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Neumark-Sztainer D, Bauer KW, Friend S, Hannan PJ, Story M, Berge JM. Family weight talk and dieting: how much do they matter for body dissatisfaction and disordered eating behaviors in adolescent girls?. J Adolesc Health. 2010;47(3):270-276. doi:10.1016/j.jadohealth.2010.02.001

This study is important because it clearly shows the negative effect of parents talking to their children about diets and weight.

Total 356 of female 9th–12th graders participated surveys about weight talk, dieting and weight-teasing by mother/father.  (1) Parents talking about their own weight, (2) parents encouraging to diet and (3) family teasing about daughters’ weight significantly affected the girls on extreme weight control and binge eating.  Especially, mother’s influence was stronger than father’s, and weight-teasing by family members which happened to 60% of girls in the past year was the strongest factor of weight related problem.

Binge eating is triggered 10 times more by consistent weight-teasing, 3 times more by parental talk about their weight, and 5 times more by mother encouraging to diet. Also, when fathers value a female body shape, self-induced vomiting by daughters increased.

This study lacks qualitative research and other factors like social media, but it gives us some ideas of nutrition intervention to parents: How to teach the youth healthy lifestyle without discussing about weigh. This is exactly same topic to the stigma and bias on obesity by practitioners we’ve just learned.

The clinical implications of this study is awareness that discussion of weight is very sensitive even between family members and likely to induce eating disorders.

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O’Connor G, Nicholls D, Hudson L, Singhal A. Refeeding Low Weight Hospitalized Adolescents With Anorexia Nervosa. Nutrition in Clinical Practice. 2016;31(5):681-689. doi:10.1177/0884533615627267

This trial compared higher calorie (@1200 kcal/day) to lower calorie (@500kcal/day) in the refeeding of hospitalized patients treated for anorexia nervosa (AN). This was important because there was a lack of evidence to guide practitioners in the most safe and effective way to refeed these patients.

In this randomized trial across 6 UK Hospitals, it was found that those adolescents with higher energy intake for the 10 day study had greater weight gain without an increase in negative outcomes related to refeeding syndrome. The incidence of electrolyte imbalance was not significantly different in the high energy intake group versus the low energy intake group. Heart rate improved in both groups after 4 days of refeeding and the change in heart rate between the two groups was not significantly different. QTc prolongation resolved by day 8 in all participants of both groups. One participant in the low energy intake group had an adverse event due to worsening QTc prolongation by day 4 and 2 participants (1 from each group) required oral phosphate supplementation. Development of refeeding syndrome does not prove to be related to rate of energy intake.

Since global guidelines for refeeding in adolescents with AN vary greatly, this findings of this study support refeeding at higher rate than previously recommended. The study could have implications for a change to global standard of care for adolescents with anorexia nervosa.

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Citation:Babbs, Richard K, Kelliher, Julia C, Scotellaro, Julia L, Luttik, Kimberly P, Mulligan, Megan K, and Bryant, Camron D. "Genetic Differences in the Behavioral Organization of Binge Eating, Conditioned Food Reward, and Compulsive-like Eating in C57BL/6J and DBA/2J Strains." Physiology & Behavior 197 (2018): 51-66. Web.

Eating disorders are high risks of disease incidence in the United States. Moreover, the researchers haven’t understood what kinds of gene expression will affect the eating disorder, especially binge eating. Binge eating causes health problems such as mood dysfunction, so the study is an important discovery of gene regulation for eating disorders.

The study shows that the two mice species (C57BL/6J and DBA/2J) consume greater food intake with the palatable food. The researchers observed the gender and species of a mouse what the different results are. One of the primary findings is three chromosomes (chromosomes 4, 6, and 11) analysis. Chromosome 6 are correlated with binge eating in DBA/2J mouse. It could know that the gene controls the patients’ eating behavior. The researchers have investigated the chromosomes modulation to induce the incidence of an eating disorder.

