Jonathan Mond

Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples

In order to examine the concurrent and criterion validity of the questionnaire version of the Eating Disorders Examination (EDE-Q), self-report and interview formats were administered to a community sample of women aged 18-45 (n = 208). Correlations between EDE-Q and EDE subscales ranged from 0.68 for Eating Concern to 0.78 for Shape Concern. Scores on the EDE-Q were significantly higher than those of the EDE for all subscales, with the mean difference ranging from 0.25 for Restraint to 0.85 for Shape Concern. Frequency of both objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) was significantly correlated between measures. Chance-corrected agreement between EDE-Q and EDE ratings of the presence of OBEs was fair, while that for SBEs was poor. Receiver operating characteristic (ROC) analysis, based on a sample of 13 cases, indicated that a score of 2.3 on the global scale of the EDE-Q in conjunction with the occurrence of any OBEs and/or use of exercise as a means of weight control, yielded optimal validity coefficients (sensitivity = 0.83, specificity = 0.96, positive predictive value = 0.56). A stepwise discriminant function analysis yielded eight EDE-Q items which best distinguished cases from non-cases, including frequency of OBEs, use of exercise as a means of weight control, use of self-induced vomiting, use of laxatives and guilt about eating. The EDE-Q has good concurrent validity and acceptable criterion validity. The measure appears well-suited to use in prospective epidemiological studies.

Eating disorder behaviors are increasing: findings from two sequential community surveys in South Australia

Background Evidence for an increase in the prevalence of eating disorders is inconsistent. Our aim was to determine change in the population point prevalence of eating disorder behaviors over a 10-year period. Methodology/Principal Findings Eating disorder behaviors were assessed in consecutive general population surveys of men and women conducted in 1995 (n = 3001, 72% respondents) and 2005 (n = 3047, 63.1% respondents). Participants were randomly sampled from households in rural and metropolitan South Australia. There was a significant (all p<0.01) and over two-fold increase in the prevalence of binge eating, purging (self-induced vomiting and/or laxative or diuretic misuse) and strict dieting or fasting for weight or shape control among both genders. The most common diagnosis in 2005 was either binge eating disorder or other “eating disorders not otherwise specified” (EDNOS; n = 119, 4.2%). Conclusions/Significance In this population sample the point prevalence of eating disorder behaviors increased over the past decade. Cases of anorexia nervosa and bulimia nervosa, as currently defined, remain uncommon.

The Link Between Body Dissatisfaction and Self-Esteem in Adolescents: Similarities Across Gender, Age, Weight Status, Race/Ethnicity, and Socioeconomic Status

PURPOSE The present study examined whether the cross-sectional association between body dissatisfaction and low self-esteem varies across gender, age, body weight status, race/ethnicity, and socioeconomic status (SES). We also examined the association longitudinally. METHODS A school-based survey of eating, weight, and related attitudes was conducted with a diverse sample of adolescents aged 11-18 years (N = 4,746). Height and weight were measured in the schools at Time 1. Participants were resurveyed through mails 5 years later (Time, 2; N = 2,516). RESULTS The relationship between body dissatisfaction and self-esteem was strong and significant in both boys and girls (all p values < .0001), and did not differ significantly between genders (p = .16), or between the middle school and high school cohorts in either boys (p = .79) or girls (p = .80). Among girls, the relationship between body dissatisfaction and self-esteem was strong, but did vary across weight status, race/ethnicity, and SES (all p values = .0001-.03). The relationship was nonsignificant in underweight girls (p = .36), and weaker but still significant among black, Asian, and low SES group girls (all p values < .0001) in comparison to white and high SES group girls. Among boys, the association did not differ significantly across demographic groups (all p values = .18-.79). In longitudinal analyses, the strength of the association did not change significantly as adolescents grew older. CONCLUSIONS Findings indicate that body dissatisfaction and self-esteem are strongly related among nearly all groups of adolescents. This suggests the importance of addressing body image concerns with adolescents of all backgrounds and ages.

