Karina L. Allen

The effectiveness of enhanced cognitive behavioural therapy for eating disorders: An open trial

The aim of this study was to examine the effectiveness of Enhanced Cognitive Behaviour Therapy (CBT-E) for eating disorders in an open trial for adults with the full range of eating disorders found in the community. The only previously published trial of CBT-E for eating disorders was a randomised controlled trial (RCT) conducted in the U.K. for patients with a BMI ≥ 17.5. The current study represents the first published trial of CBT-E to include patients with a BMI<17.5. The study involved 125 patients referred to a public outpatient clinic in Perth, Western Australia. Patients attended, on average, 20-40 individual sessions with a clinical psychologist. Of those who entered the trial, 53% completed treatment. Longer waiting time for treatment was significantly associated with drop out. By the end of treatment full remission (cessation of all key eating disorder behaviours, BMI ≥ 18.5 kg/m(2), not meeting DSM-IV criteria for an eating disorder) or partial remission (meeting at least 2 these criteria) was achieved by two thirds of the patients who completed treatment and 40% of the total sample. The results compared favourably to those reported in the previous RCT of CBT-E, with one exception being the higher drop-out rate in the current study. Overall, the findings indicated that CBT-E results in significant improvements, in both eating and more general psychopathology, in patients with all eating disorders attending an outpatient clinic.

Why do some overweight children experience psychological problems? The role of weight and shape concern

OBJECTIVE To examine the associations between weight status, weight and shape concern, self-esteem, body dissatisfaction and depression in children. METHODS Interviews were conducted with 7- to 13-year-old overweight (n = 89) and healthy weight (n = 118) children, using the Child Eating Disorder Examination, Self-Perception Profile for Children, Childrens Body Image Scale and Child Depression Inventory. RESULTS Overweight children were more concerned about weight and shape than healthy weight children. After controlling for BMI z-score, children with high weight and shape concern reported lower self-esteem, higher body dissatisfaction and higher depression than children with low weight and shape concern. Concern about weight and shape mediated the relationships between BMI z-score and low self-esteem, body dissatisfaction and depression. CONCLUSIONS Results support the hypothesis that differences in weight and shape concern, within samples of overweight and healthy weight children, can account for differences in degree of psychological distress. Findings have implications for the prevention and treatment of psychological problems in overweight children.

Overconcern with weight and shape is not the same as body dissatisfaction: Evidence from a prospective study of pre-adolescent boys and girls

Overconcern with weight and shape and body dissatisfaction have both emerged as significant predictors of disordered eating. However, it is unclear how these constructs relate to each other, and if each has different antecedents and consequences. This study aimed to identify prospective predictors of each construct and to determine their relative importance in predicting dietary restraint and binge eating. Eight- to 13-year-old boys and girls (N=259) were assessed at baseline and one-year follow-up, using a range of measures that included the Child Eating Disorder Examination. Psychosocial variables predicted overconcern with weight and shape whilst objective weight predicted body dissatisfaction. Body dissatisfaction and weight and shape concern predicted restraint, and weight and shape concern and restraint predicted binge eating. Findings provide support for the theoretical differences between body dissatisfaction and overconcern with weight and shape, and highlight the importance of focusing on specific body image variables.

Risk Factors for Full- and Partial-Syndrome Early Adolescent Eating Disorders: A Population-Based Pregnancy Cohort Study

OBJECTIVE To identify prospective predictors of eating disorders in a population-based sample of 14-year-old boys and girls, using previously collected antenatal, biomedical, familial, demographic, and psychosocial data. METHOD Participants (N = 1,597) were drawn from the Western Australian Pregnancy Cohort (Raine) Study. Data were collected during pregnancy, at birth, and when children were aged 1, 2, 5, 8, 10, and 14 years. An adapted version of the Eating Disorder Examination Questionnaire was used to assess eating disorder symptoms at age 14 years. Logistic regression was used to identify prospective predictors of eating disorder caseness, relative to general control and psychiatric control groups. RESULTS At age 14 years, 6% of the sample met full or partial criteria for a DSM-IV eating disorder. Being female and being perceived as overweight by ones parent were the strongest predictors of eating disorder caseness in the final multivariate models, relative to both control groups. Maternal body mass index, social problems, low social-related self-efficacy, and neurocognitive difficulties were also predictive of eating disorder caseness relative to the general control group only. CONCLUSIONS The results suggest that parents perceptions of their childs weight are more powerful than objective child body weight in predicting the development of eating disorders. Parent-perceived child overweight was also a specific risk factor for eating disorders, whereas elevated maternal weight and childhood psychosocial difficulties seem to be associated with increased risk for psychiatric disturbance more generally. These results have implications for the prevention of eating disorders, particularly in light of recent increases in the prevalence of childhood obesity.