The study provides the pre-clinic experiment, and it may treat the human subjects to whether the results consistent with the animal models. It also helps the certain mechanism of an eating disorder.

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Citation:   Syurina EV, Bood ZM, Ryman FVM and Muftugil-Yalcin S (2018) Cultural Phenomena Believed to Be Associated With Orthorexia Nervosa – Opinion Study in Dutch Health Professionals. Front. Psychol. 9:1419. doi: 10.3389/fpsyg.2018.01419
This study is important because it shows that ideals emphasized by western cultures plays a large role in the development of orthorexia nervosa. Western culture is often linked with three main components for social organization: materialism, individualism, and capitalism. Beliefs from these main components are transmitted and maintained through the use of media, often social media. It is through media outlets that many beliefs of what constitutes pure and healthy foods is maintained in society. For example, individuals feel in control when they are able to discontinue consumption of a food group because of the “risks” associated with its consumption, such as deviation from a body-type ideal.

A key finding from this study is that Western ideals encourage the development of many behaviors that are  associated with orthorexia nervosa. It is okay to evaluate the risks of unhealthy nutrition, however, this disorder causes people to emphasize nutrition to such an extreme that other social spheres of their life begin to deteriorate. To state it bluntly the meaning of life exceeds far beyond nutrition.

The clinical implication is that excessive behavior and lifestyle change that is associated with orthorexia nervosa is not healthy. As we move forward I expect the occurrence of this disorder to increase. It will be beneficial to educate individuals about the importance of a balanced lifestyle. This is slightly problematic because orthorexia nervosa carries less stigma compared to other eating disorders such as anorexia nervosa because people fail to see that they have “lost control” of their eating habits. Orthorexia nervosa carries the risk of pathogenesis just like any other eating disorder.

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Sonneville KR, Lipson SK. Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. Int J Eat Disord. 2018 Jun;51(6):518-526. doi: 10.1002/eat.22846. Epub 2018 Mar 2. PMID: 29500865.

Importance: Diagnosis is the first step in establishing a treatment plan for an eating disorder. If a patient isn’t diagnosed, they are unlikely to realize the seriousness of their condition or the treatment options.

Key Finding: This was a survey-based study of college students that gave participants the eating disorder evaluation questionnaire and collected their socioeconomic/BMI data and compared the rates of ED diagnosis and treatment. They found that people of color were significantly less likely to have been diagnosed or have been in treatment for an ED. They also found that patients who were overweight or obese were less likely to have been given a diagnosis despite having a high rate of symptoms concerning for BN or BED.

Clinical Implications: Before any kind of treatment or recovery can occur, a diagnosis has to be made. While BED doesn’t have the mortality rate than AN does, it still has extremely significant metabolic side effects in the long run. Just telling a patient with underlying BED to “just lose weight” and not considering the diagnosis of BED is doing a disservice to the patient and their ability to recover. Racial and socioeconomic bias is unfortunately real in medicine – acknowledging our implicit bias and confronting it is the only way to improve how we care for patients of color.

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Martinsen M, Bahr R, Børresen R, Holme I, Pensgaard AM, Sundgot-Borgen J. Preventing eating disorders among young elite athletes: a randomized controlled trial. Med Sci Sports Exerc. 2014 Mar;46(3):435-47. doi: 10.1249/MSS.0b013e3182a702fc. PMID: 24549033.

The purpose of this study was to examine the effect of a 1-year school based intervention program in order to prevent the development of new cases of eating disorders and symptoms associated among adolescent elite athletes.  There were a total of 465 male and female elite athletes that were followed during high school that completed Eating Disorder Inventory 2 and questions related for a pretest, posttest 1 (immediately after intervention), and posttest2 ( 9 months after intervention). The results found that there were no new cases of eating disorders found among the female population that had the intervention. This study concludes that a one-year intervention program can help prevent new cases of eating disorders among adolescent female elite athletes. This finding is related to eating disorders in nutritional sciences. The implications of this study suggest that an intervention program should be implemented in high schools that focus on competitive sports.

