also significantly predicted compulsive exercise outcomes.
Conclusion: This newly developed measure holds promise. Further psychometric testing and validation of the SIEBAQ is the recommended next step to confirm the measure’s nine-factor structure identified through EFA.
Weight Stigma, Part 3 of 3
ML NOTE 5 - The article described below in #7 came to my attention via the Obesity and Energetics Offerings online newsletter of 5 July 2024. For more information about free participation in this ongoing and valuable exercise in education, research methods, and critical thinking, see Obesity and Energetics Offerings.
7. Anastasiadou, D., Tárrega, S., Fornieles-Deu, A., Moncada-Ribera, A., Bach-Faig, A., & Sánchez-Carracedo, D. (2024). Experienced and internalized weight stigma among Spanish adolescents. BMC Public Health, 24, 1743. https://doi.org/10.1186/s12889-024-19246-7
Full text available for download at: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-19246-7#citeas
ABSTRACT. Background and objective: Weight stigma has negative consequences for both physiological and psychological health. Studies on weight stigma in adolescence, particularly from general populations, are scarce in the Mediterranean area. The main aim of this study is to describe the prevalence of experienced and internalized weight stigma among a representative sample of adolescents from the Spanish city of Terrassa, and to determine its association with sociodemographic variables and weight status.
Methods: Drawing on data from the initial assessment of a longitudinally funded project on weight stigma in adolescents, a cross-sectional survey-based study was conducted using random multistage cluster sampling. Weight stigma experiences, their frequency and sources, and weight bias internalization with the Modified Weight Bias Internalization Scale (WBISM) were assessed in a sample of 1016 adolescents. Adjusted odds ratios (AOR) between sociodemographic variables, weight status and having experienced weight stigma, and having reported high scores of WBISM (WBISM ≥ 4) were estimated by multiple logistic regression models.
Results: The prevalence of weight-related stigma experiences was 43.2% in the sample (81.8 in adolescents with obesity) and the prevalence of high levels of weight bias internalization was 19.4% (50.7 in adolescents with obesity). Other kids and school were the most prevalent sources of weight stigma, with society and family being other significant sources of stigma reported by girls. A significantly higher risk of having experienced weight stigma was observed in girls (AOR = 2.6) and in older adolescents (AOR = 1.9).
Compared to normal weight adolescents, all weight statuses showed higher risk, being 3.4 times higher in adolescents with underweight and reaching 11.4 times higher risk in those with obesity. Regarding high levels of weight bias internalization, girls had a risk 6.6 times higher than boys. Once again, a “J-shaped” pattern was observed, with a higher risk at the lowest and highest weight statuses. The risk was 6.3 times higher in adolescents with underweight, and 13.1 times higher in adolescents with obesity compared to those with normal weight.
Conclusions: Considering the high prevalence of experienced and internalized weight stigma among adolescents in Spain, especially in adolescents with obesity and girls, it seems important to implement preventive strategies in different settings and address all sources of stigma.
8. Borgatti, A., Morgan, C., Stager, L., & Dutton, G. R. (2024). Associations between weight bias internalization, weight status, and health among a diverse cohort of freshman college students. Journal of American College Health. Advance online publication. https://doi.org/10.1080/07448481.2024.2346351
Email address for correspondence: aborgatti@uabmc.edu
ABSTRACT. Mental health concerns are common among college students, especially students with higher body mass index (BMI). Weight bias internalization (WBI) is thought to contribute to these mental health disparities. However, little is known about how WBI differs among more diverse students, and to what extent WBI may explain associations between BMI and health in college populations.
This study compared rates of WBI in Freshman college students (N = 1289) across gender, race/ethnicity, and sexual orientation, and assessed whether WBI mediated associations between BMI and mental health (depression, self-esteem, stress, loneliness) and behavioral health (disordered eating, physical activity, gym use). Black students and men demonstrated reduced WBI while bisexual women showed increased WBI. Further, WBI mediated the association of BMI with mental health and disordered eating, but not physical activity. These findings suggest that stigma may account for mental health disparities among higher-BMI students, and that minoritized groups are disproportionately impacted.