Assessing quality of life in eating disorder patients

Objective: To examine quality of life among subgroups of eating disorder patients. Method: Self-report questionnaires which included two quality of life measures were completed by 87 individuals referred for treatment to the Australian Capital Territory Eating Disorders Day Program. Health-related quality of life, as measured by the Medical Outcomes Study 12-item Short Form Mental Component Summary scale, and subjective quality of life, as measured by subscales of the World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF), were compared among individuals who received the diagnosis of anorexia nervosa purging subtype (n=15), anorexia nervosa restricting subtype (n=19), bulimia nervosa (n=40) and binge eating disorder (n=10), and among a general population sample of young adult women employed as a control group (n=495). Results: Eating disorder patients, when considered together, showed marked impairment in both health-related and subjective quality of life relative to normal control subjects. However, in both domains, restricting anorexia nervosa patients reported significantly better quality of life than other patient groups, after controlling for levels of general psychological distress. Scores on the Social Relationships subscale of the WHOQOL-BREF among individuals in this subgroup were similar to those of normal control subjects. Conclusions: Reliance on any one instrument is likely to be misleading in assessing the quality of life of eating disorder patients. Careful consideration needs to be given to the assessment of restricting anorexia nervosa patients in particular.

Obesity, Body Dissatisfaction, and Emotional Well-Being in Early and Late Adolescence: Findings From the Project EAT Study

PURPOSE We tested the hypothesis that, at two different stages of adolescence, impairment in emotional well-being associated with obesity is mediated by body dissatisfaction (BD). METHODS Self-reported measures of BD, emotional well-being (self-esteem, depressive mood), height and weight, and socio-demographic information were completed by the same female (n = 366) and male (n = 440) participants during early (mean age = 12.8 years) and late (17.3 years) adolescence. For each measure and at each time point, the hypothesis of mediation was tested using the methods suggested by Baron and Kenny (1986). RESULTS The conditions of complete mediation were satisfied in all the six cases for which an effect of obesity on emotional well-being was observed. That is, in each of these cases, obesity was no longer associated with lower self-esteem or with higher depressive mood after the effects of BD were statistically controlled. Among females, there was no association between obesity and depressive mood at either time point. CONCLUSION Impairment in the emotional well-being of overweight adolescents, where this is observed, may be primarily due to the effects of weight-related BD. This appears to be the case for both boys and girls and during both early and late adolescence. The findings are consistent with the view that BD is central to the health and well-being of children and adolescents who are overweight and that distress associated with negative body image may warrant greater attention in the context of obesity prevention and treatment programs.

Associations between obesity and developmental functioning in pre-school children: a population-based study

Objective:To examine associations between obesity and impairment in developmental functioning in a general population sample of pre-school children.Method:Standardized medical examinations were conducted in nine consecutive cohorts of male and female children (n=9415) aged between 4.4 and 8.6 years (mean=6.0, s.d.=0.37) residing in the Lower Bavaria region of Germany. Tests designed to assess performance in subdivisions representing four broad developmental domains, namely, motor development, speech development, cognitive development and psycho-social development, were completed by all participants.Results:Boys had significantly higher rates of impairment than girls. The prevalence of obesity in boys was 2.4%, whereas in girls it was 4.3% (χ 2=21.51, P< 0.01). After controlling for age, gender, year of recruitment and other potential covariates, the prevalence of impairment in gross motor skills was higher among obese male children than normal-weight male children (adjusted odds ratio=1.76, 95% confidence interval (CI)=1.02, 3.01, P< 0.05), whereas the prevalence of impairment in the ability to focus attention was higher in obese female children than normal-weight female children (adjusted odds ratio=1.86, 95% CI=1.00, 3.44, P< 0.05).Conclusions:The findings suggest that gender-specific associations between obesity and impairment in specific aspects of developmental functioning may be evident in younger children.