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Steinglass, J. E., Sysko, R., Mayer, L., Berner, L. A., Schebendach, J., Wang, Y., Chen, H., Albano, A. M., Simpson, H. B., & Walsh, B. T. (2010). Pre-meal anxiety and food intake in anorexia nervosa. Appetite, 55(2), 214–218. https://doi.org/10.1016/j.appet.2010.05.090

This study is important because it looks at the role anxiety plays on calorie intake and risk for anorexia nervosa. In the material for this module we learned that mental health and wellness can play a role on diagnosis and severity of eating disorders. This particular study looks at how mental wellness can impact the severity of anorexia nervosa.

One key finding in this study is that patients diagnosed with both anorexia nervosa and higher levels of anxiety had a lower calorie intake. The data in this study suggests that anxiety is associated with anorexia nervosa risk and severity. Anorexia nervosa patients with higher levels of anxiety were consuming less calories which would lead to a lower body weight.

This study is important clinically because it suggests that there is a positive association between high anxiety and lower caloric intake for patients with anorexia nervosa. Anxiety could potentially be a therapeutic target for patients who are suffering from anorexia nervosa. If anxiety can be managed clinically then it is likely that this eating disorder will be less severe. Anxiety management might also decrease the risk of developing anorexia nervosa.

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Touyz, S., Lacey, H. & Hay, P. Eating disorders in the time of COVID-19. J Eat Disord 8, 19 (2020). https://doi.org/10.1186/s40337-020-00295-3

I found this article extremely informative and interesting. It was written last year, in the midst of the beginning of the pandemic. Eating disorders are serious, life-threatening disorders that cannot be taken lightly. The Covid pandemic has taken a toll on everyone involved and all that have experienced it. This article is important as it takes the material we are learning about and puts it into context of the current world we live in. It explains that the effects of quarantine and fear caused by COVID have worsened the impacts of eating disorders such as anorexia nervosa, and feelings of being isolated, anger, sadness, loneliness are worsening because of it. One key finding stated that the phases of the world going through impacts of panic buying and food insecurity would be enhanced due to the pandemic. These were some other tragedies occurring that I did not consider to be going on along with the illness and tragedy from firsthand COVID complications. This study and research very much opened my eyes to additional problems individuals may be facing related to nutritional sciences. Clinical implications include taking other factors and concerns into consideration when helping a patient and being open to assisting and understanding the patients with any type of issue they have. I would not have thought of this aspect of disorders being negatively impacted by the pandemic in other ways than what you typically hear or see on the news.

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Bang, L., Kristensen, U. B., Wisting, L., Stedal, K., Garte, M., Minde, Å., & Rø, Ø. (2020). Presence of eating disorder symptoms in patients with obsessive-compulsive disorder. BMC Psychiatry, 20(1), 1–10. https://doi-org.ezproxy.uky.edu/10.1186/s12888-020-2457-0

- Obsessive-compulsive disorder (OCD) is a one of the chronic mental disorders in which people experience repeated uncontrollable thoughts and behaviors that they feel the need to redo things again and again. Additionally, some studies have shown that 20–60% of patients with EDs have a history of OCD.

- This is an important study because it aimed to assess the presence of ED symptoms in patients with OCD in order to prevent the ED occurrence or to control its sequences.

- The key finding of this study is that ED symptoms are not generally elevated in female patients with OCD; however, a considerable subset of  patients may have a clinical ED or be at high risk of developing one. Therefore, a proper application of the nutrition care process (NCP) for  patients with OCD is vital, which helps in ED's diagnosis.

- The most clinical implication of this research is that healthcare providers should be oriented to the signs, symptoms, and risk factors of ED in

patients with OCD in order to prevent the occurrence or decrease the complications of eating disorders.

