International Journal of Eating Disorders最新文献

Objective: Research on the incidence trends of eating disorders remains limited in Asia. This study aims to analyze the annual incidence rates and incident case characteristics in the Korean general population.

Method: The National Health Insurance Service database was used to examine the incidence rates of eating disorders from 2012 to 2021. A total of 34,615 patients with incident eating disorders aged 0-49 years were analyzed. Comorbidity and medication analyses used a 2013-2020 subset. Linear regression analyses and Mann-Kendall trend tests were conducted to examine temporal trends across age and sex. Chi-square and Wilcoxon rank-sum tests were applied for epidemiological and clinical characteristics of the 0-19 and ≥ 20 age groups.

Results: Adults' annual incidence rates increased over the study period (τ = 0.689, p = 0.007). The 20-24 age group had the highest incidence (16.75-38.38 per 100,000 person-years). Individuals aged 0-19 years showed a stable incidence rate (τ = 0.244, p = 0.371), although males aged 0-19 years demonstrated a decreasing trend (B = -0.272, SE = 0.091, p = 0.018, 95% CI = [-0.483, -0.061]). Mood and anxiety disorders were the most frequent comorbidities. The 0-19 age group more frequently utilized tertiary healthcare institutions. Antidepressants were prescribed more frequently than antipsychotics. Fluoxetine and aripiprazole were the most common antidepressant and antipsychotic, respectively.

Discussion: The findings show distinct age- and sex-specific patterns in eating disorder incidence, underscoring the need for a tailored approach. Worldwide differences may offer etiological insights. A limitation is the aggregation of eating disorder subtypes.

Objective: Individuals with eating disorders (EDs) often face significant barriers to accessing care, including prolonged waitlists and systemic delays. Digital interventions, such as mobile apps, offer a scalable way to enhance pre-treatment engagement during this high-risk period. This pilot study evaluated the feasibility and acceptability of MI-Coach: ED, a program-led mobile app designed to support motivation among female-identifying individuals awaiting ED treatment.

Method: Twenty-three female-identifying individuals on waitlists at ED clinics across British Columbia, Canada, participated in a 4-week single-arm pilot trial of MI-Coach: ED. The app delivered motivational interviewing-informed content through seven sequential modules containing reflective exercises, psychoeducational articles, and psychologist-led videos. Feasibility was assessed via service-provider uptake, participant enrollment, engagement, and retention metrics. Acceptability was measured using the user version of the Mobile App Rating Scale and adapted Technology Acceptance Model ratings. Exploratory analyses descriptively examined pre-to-post changes in motivation and related symptoms.

Results: Feasibility was constrained at the service-provider level, with 6% of contacted sites agreeing to distribute study materials. At the participant level, 67.6% initiated app use and 44% completed at least four modules, and 78% completed pre- and post-assessments, indicating partial engagement across the sample. Participants rated the app positively across domains of quality, ease of use, and perceived usefulness. Small-to-medium reductions in global ED severity and depressive symptoms, as well as increases in motivational confidence, were observed with confidence intervals that did not cross zero. Change scores were moderately correlated across select motivational and symptom measures.

Discussion: Findings suggest that MI-Coach: ED was acceptable among users who engaged, while feasibility was substantially influenced by system-level recruitment constraints and variable participant engagement. Observed engagement patterns were lower than those reported for general mental health apps but consistent with prior digital ED intervention literature, underscoring the importance of disorder-specific feasibility benchmarks. Results will inform ongoing refinements and implementation strategies for a future randomized trial.

Objective: This review aimed to quantify rates of uptake (treatment initiation), adherence (program completion), and attrition (study dropout) in randomized trials of digital eating disorder (ED) interventions, and to synthesize engagement reporting practices, their consistency, and associations with clinical outcomes.

Methods: Randomized trials of digital interventions (web, app, computerized, chatbots, etc.) delivered to people with diagnostic, subthreshold, or self-reported EDs were included. Random-effects meta-analyses were conducted to compute absolute rates of uptake, adherence, and attrition, while a narrative synthesis summarized engagement patterns and reporting.

