Kimberley J. Hoiles

Prevention of eating disorders: A systematic review of randomized, controlled trials.

OBJECTIVE This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention. METHOD A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted. RESULTS Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up. DISCUSSION The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required.

The validity of the transdiagnostic cognitive behavioural model of eating disorders in predicting dietary restraint

The study examined the validity of the transdiagnostic cognitive behavioural theory of eating disorders. The aim was to determine if the maintaining mechanisms of clinical perfectionism, core low self esteem, mood intolerance and interpersonal difficulties have a direct impact on dietary restraint or an indirect impact via eating, shape and weight concerns. The model was tested in a community sample of 224 females recruited via the internet. The structural equation model provided a good fit for the data. The relationship between maintaining mechanisms and dietary restraint was due to maintaining mechanisms impacting indirectly on dietary restraint via eating disorder psychopathology. The results lend support for the validity of the transdiagnostic model of eating disorders as the maintaining mechanisms lead to restraint via the core psychopathology of eating concerns, weight concerns and shape concerns. The findings suggest the four maintaining mechanisms alone are not enough to lead to dietary restraint, the core psychopathology of eating disorders needs to be present, which supports the predictions of the theory. These results help establish the validity of the transdiagnostic cognitive behavioural theory of eating disorders.

Serum ferritin and nutritional status: insights from an eating disorders clinic population

Objective To determine the relationship between serum ferritin and malnutrition in newly assessed patients at a paediatric eating disorders clinic. Design This was a prospectively assessed clinical cohort study. Setting Intake assessment clinic of a tertiary eating disorders service for children and adolescents. Methods Clinical, anthropometric and laboratory features of children and adolescents were systematically measured. The relationship of serum ferritin to other clinical, anthropometric and laboratory measures was determined using linear regression. Results A total of 121 female patients aged 9.5–17.6 years were included, with body mass index (BMI) z score −5.7 to 1.9 (median −1.3). Using multiple regression, serum ferritin was inversely associated with BMI z score (regression coefficient (β)=−0.234, 95% CI −0.413 to −0.055) and serum insulin-like growth factor 1 (IGF-1) (β=−0.476, 95% CI −0.884 to −0.068) and positively associated with alanine aminotransferase (β=0.357, 95% CI 0.055 to 0.659, controlling for age, pubertal stage and serum iron). Conclusions In malnourished adolescents with eating disorders increased serum ferritin is associated with lower BMI z score and serum IGF-1.

Normative data for female adolescents with eating disorders on the Children's depression inventory

OBJECTIVE Given the importance of assessing depressive symptoms and suicidal ideation in adolescents with eating disorders (EDs), the aim was to provide normative data on the Childrens Depression Inventory (CDI) for female adolescents presenting for treatment of an ED. METHOD The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry (N = 1000), a prospective, ongoing registry study comprising consecutive pediatric tertiary ED referrals. Females (N = 256; 12-17 years) with DSM-5 EDs completed the CDI at intake. RESULTS Results on the CDI revealed a pattern of increasing depressive scores with age and higher scores among patients with anorexic spectrum disorders. The prevalence of suicidal ideation was high and had the same pattern as CDI scores. The mean score on the CDI in the sample was higher than community samples and clinical samples of adolescents with post-traumatic stress disorder, obsessive compulsive disorder, and other clinical disorders. DISCUSSION Females adolescents with EDs are at high-risk of depression and suicidal ideation. These data provide information about variation in CDI scores to guide clinicians in interpretation of scores.

A decade of data from a specialist statewide child and adolescent eating disorder service: does local service access correspond with the severity of medical and eating disorder symptoms at presentation?

BackgroundEating disorders affect up to 3% of children and adolescents, with recovery often requiring specialist treatment. A substantial literature has accrued suggesting that lower access to health care services, experienced by rural populations, has a staggering effect on health-related morbidity and mortality. The aim of this study was to evaluate whether lower service access foreshadowed a more severe medical and symptom presentation among children and adolescents presenting to a specialist eating disorders program.MethodThe data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry (N ~1000), a prospective ongoing registry study comprising consecutive paediatric tertiary eating disorder referrals. The sample consisted of 399 children and adolescents aged 8 to 16 years (M =14.49, 92% female) meeting criteria for a DSM-5 eating disorder.ResultsConsistent with the hypotheses, lower service access was associated with a lower body mass index z-score and a higher likelihood of medical complications at intake assessment. Contrary to our hypothesis, eating pathology assessed at intake was associated with higher service access. No relationship was observed between service access and duration of illness or percentage of body weight lost.ConclusionsLower service access is associated with more severe malnutrition and medical complications at referral to a specialist eating disorder program. These findings have implications for service planning and provision for rural communities to equalize health outcomes.

