International Journal of Eating Disorders最新文献

Objective: Eating disorders (ED) and psychological distress are highly prevalent in individuals with Class 3 obesity (BMI ≥ 40 kg/m²). With the increasing use of glucagon-like peptide-1 receptor agonists (GLP1-RA), concerns have emerged about the potential worsening of ED symptoms. This study aimed to compare ED risk and psychological distress in adults with Class 3 obesity: (1) between those already on GLP1-RA and those not and (2) between baseline and 12 months in individuals initiated on GLP1-RA in the program.

Method: This retrospective observational cohort study included adults with Class 3 obesity enrolled in a publicly funded multidisciplinary weight management program in Sydney from January 2018 to June 2024. Participants completed the Eating Disorder Examination-Questionnaire Short (EDE-QS), Kessler Psychological Distress Scale (K10), and Depression, Anxiety and Stress Scale-21 (DASS-21) at baseline and 12-months.

Results: Among 666 participants, 59 (9%) were on GLP1-RA at baseline, with no significant differences in EDE-QS, K10, or DASS-21 scores compared to those not on GLP1-RA. Of 203 participants not on a GLP1-RA at baseline and having 12-month data, 31 (15.3%) initiated GLP1-RA treatment, with the majority on semaglutide 1 mg and a mean duration of use of 7.1 ± 3.7 months. Those initiated on GLP1-RA had a significant reduction in median weight, from 131.0 (118.7-149.6) kg at baseline to 120.0 (109.2-135.3) kg at 12 months, p < 0.001. There were no statistically significant changes in EDE-QS, K10, and DASS-21 scores from baseline to 12 months, and none stopped GLP1-RA due to ED symptoms or psychological distress.

Discussion: This study suggests that GLP1-RAs may not significantly worsen ED risk or psychological distress in adults with Class 3 obesity.

In her commentary Dietary Restraint Fallacy, Jansen argues that the theory linking dietary restraint to binge eating and weight gain can be dismissed as a "fallacy." This conclusion is largely drawn from Grilo and Pittman, who found that rigid restraint was associated with reduced binge frequency and greater weight loss. We contend that dietary restraint remains a profoundly complex and unsettled issue, with implications for weight regain and eating disorder prevention. Importantly, the three Commentaries on Grilo and Pittman were invited simultaneously. Readers encountering only one of them may not realize that these papers were designed to present contrasting viewpoints. In this Commentary, we stress why restraint theory cannot be dismissed wholesale, highlight the need for integration between obesity and eating disorders fields, and emphasize that premature simplifications risk distorting both scientific understanding and clinical practice.

Objective: Prenatal exposures have been suggested to have a programming effect on neural and metabolic development, which may affect the risk of eating disorders. We investigated the association between prospectively measured maternal gestational high-sensitivity C-reactive protein (hs-CRP), an established inflammatory biomarker, and subsequent risk of AN in daughters.

Method: This nested case-control study with sibling-comparison design used systematic sampling from a register-based cohort including all eating disorder patients in Finland born 1991-2000 and diagnosed in specialized health care. Final sample included 150 full triads of females with severe AN (ICD-10 code F50.0), age- and sex-matched population controls, and biological sister controls (total N = 450).

Results: Mean gestational hs-CRP values were 4.10 mg/L (SD 5.22), 4.83 mg/L (SD 4.88), and 5.53 mg/L (SD 10.36), for individuals with AN, population controls, and sister controls, respectively. Higher hs-CRP was associated with decreased risk for AN when compared to sister controls (adjusted OR 0.68, 95% Cl 0.48-0.97, p = 0.03). Analyzing hs-CRP in tertiles, maternal hs-CRP in the highest tertile (≥ 5.13 mg/L) versus lowest tertile (≤ 1.94 mg/L) was associated with decreased risk for AN compared to sisters (adjusted OR 0.35, 95% Cl 0.15-0.80, p = 0.01), and to all controls combined (adjusted OR 0.52, 95% Cl 0.29-0.93, p = 0.03).

Discussion: We found no evidence that higher gestational CRP would increase the later risk of AN. On the contrary, lower maternal low-grade inflammation early in pregnancy was associated with an increased risk of AN in daughters.

There is an increased interest in targeting transdiagnostic processes in the prevention, early intervention and treatment of mental illness. Targeting transdiagnostic processes may produce more acceptable, engaging, and efficient approaches to addressing mental health disorders, including eating disorders. Given the high prevalence of comorbidities, transdiagnostic approaches may have broader reach, uptake and adoption in real-world applications and clinical practice. Transdiagnostic models may be particularly well-suited to young people, who often present with shifting symptom profiles and are embedded within complex family and education systems. Identification of shared transdiagnostic processes among eating disorders, depression, anxiety, and suicidality and other common comorbid conditions will inform the development of future mental health interventions. To assist in facilitating further research, the International Journal of Eating Disorders will devote a special issue to this topic.