The onset and course of binge eating in 8- to 13-year-old healthy weight, overweight and obese children

OBJECTIVES This study aimed to (1) determine the prevalence of binge eating and overeating in 8- to 13-year-old children; (2) identify factors that cross-sectionally predict binge eating and overeating; and (3) identify factors that prospectively predict onset of binge eating and overeating. METHODS Participants were 259 boys and girls who were assessed at baseline and one-year follow-up, using a range of semi-structured interviews that included the Child Eating Disorder Examination. RESULTS At baseline, 9% of children reported binge eating and 6% reported overeating. Obese children were most at risk for these behaviours. Dietary restraint and the tendency to use food to regulate emotions were significant in predicting binge eating onset prospectively, and eating concern was significant in predicting binge eating cross-sectionally. CONCLUSION Results provide support for current cognitive-behavioural models of binge eating, and have implications for guiding binge eating prevention and intervention efforts with children.

Vitamin D in Fetal Development: Findings From a Birth Cohort Study

Birth cohort studies provide an invaluable resource for studies of the influence of the fetal environment on health in later life. It is uncertain to what extent maternal vitamin D status influences fetal development. Using an unselected community-based cohort of 901 mother-offspring pairs (the Western Australian Pregnancy Cohort [Raine] Study), we examined the relationship between maternal vitamin D deficiency at 18 weeks’ pregnancy and long-term health outcomes of offspring who were born in Perth, Western Australia (32° South), in 1989–1991. Vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] <50 nmol/L) was present in 36% (323 of 901) of the pregnant women. After adjusting for relevant covariates, maternal vitamin D deficiency during pregnancy was associated with impaired lung development in 6-year-old offspring, neurocognitive difficulties at age 10, increased risk of eating disorders in adolescence, and lower peak bone mass at 20 years. In summary, vitamin D may have an important, multifaceted role in the development of fetal lungs, brain, and bone. Experimental animal studies support an active contribution of vitamin D to organ development. Randomized controlled trials of vitamin D supplementation in pregnant women with long-term follow-up of offspring are urgently required to examine whether the correction of vitamin D deficiency in pregnant women is beneficial for their offspring and to determine the optimal level of maternal serum 25(OH)D for fetal development.

Confirmatory factor analysis of the Eating Disorder Examination-Questionnaire (EDE-Q)

OBJECTIVE To compare the goodness-of-fit of five models of Eating Disorder Examination-Questionnaire (EDE-Q) data, in clinical and community samples. METHOD The EDE-Q was administered to 228 eating disorder patients and 211 non-eating disordered university students. Confirmatory factor analysis was used to compare the validity of the original four EDE-Q subscales with that of brief one-factor, extended one-factor, two-factor, and three-factor models. Measurement invariance across the two samples was considered. RESULTS The only model to provide an acceptable fit to the data was the brief one-factor model consisting of eight Weight and Shape Concern items. Scores on this scale correlated highly with the original EDE-Q subscales. CONCLUSION The reliability of the EDE-Q may be increased if a modified scoring system is used. This complements findings from recent research with the Eating Disorder Examination (EDE).