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Jonathan, Schouten¹; Ghassan, Wahbeh¹ P055 Restrictive Eating Symptoms May Persist in Children & Adolescents With Treated IBD: Case Series, The American Journal of Gastroenterology: December 2020 - Volume 115 - Issue - p S14-S15 doi: 10.14309/01.ajg.0000723016.65507.97

This study is important because it emphasizes the importance of diet habit formation in children. Much of the dietary habits and food preferences we have are formed and have a basis in what we at as children. This is why healthy eating habits and introduction of a wide range of fruits/vegetables/whole grains is vital with toddlers/school aged children.
The key finding of this study was that approximately 8 out of 10 children with IBD have an eating disorder that persisted after disease was managed with therapy. The clinical implication of this is that children with diseases that are diagnosed as a child would likely benefit not only from nutrition and food education, but also from counselling and possibly psychiatric intervention. Childhood is a time of rapid growth and development, and in the best of circumstances, children need support and to be helped with understanding the world around them, however that support is even more vital with diseases present. IBD can be painful with eating, and may cause children to develop the habit of avoiding food. Often I have encountered adults who have dealt with new diagnosis of IBD in a similar way, and adults have a far more advanced processing system of the situation, as opposed to children who may simply think eating = pain so therefore I won't eat much.
This was a very small study, with only 10 participants, but I feel it is an important topic to heal the patient as they age to develop healthy eating patterns so their body is able to heal and maintain a healthy gut dysbiosis.

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Citation: Darakhshan Jabeen Haleem. Improving therapeutics in anorexia nervosa with tryptophan. Life Sciences, Volume 178, 2017, Pages 87-93, ISSN 0024-3205, https://doi.org/10.1016/j.lfs.2017.04.015.

Diet is an important contributing factor in the development, management, prevention of a number of eating disorders. Tryptophan is an essential amino acid and precursor of 5-hydroxytryptamine (5-HT or serotonin). Evidence suggests that excessive dieting and food restriction can decrease brain tryptophan and serotonin in Anorexia Nervosa (AN) patients to psychological comorbidities including depression, psychosis, and hyperactivity. There is limited pharmacological treatments available for AN patients. This study evaluates potential importance of tryptophan supplementation in improving therapeutics in AN patients.

The studies provide evidence that behavioral dysregulation in AN are relevant to an arrested serotonin and overactive dopamine neurotransmission. Antidepressants and antipsychotics are often used to treat psychiatric comorbidities in AN patients, along with the psychotherapy. It is suggested that nutritional deficiency of tryptophan can weaken SSRIs-induced enhancement of serotonin neurotransmission and their therapeutic effects. It also reduces efficacy of antipsychotic medication by reducing the effectiveness of inhibitory serotonergic tone on dopamine neutrotransmission.

This finding suggested that multidisciplinary approach including psychotherapy, pharmacotherapy, and tryptophan supplementation together with frequent monitoring of circulating tryptophan may have potentials to improve therapeutic effects and better response in patients with AN. It is also worth considering that tryptophan administration can facilitate serotonin neurotransmission and may be useful in treating other 5-HT deficiency in various brain diseases.

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Citation:
Solmi, F., Mascarell, M., Zammit, S., Kirkbride, J., & Lewis, G. (2019, March 06). Polygenic risk for schizophrenia, Disordered eating behaviours and body mass index IN adolescents: The British Journal of psychiatry. Retrieved March 09, 2021, from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/polygenic-risk-for-schizophrenia-disordered-eating-behaviours-and-body-mass-index-in-adolescents/D3A057CBF4463D42B8992303AE2E8BAA

Importance of Study
This study is important because it identifies a correlation between genetic risk of schizophrenia and developing a disordered eating behavior in a young population. This is an important indication to make in a population that struggles to find a lot of assistance due to a lack of understanding of the illness of schizophrenia. Mental illnesses are very broadly categorized, and distinctly scrutinized societally. In my own (biased) opinion, not nearly enough is done for our young people in helping them understand that healthy eating is so much more than just making you feel better when you get hungry. It impacts everything. Especially in populations that may be susceptible to mental health issues. Continuing to find ways to bolster their health and immune system while they find some stability in  dealing with the (sometimes) extremely challenging symptoms of schizophrenia. That is why this study is valuable. It is the largest retrospective study to date that has correlated genetic susceptibility to schizophrenia and disordered eating behaviors.