Nature, Course, and Correlates of Eating Disorders, Part 1 of 6
9. Liao, Z., Birgegård, A., Monell, E., Borg, S., Bulik, C. M., & Forsén Mantilla, E. (2024). Maladaptive exercise in eating disorders: Lifetime and current impact on mental health and treatment seeking. Journal of Eating Disorders, 12, 86. https://doi.org/10.1186/s40337-024-01048-2
Full text available for download at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01048-2#citea
ABSTRACT. Background: Many patients with eating disorders report exercise as a central symptom of their illness—as a way to compensate for food intake, prevent weight-gain, and/or reduce negative affect. Previous findings show associations between maladaptive exercise and more severe eating disorder pathology, higher risk for relapse, other co-morbid symptoms, and worse treatment outcome.
Methods: In this study, we included 8252 participants with eating disorders and investigated associations between maladaptive exercise (both lifetime and current) and ED pathology, illness duration, depression, anxiety, self-harm and suicidal ideation, and treatment seeking patterns in individuals with lifetime maladaptive exercise. Participants were included via the Swedish site of the large global study The Eating Disorders Genetics Initiative (EDGI) and completed measures of both lifetime and current symptomatology.
Results: Results indicate that lifetime maladaptive exercise is associated with higher prevalence of lifetime depression and anxiety and with patients more often receiving treatment, although these results need to be investigated in future studies. Current maladaptive exercise was associated with more severe ED symptoms, and higher levels of depression, anxiety, obsessive-compulsive traits, and suicidal ideation. Conclusions: Our findings point to the complexities of exercise as an eating disorder symptom and the need for clearly assessing and acknowledging this, as well as tailoring interventions to treat this symptom to achieve sustainable recovery.
Plain English summary: Many individuals with eating disorders view exercise as a crucial aspect of their illness, often using it to control weight and emotions. Research suggests that maladaptive exercise correlates with more severe eating disorder symptoms, increased risk of relapse, and poorer treatment outcomes. Analyzing data from 8252 participants with eating disorders, this study from the Swedish site of The Eating Disorders Genetics Initiative (EDGI) found that lifetime maladaptive exercise is linked to higher rates of depression and anxiety and increased treatment seeking behaviors.
Current maladaptive exercise was associated with heightened eating disorder severity, depression, anxiety, obsessive-compulsive traits, and suicidal thoughts. These findings underscore the importance of recognizing exercise as a symptom of eating disorders and tailoring interventions accordingly for sustainable recovery.
10. Singh, S., Mayer, L., Rosenbaum, M., & Lowe, M. R. (2024). Weight history correlates of resting energy expenditure in women with bulimia nervosa. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24250
Email address for correspondence: simar.singh2@ucsf.edu
ABSTRACT. Objective: Among those with bulimia nervosa, weight suppression has been associated with illness severity and treatment prognosis. Although significant weight loss is known to reduce metabolic rate, the relation between weight suppression and resting energy expenditure (REE) in bulimia nervosa has not been examined. This study tested the hypothesis of an inverse relation between weight suppression and REE in a sample of women with bulimia nervosa (N = 84).
Methods: In primary analyses, linear regressions were conducted between weight suppression and REE, corrected for fat-free mass. In follow-up, exploratory analyses, stepwise linear regressions were conducted to explore the main and interaction effects of weight history and weight suppression on RE.
Results: Neither traditional (TWS) nor developmental weight suppression (DWS) correlated with REE. Results from exploratory analyses, however, revealed a medium-to-large inverse relation between several weight history variables and REE (highest past weight, sr2 = 0.05; lowest postmorbid weight, sr2 = 0.07; current weight, sr2 = 0.05). Additionally, DWS interacted with current (sr2 = 0.08) and highest premorbid (sr2 = 0.05) z-BMI to influence REE with a medium-to-large effect. For individuals low in current and premorbid z-BMIs, higher DWS associated with lower REE levels. However, for individuals at higher premorbid z-BMIs, higher DWS unexpectedly associated with greater REE levels.
Discussion: In this sample of women with bulimia nervosa, reduced REE associated with higher weights across all timepoints. If the interaction effect between DWS and z-BMI history persists in future studies, this may indicate unique challenges faced by individuals low in z-BMI and high in DWS related to weight gain and normalization of eating.