Energy drink consumption among young Australian adults: Associations with alcohol and illicit drug use

BACKGROUND Energy drinks are becoming increasingly popular among young people. The purpose of this study was to determine the prevalence of energy drink consumption and its associations with socio-demographic characteristics, alcohol, cigarette and illicit drug use in a population-based sample of young adults participating in the Western Australian Pregnancy Cohort (Raine) Study. METHODS We used self-administered questionnaires to assess energy drink consumption patterns, alcohol intake, cigarette and illicit drug use at the 20-year cohort follow-up. Data was also collected on socio-demographics, physical activity, body mass index (BMI) and dietary intake. Our sample included 1234 participants (47% male, mean age 20 ± 0.5 years). We considered energy-drink consumption as a categorical (users versus non-users) variable. RESULTS Overall, 48% of participants consumed energy drinks at least once per month, with an average intake of 1.31 ± 0.75 cans per day amongst energy drink users. The most significant correlates of energy drink use were being in part-time or full-time employment, being male, being a cigarette smoker, having heavier alcoholic spirit consumption patterns and being an ecstasy user (all p<0.05). No significant associations were observed with BMI or dietary intake. CONCLUSIONS Australian energy drink users tend to have heavier alcohol consumption patterns be a cigarette smoker and use illicit drugs relative to non-users. More research is needed regarding the health risks associated with energy drink use in young adults, including their possible role in the development of substance abuse problems.

Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders

Between 30 and 70% of patients with eating disorders drop out from outpatient treatment. However, research has been unable to identify factors that consistently predict dropout from eating disorder treatment. Most studies have exclusively investigated the role that individual patient characteristics play in dropout and have ignored more process-based factors such as expectations about treatment, the therapeutic alliance, or time spent on a treatment waiting list. This study aimed to investigate the roles of both individual patient characteristics and process-based factors in dropout from outpatient treatment for eating disorders. The study involved data collected from consecutive eating disorder referrals to the only public specialist eating disorder service for youth and adults in Perth, Western Australia. The standard treatment provided at this service is Enhanced Cognitive Behaviour Therapy on an individual basis. The study involved 189 patients referred to the service between 2005 and 2010. Forty five percent of this sample dropped out of treatment. Results showed that, in this sample, two individual factors, lowest reported weight and the tendency to avoid affect, and one process-based factor, time spent on the wait list for treatment, were significant predictors of dropout. These findings are valuable because a process-based factor, such as wait-list time, may be easier to address and modify than a patients weight history or the trait of mood intolerance. Increased resources for eating disorder services may reduce waiting list times which would help to reduce dropout and maximize treatment outcomes.

Low vitamin D levels are associated with symptoms of depression in young adult males

Objective: Results from studies examining associations between serum 25-hydroxyvitamin D (25(OH)D) concentrations and depressive symptoms are equivocal. We investigated the relationship between serum 25(OH)D concentrations and symptoms of depression, anxiety and stress in a cross-sectional analysis of a population-based sample of young adults participating in the Western Australian Pregnancy Cohort (Raine) Study. Methods: Participants provided a blood sample at the 20-year follow-up (March 2010-April 2012) for the measurement of serum 25(OH)D concentrations. Mental health symptoms were assessed using the 21-item Depression Anxiety Stress Scales (DASS-21). Associations between serum 25(OH)D concentrations and total DASS-21 scores and subscale scores of depression, anxiety and stress were explored in males and females using negative binomial regression, adjusting for age, race, body mass index (BMI) and physical activity (n=735). Models examining subscale scores were also adjusted for the other subscale scores. Results: After adjusting for confounders, an increase in serum 25(OH)D concentrations of 10 nmol/L decreased total DASS-21 scores in males by 9% (rate ratio (RR) 0.91; 95%CI 0.87,0.95; p<0.001) and depression subscale scores in males by 8% (RR 0.92; 95%CI 0.87,0.96; p=0.001). However, in adjusted models there were no significant associations between serum 25(OH)D concentrations and symptoms of anxiety and stress in males. There were no significant associations between serum 25(OH)D concentrations and symptoms of depression, anxiety and stress in females. Conclusions: We found an association between serum 25(OH)D concentrations and symptoms of depression, but not anxiety and stress, in males. Randomised controlled trials are necessary to determine any benefit of vitamin D supplementation in the prevention and treatment of depressive symptoms in young adults.