Rosa M. Raich

Disordered eating prevention programme in schools: a 30-month follow-up.

OBJECTIVE The present study aims to evaluate the long-term effects of a school-based prevention programme administered to adolescents; the purpose of the said programme was to reduce disordered eating attitudes and sociocultural influences on the internalisation of the aesthetical body ideal. METHODS A total of 254 girls and 189 boys were assigned to a control (n = 201) or to two experimental conditions: media literacy programme (n = 143) and media literacy plus nutrition awareness programme (n = 99). Pretest, post-test (1 month later) and 7-month and 30-month follow-up measurements were taken using the Eating Attitudes Test (EAT-40) and the questionnaire on influences of aesthetic body ideal-26/cuestionario de influencias del modelo estético corporal (CIMEC-26). Linear mixed-model analyses were conducted with a 2 × 3 × 3 ANOVA (sex × group × phase), adjusted by the baseline level. RESULTS The participants from both prevention programmes scored lower than the participants in the control group at follow-up assessments on EAT-40 and CIMEC-26 scores. DISCUSSION Both media literacy-based programmes can be effective interventions reducing long-term self-reported disordered eating attitudes and internalisation of the aesthetic body ideal in a universal mixed-sex school-going adolescent population.

Obsessive-compulsive and eating disorders: Comparison of clinical and personality features

Abstract  The aim of the present study was to determine whether anorexia nervosa (AN), bulimia nervosa (BN) and obsessive‐compulsive disorder (OCD) share clinical and psychopathological traits. The sample consisted of 90 female patients (30 OCD; 30 AN; 30 BN), who had been consecutively referred to the Department of Psychiatry, University Hospital of Bellvitge, Barcelona. All subjects met DSM‐IV criteria for those pathologies. The assessment consisted of the Maudsley Obsessive‐Compulsive Inventory (MOCI), Questionnaire of obsessive traits and personality by Vallejo, Eating Attitudes Test‐40 (EAT‐40), Eating Disorder Inventory (EDI), and Beck Depression Inventory (BDI). ancova tests (adjusted for age and body mass index) and multiple linear regression models based on obsessive‐compulsiveness, obsessive personality traits and perfectionism, as independent variables, were applied to determine the best predictors of eating disorder severity. On ancova several significant differences were found between obsessive‐compulsive and eating‐disordered patients (MOCI, P < 0.001; EAT, P < 0.001; EDI, P < 0.001), whereas some obsessive personality traits were not eating disorder specific. A total of 16.7% OCD patients presented a comorbid eating disorder, whereas 3.3% eating disorders patients had an OCD diagnosis. In the eating disorder group, the presence of OC symptomatology was positively associated (r = 0.57, P < 0.001) with the severity of the eating disorder. The results were maintained after adjusting for comorbidity. Although some obsessive‐compulsive and eating disorder patients share common traits (e.g. some personality traits especially between OCD and AN), both disorders seem to be clinically and psychopathologically different.

Disordered eating behaviors and body image in a longitudinal pilot study of adolescent girls: What happens 2 years later?

We assessed the prospective association of risk factors for eating and body image disturbances after a 2-year follow-up in a community sample of Spanish adolescent girls. The participants included 128 Spanish girls aged 12-14, who took part in a 28-month prospective study. Aspects assessed were eating attitudes (Eating Attitudes Test), influence of the body shape model (questionnaire on influences of the aesthetic body shape model), extreme weight-control behaviors (Eating Disorder Examination-Questionnaire), body image (Body Image Questionnaire) and Body Mass Index (BMI). BMI, extreme weight-control behaviors and body image problems emerged as potential predictors of an increase in eating disturbances. An increased influence of the thinness model was significantly associated with reduced body satisfaction and body image problems. Preventive programs are needed to contribute reducing the impact of sociocultural influences with regard to thinness, the use of extreme weight-control behaviors and overweight in adolescents.