Introduction: Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding and eating disorder characterized by avoidant/restrictive eating behaviors that lead to medical and/or functional impairments. While ARFID is increasingly recognized within pediatric populations and specialist clinics, data on its prevalence and burden within the adult general population remain sparse. We sought to address this knowledge gap.

Methods: We conducted a population-based internet survey with predefined demographic quotas across the UK and USA. The survey included the Nine-Item ARFID Screen (NIAS), the Rome IV diagnostic questionnaire for disorders of gut-brain interaction (e.g., irritable bowel syndrome, functional dyspepsia), and questions regarding demographics, body mass index, somatic symptoms, anxiety and depression, quality of life, and healthcare utilization.

Results: Among 4002 participants (mean age 47.1 years, 50% female), 26.0% screened positive for ARFID. Prevalence was significantly higher in females versus males (29.6% vs. 22.1%, OR 1.48, 95% CI 1.28-1.71) and varied by age: 18-39 years (31.6%), 40-64 years (25.0%), and ≥ 65 years (16.1%; p < 0.001). Participants with a positive ARFID screen demonstrated significantly higher rates of underweight status, disorders of gut-brain interaction, mood disturbances, somatic symptoms, reduced mental and physical quality of life, and increased healthcare utilization compared to unaffected individuals. Increasing severity of ARFID correlated with greater general health impairment (all p < 0.001).

Conclusion: A positive ARFID screen is common within the adult general population, affecting 1-in-4 people, and associated with a substantial health burden. Increased awareness of ARFID will facilitate clinical service provision and guide future research.

Objective: The relationship between resilience and eating disorder psychopathology among adolescents has been understudied. This study assessed prospective associations between baseline resilience and subsequent eating disorder psychopathology in a nationally representative longitudinal cohort of Japanese adolescents.

Method: We conducted a prospective cohort study with participants in grades 5-9 (10-15 years; n = 987) drawn from the Japan Adolescent and Youth longitudinal study. In 2021, resilience was measured using the Rasch-validated version of the Child and Youth Resilience Measure, while eating disorder psychopathology was assessed at the 2022 follow-up using the Eating Disorder Examination-Questionnaire adapted for children. Both instruments were child-reported. Linear regression examined relationships between resilience scores and eating disorder psychopathology, adjusting for grade and maternal education.

Results: Higher overall resilience (β = -0.116; 95% confidence interval [CI]: -0.198, -0.034), personal resilience (-0.113; 95% CI: -0.196, -0.031), and caregiver resilience (-0.109; 95% CI: -0.192, -0.026) were each significantly associated with lower eating disorder psychopathology scores. Higher caregiver resilience was significantly associated with lower levels of restraint over eating (-0.093; 95% CI: -0.179, -0.006), while higher personal resilience was significantly associated with lower levels of guilt about eating (-0.103; 95% CI: -0.200, -0.005).

Discussion: Higher resilience was associated with fewer eating disorder symptoms among adolescents. Personal resilience was observed to be more salient for some symptoms, while caregiver resilience was more salient for others. These findings highlight the multifaceted role of resilience and suggest that interventions may benefit from strengthening both adolescents' individual coping resources and the supportive capacities of caregivers.

Objective: Avoidant/restrictive food intake disorder (ARFID) involves restrictive eating driven by sensory sensitivity, low interest in food, or fear of negative consequences of eating. ARFID affects males and females equally and presents across the weight spectrum. Leptin, an anorexigenic hormone linked to adiposity, may contribute to low hunger and early satiety in ARFID. Prior findings indicate low leptin levels in low-weight females with ARFID; however, the role of leptin in ARFID across weight status and sex remains unknown. We hypothesized that youth with full/subthreshold ARFID, including a subgroup of low-weight males, would exhibit lower fasting leptin levels than healthy controls (HCs). We explored cross-sectional and longitudinal associations between leptin and clinical characteristics.

Method: Participants were youth aged 10-23 years (BMI percentile M [SD] = 41.4 (33.6)) with full/subthreshold ARFID (n = 95; 49.5% female) and HCs (n = 28; 50.0% female). At baseline, participants completed questionnaires, a fasted blood draw, and a diagnostic interview for ARFID, readministered at 1- and 2year follow-ups.

Results: Leptin levels did not differ between ARFID and HC groups. Low-weight ARFID males had significantly lower leptin than HC males (η² = 0.258); however, this difference was nonsignificant after adjusting for BMI percentile. Leptin showed medium-to-large positive associations with age, BMI, and anxiety but not appetite or ARFID severity. Baseline leptin did not predict symptom or weight changes longitudinally.

Discussion: Hypoleptinemia was only evident in low-weight ARIFD and strongly correlated with BMI percentile. However, relationships with anxiety may suggest additional roles of leptin in underlying ARFID psychopathology. Findings should be replicated in larger, more representative samples.

