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.  

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.

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! 

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.

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.

 

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

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.

 

 

- 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. 

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. 

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. 

 

 

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.

 

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. 

              

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.

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.