Psychometric Properties of the Eating Disorder Examination Questionnaire (EDE-Q) and Norms for Rural and Urban Adolescent Males and Females in Mexico

Aims To contribute new evidence to the controversy about the factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) and to provide, for the first time, norms based on a large adolescent Mexican community sample, regarding sex and area of residence (urban/rural). Methods A total of 2928 schoolchildren (1544 females and 1384 males) aged 11-18 were assessed with the EDE-Q and other disordered eating questionnaire measures. Results Confirmatory factor analysis of the attitudinal items of the EDE-Q did not support the four theorized subscales, and a two-factor solution, Restraint and Eating-Shape-Weight concern, showed better fit than the other models examined (RMSEA = .054); measurement invariance for this two-factor model across sex and area of residence was found. Satisfactory internal consistency (ω ≥ .80) and two-week test-retest reliability (ICCa ≥ .84; κ ≥ .56), and evidence for convergent validity with external measures was obtained. The highest attitudinal EDE-Q scores were found for urban females and the lowest scores were found for rural males, whereas the occurrence of key eating disorder behavioural features and compensatory behaviours was similar in both areas of residence. Conclusions This study reveals satisfactory psychometric properties and provides population norms of the EDE-Q, which may help clinicians and researchers to interpret the EDE-Q scores of adolescents from urban and rural areas in Mexico.

Evaluation of a school-based programme of universal eating disorders prevention: is it more effective in girls at risk?

There is currently controversy surrounding the effectiveness of universal versus selective prevention in eating disorders (ED). The present study aims at evaluating the effectiveness of universal school-based ED prevention administered to female secondary school students (n = 349). Students received either the full prevention programme (learning basic concepts of nutrition, criticism of aesthetic models of beauty emphasising extreme thinness, media literacy (ML)), a partial version of the programme (without nutritional education), or no prevention programme. Students were also classified on the presence or absence of distinct risk factors for ED: Early menarche, overweight, dieting, negative attitudes to food and perceived pressure to be thin. Pre-test data were collected 1 week prior to implementation of the prevention programme, and post-test data were collected on the last day of the programme. Results suggested that both the full and partial prevention programmes reduced perceived pressure to be thin and improved eating attitudes and knowledge of nutrition in all the participants (regardless of risk); however, greater effect sizes were found among particular high-risk groups (early menarche, overweight and highly influenced by aesthetic models of beauty emphasising extreme thinness). School-based programmes of universal intervention may have an important role to play in the prevention of ED.

A Controlled Assessment of School-Based Preventive Programs for Reducing Eating Disorder Risk Factors in Adolescent Spanish Girls

This study assesses the impact of an eating disorders universal preventive program on a representative sample of Spanish adolescents in the area of Barcelona, Spain. 323 adolescent girls were assigned to three experimental conditions: complete intervention, partial intervention, and non-treatment. The program obtained a significant change in reducing the influences of the aesthetic body ideal and in improving the knowledge of nutrition. Nevertheless, attained post-treatment changes dissipate at the 6 month follow-up. In our opinion, the lack of lasting effects should be attributed to a series of considerations such as format, tests not validated for this age, or insufficient research.

Effects of a brief and economical intervention in preparing patients for surgery: does coping style matter?

The objective of this study was to examine the effects of a brief and economical procedure in the preparation of surgical patients. More specifically, the study was intended to test whether patients monitoring style (high vs. low) makes any difference to the benefits of a relaxation technique. Ninety-two patients scheduled for hysterectomy with double oophorectomy were assessed for preferred coping style and randomly assigned to one of two conditions: (a) relaxation training and (b) attention control. It was hypothesized that low monitors would report less pain, less analgesic use and a higher activity level when trained in relaxation than low monitor controls or than high monitors trained in relaxation. Results showed no differences between individuals with different coping styles. On the other hand, however, statistically significant differences were observed between trained patients and controls. Namely, individuals trained in relaxation experienced less pain along the surgical process, pain interfered less with their daily activities, and performed a higher activity level three weeks after surgery, compared to non trained patients.

Factors associated with body image dissatisfaction among adolescents in public schools students in Salvador, Brazil.

