Michael J. Maloney

Reliability Testing of a Children's Version of the Eating Attitude Test

Abstract To study eating disorders in children, a measurement of childrens eating attitudes must be available. Adolescents and adults are commonly surveyed with the Eating Attitude Test (EAT), but it is incomprehensible to children. A childrens version of the EAT (ChEAT) was designed and tested on 318 children aged 8 through 13 years. Test-retest and internal reliability coefficients of the ChEAT were comparable to published studies with adults. Almost 7% of the children scored within the anorectic range on the ChEAT, closely matching the percentage reported for adolescents and adults on the EAT.

A controlled study of type a behavior and psychophysiologic responses to stress in anorexia nervosa

Adolescents and young adults meeting DSM-III criteria for anorexia nervosa (n = 13) and atypical eating disorders (n = 7) were compared with weight-recovered anorectics (n = 6) and normal weight controls (n = 11) using a type-A structured interview and a computerized stress procedure. Heart rate, blood pressure, and electrocardiographic changes were monitored. Anorexia nervosa subjects demonstrated significantly more type-A characteristics than controls. The emaciated and weight-recovered anorectics had elevated hostility scores on the type-A interview, which has been shown in recent studies of type-A behavior to be a risk factor for cardiovascular disease. This pilot study is the first to demonstrate a significant relationship between anorexia and the type-A behavioral pattern. Also the anorectic subjects showed significantly more cardiovascular reactivity than controls as measured by failure of stressed anorectic subjects to lower their systolic blood pressure to baseline levels as controls did. These results support the importance of monitoring stress reactions and personality traits as well as traditional biological measures.

A role for Helicobacter pylori in the gastrointestinal complaints of eating disorder patients

UNLABELLED Eating disorder patients frequently present with gastrointestinal complaints. Helicobacter pylori is an etiologic factor in type B gastritis, gastric and duodenal ulcers, and may cause nausea and anorexia. OBJECTIVE To determine whether or not there is an increased prevalence of H. pylori infection in patients with eating disorders. METHOD Serum H. pylori IgG antibody and gastrointestinal symptoms were assessed in 32 patients admitted for inpatient treatment of anorexia nervosa and/or bulimia nervosa. RESULTS Eating disorder patients did not have an increased rate of detectable serum H. pylori IgG antibody. DISCUSSION There is not an increased prevalence of H. pylori infection in eating disorder patients. Thus, the increased frequency of gastrointestinal complaints in eating disorder patients cannot be attributed to H. pylori infection.

Group Consultation with Highly Stressed Medical Personnel to Avoid Burnout

Group consultation involves weekly meetings of a consultant with a group of consultees to assist them in identifying, understanding, and dealing with stresses at work. The outcome measurements used to document a 50% decrease in the annual dropout rates for nurses on each of two high-stress pediatric inpatient units conducting group consultation sessions are described. The dynamics of burnout are summarized and some techniques used in group consultation which may prevent burnout are discussed.

Lower dosages of phentermine-fenfluramine given in the afternoon: five cases with significant weight loss.

Phentermine and fenfluramine are widely used in the treatment of obesity. Despite the fact that primary pulmonary hypertension and mitral valve insufficiency have been associated with fenfluramine use, many of these patients need medication to achieve weight loss. Small degrees of weight loss have been shown to significantly improve obesity-related medical conditions such as hypertension, hypercholesterolemia, and noninsulin-dependent diabetes mellitus. Current practice is to give phentermine and fenfluramine in the morning and afternoon. Doses for phentermine have ranged from 15 to 37.5 mg and for fenfluramine from 20 to 120 mg per day. We report five cases of severely obese women with medical complications who were treated with phentermine 8 mg twice per day (at 1:00 p.m. and 4:00 p.m.) and fenfluramine 20 mg per day (at 4:00 p.m.). Because many obese patients skip breakfast and eat more in the afternoon and evening, medication was dosed in order to cover these high-risk eating periods. Overall, these patients lost a mean of 22.4% of their initial weight (range 18.6% to 32.8%) over an average of 8.4 months (range 3.5 to 16 months). These cases suggest that short-term weight loss can be achieved with a low dose of fenfluramine when both medications are given in the afternoon to better target the eating patterns of obese subjects.

Soft Drink Consumption Among US Children and Adolescents: Nutritional Consequences

Objective To determine whether carbonated soft drink consumption is associated with consumption of milk, fruit juice, and the nutrients concentrated in these beverages. Design : Data collected as part of the 1994 Continuing Survey of Food Intakes by Individuals were analyzed. Information on food and nutrient intake was derived from 2 days of dietary recall data collected via an in-person interview. Subjects and Participants : Nationally representative sample of people of all ages residing in the United States (response rate = 76.2%). Analyses were restricted to children aged 2 to 18 years (N = 1,810). Statistical Analyses Performed : Logistic regression analyses were conducted to predict the odds of low milk and juice consumption by soft drink consumption level. To determine whether intake of select nutrients varied by soft drink consumption, multiple linear regression modeling was conducted. Analyses were conducted using sample weights and software appropriate for the survey design. Results Energy intake was positively associated with consumption of nondiet soft drinks. For example, mean adjusted energy intake was 1,830 kcal/day for school-aged children who were nonconsumers of soft drinks compared with 2,018 kcal/day for children in this age group who consumed an average of 9 oz of soda or more per day. Those in the highest soft drink consumption category consumed less milk and fruit juice compared with those in the lowest consumption category (nonconsumers). Conclusions Nutrition education messages targeted to children and/or their parents should encourage limited consumption of soft drinks. Policies that limit childrens access to soft drinks at day care centers and schools should be promoted. J Am Diet Assoc 1999;99:436–441. Copyright the American Dietetic Association. Reprinted by permission from Journal of The American Dietetic Association.

Beach Week: A High School Graduation Rite of Passage for Sun, Sand, Suds, and Sex

Background: Every year, thousands of suburban high school graduates from mid Atlantic states flock to nearby coastal beaches for a long-anticipated rite of passage known as “beach week.” Sand, sun, and sea, and also smoking, binge drinking, drugs, and sex, are reported to be dominant themes. Objective: To document risk-taking behaviors by girls during beach week. Method: Fifty-nine female suburban high school graduates who attended beach week in 1996 volunteered to fill out a confidential printed survey. Twenty-five girls (42%) completed the survey during a typical beach week party. Their activities were verified on site by a peer, recommended by her grade advisor for her integrity and popularity. Breath alcohol values were obtained at entry and departure from the party. The remaining 34 girls completed the supervised survey 2 to 3 months later. Results: Daily cigarette smoking (54%), daily drunkenness (75%), and sex (46%) were the norm among respondents of our survey. Few reported first-time sex (n=4) or drug use (n=2). Abstinence from drugs (67%) and sex (55%) was not unusual but only 12% abstained from getting drunk. Sixteen girls (64%) reported that they drank 8 or more beers/wine during a typical beach week party. By departure from the party, 15 girls had breath alcohol values of 0.017 mmol/L or greater (reference range, ,21.7 mmol/L), and 8 additional girls had breath alcohol values of 0.01 mmol/L to 0.015 mmol/L. Fifteen percent of the 59 reported injuries or illness were related to alcohol or drugs. Conclusion: Most respondents enjoyed beach week but a large percentage engaged in serious risk-taking behaviors.