Objective: Although international treatment guidelines for eating disorders recommend varying psychological approaches for adolescents with anorexia nervosa (AN), most existing reviews have combined adolescent and adult samples, leaving the overall evidence base for this population poorly defined. This systematic review is the first to synthesize randomized controlled trials (RCTs) of psychological treatments for adolescents with AN across outpatient, inpatient, and day-patient settings.

Method: A systematic search of databases (e.g., PubMed, APA PsycINFO) identified 22 relevant studies through June 2025. Eligible studies focused on adolescents (ages 8-18 years) with AN undergoing psychological treatment.

Results: Evidence from the nine RCTs consistently indicates that family therapy produces significant positive effects on somatic parameters (e.g., weight) and short-term eating-disorder symptoms. In four, mostly underpowered comparative RCTs, outpatient family therapy showed small-to-moderate effect sizes over individual therapy, though these were restricted to outcomes related to medical recovery. For inpatient care, a limited evidence base suggests that shorter inpatient treatment followed by outpatient care may achieve outcomes comparable to extended hospitalization. Psychological modules delivered during inpatient treatment (e.g., Cognitive Remediation Therapy, CBT-Insomnia) showed some improvements confined to narrow symptom domains but did not translate into broader recovery.

Conclusion: The evidence base remains limited, with few RCTs in adolescents with AN and a geographically narrow, demographically homogeneous sample, predominantly girls from Western settings. Family therapy is supported as the first-line treatment, yet substantial uncertainties persist. Larger and more inclusive RCTs are needed to clarify mechanisms of change, long-term outcomes, and the effectiveness of individual-focused approaches.

Objective: Prevention programs for eating disorders (EDs) have the potential to reduce the onset of these diseases and improve the mental health and well-being of the general population. However, there is mixed evidence on whether routine implementation of such programs at the population level is cost-effective. This study intends to investigate the cost-effectiveness of an evidence-based preventive intervention for EDs, the Body Project, at the population level.

Method: The Body Project is a targeted school-based intervention that aims to prevent EDs among adolescents. A Markov model was developed to evaluate the incremental cost-effectiveness of the hypothetical implementation of the Body Project among female-identifying secondary students in Australia versus a 'no intervention' comparator. A cost-utility analysis was conducted from a "healthcare and limited education" sector perspective with costs and health impacts modeled over the lifetime of the target population. An incremental cost-effectiveness ratio (ICER), expressed as cost per health-adjusted life year (HALY) gained, was calculated. Sensitivity analyses were done to test model assumptions.

Results: If implemented across 1416 Australian secondary schools, the modeled Body Project consisting of four group sessions for eligible girls aged 15-18 years with high body image concerns was estimated to yield about 92 HALYs (95% CI: 58-131) and save $2.56 million in future healthcare costs at an implementation cost of $1.88 million (95% CI: $1.62-$2.15 million).

Discussion: The Body Project intervention is likely to represent good value for money. Successful implementation of this program will require further research into its feasibility and acceptability among schools and the wider community.

Objective: The distinct associations of coaches' and teammates' beliefs about ideal body weight/shape with athletes' disordered eating remain unclear. This study examined how athletes' perceptions of their coaches' and teammates' weight- and shape-related beliefs were associated with eating disorder symptoms and body dissatisfaction among National Collegiate Athletic Association (NCAA) swimmers. We hypothesized that both perceived coaches' and teammates' beliefs would be significantly associated with eating disorder symptoms and body dissatisfaction.

Method: Participants were 190 in-season NCAA swimmers (81% female) who completed a newly developed brief questionnaire designed to assess perceived coach and teammate weight/shape-related beliefs (Coach and Teammate Weight/Shape Beliefs Questionnaire; CTWSBQ), as well as scales assessing eating disorder symptoms (Eating Disorder Examination-Questionnaire, EDE-Q) and thinness- and muscularity-related body dissatisfaction (ATHLETE Questionnaire Your Body and Sports subscale and Drive for Muscularity Scale, respectively). Multiple linear regression was used to model disordered eating as a function of CTWSBQ Teammate and Coach scores and covariates.

Results: Only the CTWSBQ Teammate score was significantly associated with EDE-Q Global (ΔR² = 0.04) and ATHLETE (ΔR² = 0.04) scores after adjustment for both demographic and psychological covariates. CTWSBQ Coach, but not Teammate, scores were significantly associated with Drive for Muscularity scores (ΔR² = 0.02) after adjustment for covariates.

Discussion: Findings from this cross-sectional study suggest distinct patterns of association for perceived teammate versus coach weight/shape-related beliefs across eating disorder symptoms, thinness-related concerns, and muscularity-related concerns in NCAA swimmers. Future work should test these patterns prospectively and determine whether they can inform prevention and education content for athletes and coaches.