Key Findings
This  study sought to find correlation between polygenic risk scores for schizophrenia and disordered eating behaviors and BMI. This study gathered longitudinal data on 6920 childrens' available genetic data and polygenic risk scores (PRS) for schizophrenia that had indicated at least one disordered eating pattern.  They correlated a presence between shared genetic risk between schizophrenia and binge eating behaviors.

Clinical Implications
This study is vitally important for populations that are at risk for schizophrenia. Patients with complex mental illness often get marginalized in our communities because they are highly stigmatized and have difficulty finding help that suits to their individual needs. I am also aware that there is a very high rate of homelessness in this population as well. This further damages their ability to have a healthy relationship with food and explains why they may be suceptible to binge eating disorder.  It is an issue with access.  Not only this, but those diagnosed with schizophrenia commonly experience a withdrawal from society. This further attributes to a potential understanding of why schizophrenia patients are highly susceptible to disordered eating behaviors. Nonetheless, this study can raise awareness and be very helpful in finding ways to better supply for this population's food needs. The broad expressivity and genetic variability of schizophrenia patients makes this population difficult to assess and treat. But giving their body a scaffold of health by supplying them with proper nutrition could likely only help their condition. I have come to find, that research on these sort of mental illnesses are tough to get good, reliable data on. But everything along these correlative retrospective studies can be helpful in identifying causes of symptom exacerbation.

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Pradeep Yarra

Citation: Klein DA, Sylvester JE, Schvey NA. Eating Disorders in Primary Care: Diagnosis and Management. Am Fam Physician. 2021;103(1):22-32.

Question 1:   Why is this study important?

Eating disorders are potentially life-threatening conditions, which required a coordinated and consorted effect from different healthcare professionals along with family support.  This article reviews of the most recent guidelines from the 2021 as recommended by American Academy of Family Physicians.  More interestingly these recommendations are important because the family physicians in the rural community is her most commonly the frontline physicians which a patient with eating disorders usually see first. Guidelines have been formulated after review of multiple studies, quality of studies and evidence.

Identify one key finding of this study and describe how it relates to nutritional sciences

Key guidelines with highest evidence based medicine (Grade A recommendations) are as follows:  Please refer to the full article for criteria, early detection, work up and management here: https://www.aafp.org/afp/2021/0101/p22.html
Key recommendations for the practice are:

1.      Family based therapy should be different line of the first-line treatment for you to with anorexia nervosa and bulimia nervosa

Level B recommendations are medication should not be used as monotherapy

Other Important points:

a)     SCOFF questionnaire should be used for screening for eating disorders

b)     Please look for co-occurring mental health conditions like depression or anxiety.

From a nutrition perspective:

a.       Based on the activity level of individuals, we should try to hold the calories that are needed.  But the nutritional aspect can also be addressed in terms of proportions, snacks or meals as per the patient preference.  Importantly if weight gain of 2.2-4.4 lb per week stabilizes cardiovascular health

What are the clinical implications of this study?

Nutritious form core personnel in the multidisciplinary approach for this patient.  A lot of consideration should be taken about caregiver stress to provide the snacks or diet recommended, significance of independence of the patient in selecting dietary options which has an effect on the mental health.  Most successful treatment, which his family-based therapy at the Grade A recommendation is also based on education of the family unit.  Nutritionists play significant role in Family based therapy, promoting and educating about healthy eating behaviors and to monitor weight.