OBJECTIVE To identify the prevalence of body image dissatisfaction and associated factors among students in Salvador, Brazil. METHODS A cross-sectional study involving a random sample of 1,494 (852 girls and 642 boys) adolescents between 11 and 17 years of age who were students in the public schools in Salvador, Brazil. Participants completed the Body Shape Questionnaire and the Eating Attitudes Test-26. Body image was characterized as satisfactory or unsatisfactory. We obtained demographic, anthropometric and economic information and information regarding the stage of maturation, self-perception of body weight, and consumption of sweetened beverages and diet soft drinks. To identify associated factors we used Poisson regression analysis. RESULTS Body image dissatisfaction was present in 19.5% of the adolescents, with a prevalence of 26.6% among the girls and 10% among the boys. Independent of sex, the prevalence of body image dissatisfaction was higher among adolescents who were overweight or obese (girls, PR: 1.38, CI: 1.09-1.73 and boys, PR: 2.26, CI: 1.08-4.75), higher among those who perceived themselves as fat (girls, PR: 2.85, CI: 2.07-3.93 and boys, PR: 3.17, CI: 1.39-7.23), and higher among those who had negative attitudes toward eating (girls, PR: 2.42, CI: 1.91-3.08 and boys, PR: 4.67, CI: 2.85-7.63).. A reduction in body image dissatisfaction was only identified among underweight girls (PR: 0.12, CI: 0.03-0.49). CONCLUSIONS A high occurrence of body image dissatisfaction was observed among the adolescents, and biological and behavioral factors were associated with this dissatisfaction.

Epidemiology and risk factors of eating disorder in adolescence: a review

INTRODUCTION Currently, there is a higher occurrence of biopsychosocial diseases, especially eating disorders, involving different body systems and aspects related to the individual and their social relations. OBJECTIVE Addressing current and relevant issues about the prevalence, incidence and risk factors for anorexia and bulimia nervosa in adolescence. METHODS Search the databases: MEDLINE, SciELO and LILACS for studies published on the epidemiology and risk factors for eating disorders in adolescence. RESULTS The highest incidence of anorexia and bulimia nervosa among girls in the middle and final phase of adolescence. Factors that increase the risk for the onset of eating disorders in adolescents are: genetics, body changes during puberty, the vulnerability of adolescents to the ideals of thinness, social pressures to be thin, body image dissatisfaction, restrictive diet, depression and low self-esteem. However, it is suggested that in different cultures, eating disorders may come from a number of conditions unrelated to compensatory behaviors or weight, but the shape of the body. CONCLUSIONS Several factors determine the occurrence of anorexia and bulimia nervosa in adolescence, however, there is no consensus how these factors interact in this complex process, which indicates the need for further investigations.

Trastornos de la conducta alimentaria en adolescentes jóvenes con diabetes mellitus tipo 1

Fundamento y objetivo: Determinar la prevalencia de trastornos de la conducta alimentaria (TCA) en pacientes con diabetes mellitus tipo 1. Sujetos y metodo:Se ha incluido a adolescentes de ambos sexos de 12 a 16 anos, 98 con diabetes mellitus tipo 1 y 575 sin ella (grupo control), a los que se aplico la version espanola validada del Eating Attitudes Test-40. Un grupo de sujetos fue posteriormente evaluado mediante la entrevista Eating Disorders Examination. Se registraron el peso, la talla, el indice de masa corporal, la hemoglobina glucosilada y la manipulacion de insulina como control de peso. Resultados: La prevalencia de TCA no especificados fue mayor en adolescentes diabeticos (en varones, el 1,7 frente al 0,9%; odds ratio [OR] = 1,7; intervalo de confianza [IC] del 95%, 0,2-17,6; en mujeres, el 5,3 frente al 1,6%; OR = 3,2; IC del 95%, 0,6-17,2). En varones diabeticos los TCA subclinicos fueron mas frecuentes que en los no diabeticos (el 10% frente al 4,4%; OR = 2,4; IC del 95%, 0,9-6,6), aunque sin diferencia estadisticamente significativa. Los valores de hemoglobina glucosilada fueron significativamente mayores (p = 0,49) en adolescentes diabeticos con TCA no especificados y TCA subclinicos (9,7% [1,5%] y 5,6 [2,8], respectivamente; n = 13) que en aquellos sin trastornos (8,4% [1,5%] y 5,1 [2,7]; n = 85). Nueve pacientes (9,1%) manipulaban dosis de insulina para controlar el peso. Conclusiones: La prevalencia de TCA no especificados en adolescentes diabeticos de ambos sexos fue mayor que en los adolescentes no diabeticos. La prevalencia de TCA subclinicos fue mayor en varones con diabetes mellitus tipo 1 que los no diabeticos.