Excessive exercise in eating disorder patients and in healthy women

Objective: In order to elucidate the nature of excessive exercise among individuals with eating disorders, exercise behaviours were compared between eating disorder patients receiving specialist treatment and healthy women, and between subgroups of patients. Methods: Self-report measures of obligatory exercise, motivation for exercise and frequency of hard exercise for weight or shape reasons were completed by eating disorder patients (n=102) and healthy women (n=184). Results: The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women. Patients with the purging form of anorexia nervosa (n=13) and those with bulimia nervosa (n=41) tended to have higher scores on measures of these behaviours than those with the restricting form of anorexia nervosa (n=15). Conclusions: Research addressing the prevalence and correlates of excessive exercise in eating disorder patients would benefit from a broader assessment of exercise behaviour than has typically been used in previous studies. In addition, the findings may indicate specific targets for the clinical management of excessive exercise as well as for community-based health promotion initiatives.

Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status

Objective:To examine levels of eating disorder behaviours and cognitions of young women with obesity in the Australian Capital Territory, Australia and assess the impact upon psychological status.Design:General population cross-sectional survey.Subjects:A total of 4891 young women from the community aged 18–42 years, of which 630 were in the obese weight range.Measurements:Body mass index (BMI), eating disorder psychopathology (eating disorder examination questionnaire), and psychological distress (K-10).Results:Women with obesity had significantly higher levels of dietary restraint, eating concern, weight concern, shape concern, binge eating, misuse of diuretics, use of diet pills and fasting compared to other women in the community. These eating disorder cognitions and behaviours were associated with increased levels of psychological distress. In women with obesity, eating concern, weight concern, shape concern, dietary restraint and decreased age predicted psychological distress in a multivariate model. Among other women in the community, behaviours such as laxative misuse, ‘hard’ exercise and subjective bulimic episodes also contributed to the model predicting psychological distress.Conclusion:As disordered eating psychopathology is high in young obese women and negatively impacts upon psychological status, obesity prevention and treatment should consider eating disorder psychopathology and mental health outcomes.

How to 'count the cost' and measure burden? a review of health-related quality of life in people with eating disorders

Background: Health-related quality of life (HRQOL) estimates are important for accurately estimating the individual and community burden from eating disorders and cost-utility of treatments. Aims: The aim was to conduct a systematic review in order to evaluate and compare attempts to estimate HRQOL in eating disorders (EDs). Method: A MEDLINE database and Quality of Life Research Journal search was conducted for relevant English-language papers that used validated measures of HRQOL and ED diagnostic symptoms. Results: Fifteen papers were identified which all supported EDs having a substantial impact on individuals HRQOL, in the mental health domain, that in some studies remained when controlling for body weight. Some studies indicated that presence of psychiatric co-morbidity increases the impact of the ED. In one study, when accounting for prevalence, community burden estimates were for EDs low relative to mood disorders. Findings were mixed for participants with AN, possibly reflecting its ego-syntonic nature. Conclusions: An important gap identified was the paucity of large scale community-based studies. In order to better estimate the “true” costs of EDs there is an urgent need for such research, and studies that include psychiatric control groups as well as medically ill and well groups. Declaration of interest: none.

Beliefs Of Women Concerning The Severity And Prevalence Of Bulimia Nervosa.

Abstract.Background:Few studies have examined attitudes towards eating-disordered behaviour among women in the general population.Methods:A vignette describing a fictional person meeting diagnostic criteria for bulimia nervosa (BN) was presented to a community sample of women aged 18–45. Respondents (n = 208) were asked a series of questions concerning the severity and prevalence of the problem described.Results:Most respondents viewed BN as a distressing condition whose sufferers are deserving of sympathy. However, more than one-third of respondents had at some stage believed that it ‘might not be too bad’ to be like the person described in the vignette. Most respondents believed that the prevalence of the problem described among women in the community was likely to be between 10 % and 30 % (48.6%) or between 30% and 50 % (23.1 %). Individuals with a clinically significant eating disorder (n = 13, 6.3%) were more likely to perceive the symptoms of BN as being acceptable, and its prevalence higher, than individuals with no eating disorder diagnosis.Conclusions:Information concerning the medical and psychological sequelae of BN and other eating disorders might usefully be incorporated in prevention programmes. Prospective community-based research is required to elucidate the nature of the relationship between perceived acceptability of eating disorder symptoms and actual eating disorder psychopathology. Extension of the present research to examine the views of women in other cultures would also be of interest.