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Citation: Depa J, Barrada JR, Roncero M. Are the Motives for Food Choices Different in Orthorexia Nervosa and Healthy Orthorexia? Nutrients. 2019 Mar 25;11(3):697. doi: 10.3390/nu11030697. PMID: 30934544; PMCID: PMC6470526.

Importance of study: This study is important as currently there are no DSM V criteria for Orthorexia, this  necessitating  more detailed evaluation of this disorder in order to  appropriately identify and delineate a pathologic disorder from a very similar one that does not necessarily pose a health problem.

Key Points:  Orthorexia is found to be bidimensional in nature, one being  associated with concern with healthy food intake  for purpose of improved health, (Healthy Orthorexia), and the second being pathologically preoccupied  with healthy eating for  primary goal of  weight loss, (Orthorexia Nervos a).
The study was conducted using a  food  questionnaire and an instrument  called  Teruel Orthorexia Scale (TOS) which , at  time of this study, was still being validated. Participants were 460 Spanish college students.
Findings were very interesting, in that food choices with both groups (healthy orthorexia vs orthorexia nervosa) were almost identical but the motivation behind the food choices was very different.   Healthy orthorexia group chose foods based primarily on the  basis of wanting to be healthy  while motivation in the  Nervosa group was primarily weight control with  affect regulation being second.  The only overlap  of the two was that neither group was inclined  to eat a particular food based solely on its appearance.

Clinical Implications : In clinical practice it is so important that we are as thorough and accurate as possible when making a diagnosis.  I feel this is important no matter what type of diagnosis, but in current climate of restricted health care coverage benefit for mental health it is even more so.  I am personally interested in being more mindful  (and more educated)  regarding what we put into a patient's chart.  It would be both inaccurate  and also sub-par practice to label someone with a
mental health diagnosis if they dont have one.  On the  opposite side of this spectrum, we also know that one does not have to meet all DSM criteria in order to have problematic behavior, so still may need addressing and  one more example of the importance of multi-disciplinary, team-based care.

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Citation: Räisänen U, Hunt KThe role of gendered constructions of eating disorders in delayed help-seeking in men: a qualitative interview studyBMJ Open 2014;4:e004342. doi: 10.1136/bmjopen-2013-004342

Importance of study:

A commonly cited estimate, whose provenance is unclear, is that 10% of clinical ED cases occur in men, but some data suggest that this prevalence could be as high as 25%. Despite this uncertainty about prevalence, the incidence of EDs in men is rising.

The objective of this study was to understand how young men recognise eating disorder (ED) symptoms and decide to seek help, and to examine their experiences of initial contacts with primary care.

Key clinical finding:

The widespread perception of EDs as uniquely or predominantly a female problem led to an initial failure by young men to recognise their behaviours as symptoms of an ED. Many presented late in their illness trajectory when ED behaviours and symptoms were entrenched, and some felt that opportunities to recognise their illness had been missed because of others’ lack of awareness of EDs in men. In addition, the men discussed the lack of gender-appropriate information and resources for men with EDs as an additional impediment to making sense of their experiences, and some felt that health and other professionals had been slow to recognise their symptoms because they were men.

Conclusion: Widespread cultural constructions of EDs as a ‘women's illness’ mean that men may fail to recognise ED symptoms until disordered behaviours become entrenched and less tractable to intervention.

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Citation: Yamazaki T, Inada S, Sawada M, Sekine R, Kubota N, Fukatsu K, Yoshiuchi K. Diets with high carbohydrate contents were associated with refeeding hypophosphatemia: A retrospective study in Japanese inpatients with anorexia nervosa. Int J Eat Disord. 2021 Jan;54(1):88-94. doi: 10.1002/eat.23416. Epub 2020 Nov 24. PMID: 33236366.