Results: Forty-eight trials were included. The weighted mean uptake rate from 44 intervention conditions was 89.7% (95% PI = 67.0-97.0) and the weighted mean adherence rate from 14 intervention conditions was 41.8% (95% PI = 0.9-83.3). These estimates remained similar in a series of sensitivity analyses that adjusted for biases, outliers, and when limiting to specific clinical population groups. The weighted trial attrition rate was 23.3% (95% PI = 0.8-54.4); for intervention arms specificially it was 29.7% (95% PI = 9.7-62.3) and for waitlist arms it was 18.7% (95% PI = 4.6-52.3). Attrition was lower in trials that had human-participant interaction, offered therapeutic guidance, provided monetary reimbursement, tested a web/computer program (compared to a smartphone application), and had a longer follow-up (> 6 weeks). Reporting of engagement was inconsistent and heterogeneous, with nearly 90 different metrics recorded across trials. There was some evidence linking sustained user engagement to greater clinical benefit.

Conclusion: Findings offer practical benchmarks to inform future trial planning and highlight design elements that could be leveraged to enhance user engagement and retention.

Pediatric patients with medical/developmental conditions face increased risk for avoidant/restrictive food intake disorder (ARFID). Diet-managed chronic illnesses may heighten risk for disordered eating, with emerging research finding medical symptoms predating disordered eating behaviors. Pediatric-onset immunoglobulin E-mediated food allergy ("food allergy") is on the rise, affecting an astonishing 8% of US children. The relationship between food allergy and ARFID is puzzlingly understudied despite food allergy clearly altering the individual's relationship with food, posing continuous danger, and requiring persistent, fundamental eating changes to maintain safety. Food allergy is managed through strict dietary avoidance of allergen(s) and confers well-documented risk to psychosocial functioning. Dietary restriction exceeding medically required avoidance (as observed in ARFID) further compounds risk for adverse health and psychosocial impacts. In this Spotlight, our team of clinical researchers working at the intersection of ARFID and food allergy proposes a model identifying three areas of food allergy-specific impact that may drive the higher prevalence of ARFID within this population. Failure to successfully regulate these universal drivers to preserve daily functioning may precipitate the development of ARFID. We propose (1) unique characteristics of allergic reactions and medical treatment, (2) the impacts of chronic vigilance and avoidance, and (3) response to learning paradigms and physiological upregulation disrupt the development of feeding/eating for both patients and caregivers. Patients with food allergy + ARFID may also be especially vulnerable to iatrogenic harm from the imprecision of current allergy testing modalities. We outline the sparse literature on food allergy + ARFID comorbidity and call for ARFID-focused research in this area.

Objective: Eating disorders (EDs) often emerge in adolescence, but developmental trajectories across different core features remain largely unclear.

Method: The prospective, community-based study included N = 898 participants aged 9.5-17.5 years (47.6% female, age 11.8 ± 1.4 years) with annual follow-up over 2-6 (3.4 ± 1.2) years. Multivariate trajectories of binge eating, restraint, weight-compensatory behaviors (Eating Disorder Examination-Questionnaire for Children), and body mass index-standard deviation score (BMI-SDS) derived from objective anthropometrics were analyzed using group-based multi-trajectory modeling (GBMTM) separately for girls and boys. ED and general psychopathology were used for validation and outcome comparisons.

Results: GBMTM identified five distinct trajectories of ED symptoms and BMI-SDS in girls and six in boys. Low-symptom trajectories at lower, normal, and higher BMI-SDS were most common and showed only mild, transient ED symptoms. In boys, trajectories were largely characterized by stable ED symptoms at different BMI-SDS levels, whereas in girls, ED symptoms showed more pronounced change over time. In both sexes, two high-risk subgroups reflected bulimic and binge-eating patterns and followed trajectories with elevated or increasing ED symptoms across ages, which in girls were particularly associated with increased ED and general psychopathology at last assessment.

Discussion: GBMTM results support the developmental specificity of bulimic/binge-eating syndromes and noneating-disordered overweight across adolescence. High-risk subgroups in both sexes-and their particularly unfavorable outcomes in girls-underscore the need for sex-specific early identification strategies that consider longitudinal constellations of multiple ED symptoms and weight status rather than single indicators.

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.