Normative data for female adolescents with eating disorders on the multidimensional anxiety scale for children

OBJECTIVE To provide normative data on the Multidimensional Anxiety Scale for Children (MASC) for female adolescents presenting for eating disorder (ED) treatment. METHOD This study is part of the Helping to Outline Paediatric Eating Disorders Project registry (N ∼ 1,000), a prospective ongoing registry study comprising consecutive pediatric tertiary ED referrals. Female adolescents (N = 278; 13-17 years) with EDs completed the MASC at intake. RESULTS Summary data including percentiles are given for the MASC total and subscales. MASC scores were higher than community norms as expected and increased with age (p <.001) and an anorexic spectrum diagnosis (p < .001). DISCUSSION The norms reported will aid clinicians in the understanding and interpretation of individual MASC scores among female adolescents with EDs and could assist future research to better understand the role of anxiety in the onset and maintenance of EDs.

Consensus-based perspectives of pediatric inpatient eating disorder services

OBJECTIVE There are few evidence-based guidelines for inpatient pediatric eating disorders. The aim was to gain perspectives from those providing and receiving inpatient pediatric eating disorder care on the essential components treatment. METHOD A modified Delphi technique was used to develop consensus-based opinions. Participants (N = 74) were recruited for three panels: clinicians (n = 24), carers (n = 31), and patients (n = 19), who endorsed three rounds of statements online. RESULTS A total of 167 statements were rated, 79 were accepted and reached a consensus level of at least 75% across all panels, and 87 were rejected. All agreed that families should be involved in treatment, and thatpsychological therapy be offered in specialist inpatient units. Areas of disagreement included that patients expressed a desire for autonomy in sessions being available without carers, and that weight gain should be gradual and admissions longer, in contrast to carers and clinicians. Carers endorsed that legal frameworks should be used to retain patients if required, and that inpatients are supervised at all times, in contrast to patients and clinicians. Clinicians endorsed that food access should be restricted outside meal times, in contrast to patients and carers. DISCUSSION The findings indicate areas of consensus in admission criteria, and that families should be involved in treatment, family involvement in treatment, while there was disagreement across groups on topics including weight goals and nutrition management. Perspectives from patients, carers, and clinicians may be useful to consider during future revisions of best practice guidelines.

Implications of DSM‐5 for the diagnosis of pediatric eating disorders

OBJECTIVE The aim of the study was to compare the DSM-IV, DSM-5, and ICD-10 eating disorders (ED) nomenclatures to assess their value in the classification of pediatric eating disorders. We investigated the prevalence of the disorders in accordance with each systems diagnostic criteria, diagnostic concordance between the systems, and interrater reliability. METHOD Participants were 1062 children and adolescents assessed at intake to a specialist Eating Disorders Program (91.6% female, mean age 14.5 years, SD = 1.75). Measures were collected from routine intake assessments. RESULTS DSM-5 categorization led to a lower prevalence of unspecified EDs when compared with DSM-IV. There was almost complete overlap for specified EDs. Kappa values indicated almost excellent agreement between the two coders on all three diagnostic systems, although there was higher interrater reliability for DSM-5 and ICD-10 when compared with DSM-IV. DISCUSSION DSM-5 nomenclature is useful in classifying eating disorders in pediatric clinical samples.

Perfectionism is associated with higher eating disorder symptoms and lower remission in children and adolescents diagnosed with eating disorders

OBJECTIVE The link between perfectionism and eating disorders is well established in adults, however little research has been conducted in children and adolescents. The aim was to examine if perfectionism was a predictor of eating disorder symptoms at intake assessment, and 6 and 12 month review. METHOD There were 175 children and adolescents aged 10-17 years (M = 14.47 years, SD = 1.31) who were assessed using the Eating Disorders Inventory-3 perfectionism subscale and the child adapted Eating Disorders Examination at intake, 6 and 12 months review. RESULTS There was a significant association between perfectionism and symptoms of eating disorders at intake assessment and at 6 and 12 month review. Higher perfectionism at intake predicted a lower likelihood of remission at 12 months. DISCUSSION The findings suggest that similar to adult samples, perfectionism is significantly associated with eating disorder symptoms in children and adolescents. Further research is required to examine the impact of perfectionism on eating disorder symptoms in longitudinal research with children and adolescents with eating disorders.

Correlates of Psychiatric Inpatient Admission in a Paediatric Eating Disorder Cohort

Method The sample comprised patients aged 8 to 17 years (91% female), with DSM-5 eating disorder diagnosis, categorised as with (n = 38) or without (n = 247) impending psychiatric admission, assessed between 2006 and 2013. The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry (N ~ 1000), a prospective, ongoing registry study comprising consecutive paediatric tertiary eating disorder referrals.