This retrospective study is self-proclaimed to be the first to examine the association between carbohydrate content in the diet and occurrence of refeeding hypophosphatemia (RH) in anorexia nervosa (AN) patients. Since RH has a prevalence of up to 45% in patients with AN, this study is a crucial piece in understanding the most tolerated diet in this population.

They found that, out of the 188 patients, the 18 with RH had a significantly higher carbohydrate percentage in their diet (56.36 vs 53.99). After adjusting for variables that are significantly associated with RH (age and BMI), they still concluded that higher carbohydrate diets were still associated with RH.

Their cutoff point for carbohydrate content significantly being related to RH was 58.4%. However, as can be seen from the average percentages in the two different patient groups (RH vs non-RH), they concluded that higher carbohydrate diets under 58.4% was still a possible risk factor for RH.

This has clinical implications because the study suggests that focusing on food composition, not just calories, could be a different strategy for preventing RH. Also, even though typically carbohydrates should not make up more than 50% of the diet, this study further stresses the importance of staying within the guidelines.

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Citation: Garber, Andrea K, Sawyer, Susan M, Golden, Neville H, Guarda, Angela S, Katzman, Debra K, Kohn, Michael R, Le Grange, Daniel, Madden, Sloane, Whitelaw, Melissa, and Redgrave, Graham W. "A Systematic Review of Approaches to Refeeding in Patients with Anorexia Nervosa." The International Journal of Eating Disorders 49.3 (2016): 293-310. Web.

Importance: This article looked at higher caloric diets in the recovery of AN patients. In the past partitioners took the "low and slow" approach to avoid refeeding syndrome in these patients, which is coupled with hypophosphatemia. However, some research shows that giving a high calorie diet from the beginning fosters better weight gain. Some have even found that the "low and slow" approach caused weight loss in the beginning of treatment. This systematic review compared these two approaches and found that refeeding syndrome had to do with the severity of malnutrition and not the caloric intervention. This is important because the faster we can get AN patients back to a healthy weight the  better it is for the patient. The question still remains is the "low in slow" approach still appropriate for the severe malnourished patient?

Key finding: Refeeding syndrome had to do with the severity of malnutrition and not the caloric intervention.

Clinical Implications: As clinicians treating AN its important to provide the most effective care. It's essential that these patients get back to a normal weight as quickly as possible. Hopefully as this area of research develops a higher caloric diet will be an acceptable intervention due to it providing more sustainable and quicker weight gain.

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Citation: Lindgreen P, Lomborg K, Clausen L. Patient use of a self-monitoring app during eating disorder treatment: Naturalistic longitudinal cohort study. Brain Behav. 2021;00:e02039. https://doi.org/10.1002/brb3.2039

Why is this study important?

This study is important because it looked at the use of an app (in this case Recovery Record) as a treatment tool for self monitoring in individuals who have Anorexia or Bulimia.  Patients could record things such as  meals, photos of meals, thoughts, feelings, restriction and exercise.  The direct messaging feature was not allowed in this particular study due to local authority restrictions.

As clinicians and dietitians look for additional ways to treat patients in remote settings, not only during the time of COVID, but also as healthcare continues to move to virtual settings, this exploration is important to assessing such effectiveness in eating disorder treatment.  It also is important because it may be a means for communicating with younger age groups where eating disorders often initially present.

Key findings related to nutritional sciences:

The findings of this study surprised me.  I thought that app activity would be much higher in younger patients than older patients due to familiarity with the use of apps, social media and other online platforms in younger individuals.  Study results showed however, that as a patient’s age increased, the frequency of app use increased.  The study also demonstrated that first time treatment patients logged more often than patients who had been treated in the past and across all treatment groups and demographics, app use went down as the study duration progressed.

Clinical implications:

Healthcare treatment continues to move to virtual settings and include the use of wearables and apps to support the clinician / patient relationship.  It is important that we understand the effectiveness of such treatment on a per disease basis.  Not all diseases will be managed as well in a remote setting.  Based on this study, it does not appear that the use of an app is effective and that the direct interaction with the doctor or dietitian may be significant to a successful health outcome for eating disorder patients.  It is also important to note the difference in age in terms of app use, indicating that the direct patient / clinician relationship may be significant for a younger age group.  This may be due to distractions, discomfort in communicating feelings remotely or other reasons.  It does also appear that there can be an attention span issue for patients if logging on the app feels like a chore and benefits or feedback are not easily assessable.

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Feldman, M. B., & Meyer, I. H. (2007). Eating disorders in diverse lesbian, gay, and bisexual populations. The International journal of eating disorders, 40(3), 218–226. https://doi.org/10.1002/eat.20360

This study is important because it brings to light the incidence of eating disorders in lesbian, gay and bisexual populations. As members of a marginalized community, LGB people face distinct challenges that increases their risk of developing an eating disorder.  This study was the first study to assess the prevalence of eating disorders using DSM in the LGB population.

Key findings: 1.) Gay and bisexual men experienced a significantly higher incidence of eating disorders than heterosexual men. 2) Prevalence of eating disorders in lesbian and bisexual women is comparable to heterosexual women.   Indicating that lesbian and bisexual women are not immune to high (unrealistic) body image standards.

Key implications of this study: a reminder that practitioners need to be aware of clinical manifestations of eating disorders and that although eating disorders have been associated with straight, young, white females, this study indicates that eating disorders disproportionately affect LGB populations. It is very important that practitioners be aware of the increased risk of eating disorders in the LGB population as patients may present to the practitioner with an undiagnosed eating disorder (I am primarily thinking of the dietetics practitioner but really any practitioner of nutritional sciences!).  Cultural competency and recommendations for care are also imperative to address- but research topics for another discussion!

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Forsén Mantilla, E., Clinton, D., & Birgegård, A. (2018). Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self-image. Psychology and psychotherapy, 91(3), 302–316. https://doi.org/10.1111/papt.12161

Eating disorders are a very complex illness that can often be life threatening as often times patients with an eating disorder have a long duration of symptoms and illness before any treatment. A major reason why this illness is so complex with different levels is the patients view of themselves and their illness. This study is important because it analyzed how female patients with an eating disorder experienced the disorder and how they viewed themselves when seeking treatment. Throughout this research the female participants were urged to shift thinking about their disorder to viewing it as a relationship with themselves in hopes that this would encourage the patients to think about it as a “real life” relationship in looking more at the health consequences and exploring this relationship would lead them to treatment. This research found that patients were in fact able to visualize their disorder as a relationship when they were able to do so and explained it as controlling. Clinically, this can provide insight into the psychological side of these disorders.

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Swinbourne, J., Hunt, C., Abbott, M., Russell, J., St Clare, T., & Touyz, S. (2012). The comorbidity between eating disorders and anxiety disorders: Prevalence in an eating disorder sample and anxiety disorder sample. Australian & New Zealand Journal of Psychiatry, 46(2), 118-131.

1. Importance
This study examines the comorbidity rate between eating disorders and anxiety disorders. This study controlled for any anxiety related to eating behaviors so that anxiety related to the eating disorder would not confound any variables. This study is important because it shows a strong connection between the two groups of disorders, which would both need to be treated simultaneously.

2. One Key Finding
PTSD, General Anxiety Disorder, and some level of Social Phobia were extremely common in individuals with eating disorders in general. It is postulated that these disorders have a high comorbidity with eating disorders due to a heightened concern of public/social image, which then takes foothold of eating and food-related behaviors.

3. Clinical Implications
As future providers, it is important for us to be aware of high comorbidities as only treating one condition will cause more significant issues with the other condition as it is ignored and could cause long-term issues for the patient. As eating disorders are relatively common in the world of nutritional-related disorders, treating the anxiety conditions frequently found with them will provide significant relief for patients.