The application of continuous glucose monitoring technology to eating disorders research: An idea worth researching

Continuous glucose monitoring (CGM) devices have revolutionized our capacity to measure blood glucose levels in real time using minimally invasive technology, yet to date there are no studies using CGM in individuals with eating disorders (EDs). Preliminary evidence suggests that eating disorder behaviors (EDBs) have substantial and characteristic impacts on blood glucose levels and glucose-related variables (e.g., binge-eating episodes cause rapid spikes in blood glucose levels, purging causes rapid drops in blood glucose to below normal levels). The aims of this article are to describe the benefits of CGM technology over older methods of measuring blood glucose levels and to discuss several specific ways in which CGM technology can be applied to EDs research to (a) improve our ability to identify and predict engagement in EDBs in real time, (b) identify relationships between blood glucose levels and maintenance factors for EDs, and (c) increase our understanding of the physiological and psychological impacts of disordered eating. We also present preliminary acceptability and feasibility data on the use of CGM devices in individuals with EDs. Overall, the article will describe several applications of CGM technology in EDs research with compelling potential to improve research methodologies.     

Shared transmission of eating disorders and anxiety disorders

OBJECTIVE: Eating disorders have high comorbidity with mood, anxiety, and substance use disorders. Using twins from the population-based Minnesota Twin Family Study (MTFS), we examined comorbidity and shared transmission between eating pathology and these disorders. METHOD: Female twins (N = 672), ages 16-18 years, completed structured clinical interviews assessing anorexia nervosa and bulimia nervosa (as described in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV; American Psychiatric Association, 1994]), as well as mood, anxiety, and substance use disorders (as described in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders [DSM-III-R]). Shared transmission was examined using a discordant monozygotic (MZ) twin design. RESULTS: Significant comorbidity was found between eating disorders and major depression, anxiety disorders, and nicotine dependence. Within MZ twin pairs discordant for eating disorders (n = 14), non-eating-disordered cotwins demonstrated increased risk for anxiety disorders compared with controls. Similarly, within MZ twin pairs discordant for anxiety disorders (n = 52), non-anxiety-disordered cotwins demonstrated increased risk for eating disorders compared with controls. DISCUSSION: Findings support shared transmission between eating disorders and anxiety disorders. However, the nature of this shared diathesis remains unknown.     

A virtual issue highlighting animal studies of eating disorders as valuable tools for examining neurobiological underpinnings and treatment of eating disorders

While studies in humans suggest a role for psychosocial factors as well as biological and genetic processes in the development of eating disorders, the specific etiologic mechanisms remain largely unknown. In this virtual issue, we present a collection of 14 archived articles from the International Journal of Eating Disorders to highlight the utility of animal studies of eating disorders to advance our understanding of eating disorder etiology. Selected articles establish animal studies as valid tools to study disordered eating behavior, offer insight into potential neurobiological mechanisms, and highlight novel targets for future pharmacological treatments. Clinical implications of each article's findings are included to demonstrate the translational value of animal studies for the eating disorders field. We hope that the exciting concepts and findings in this issue inspire future animal studies of eating disorders.     

Comorbidity of obsessive-compulsive disorders and duration of eating disorders

OBJECTIVE: This study explored the comorbidity of obsessive-compulsive disorder (OCD) and eating disorders (ED) and examined the relationship between OCD comorbidity and the duration of ED. Subjects with OCD were expected to show a longer history of ED. METHOD: ED females (N = 237; 84 with anorexia nervosa and 153 with bulimia nervosa) were assessed using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-1). Data were analyzed by logistic regression to determine whether OCD comorbidity is associated with duration of ED. RESULTS: The total sample showed a prevalence rate for OCD of 29.5%. OCD prevalence did not differ between anorexic and bulimic subjects. OCD comorbidity was significantly associated with a longer history of ED. CONCLUSION: The findings of the study support previous research indicating a high comorbidity of ED with OCD. The results also suggest that OCD may play a role in the course of ED. Prospective studies are necessary to examine this hypothesis further.     

The interrater reliability of physical signs in patients with eating disorders.

OBJECTIVE: To evaluate the interrater reliability of five common signs of eating disorders. METHODS: Eating disorder patients with anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (ED-NOS), at various stages of recovery, were evaluated for the presence or absence of lanugo hair, acrocyanosis, parotid hypertrophy, hypercarotinemia, and Russell's sign. Patients were examined by two physicians with similar experience and training. Results are analyzed for reliability using the kappa statistic. RESULTS: Kappa scores were as follows, indicating marginal reproducibility of results: lanugo hair (kappa = 0.606), acrocyanosis (kappa = 0.014), parotid hypertrophy (kappa = 0.266), hypercarotinemia (kappa = 0.101) , and Russell's sign (kappa = 0.140). CONCLUSION: The interrater reliability for individual items ranged from poor to moderate. Overall, there is marginal interrater reliability for the five common signs of eating disorders assessed.     

Comparative prevalence,correlates of impairment,and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders

Objective:

The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non‐Latino Whites.

Method:

Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES;NIMH, 2007) were used.

Results:

The prevalence of anorexia nervosa (AN) and binge‐eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non‐Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non‐Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non‐Latino Whites for respondents with a lifetime history of any eating disorder.

Discussion:

These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2011)

     

Artificial sweetener use among individuals with eating disorders

Women with eating disorders report using large quantities of artificially sweetened products, but this has not been quantified. OBJECTIVE: The authors assessed the use of selected artificially sweetened low-calorie products among women with eating disorders compared with controls. METHOD: Thirty women with anorexia nervosa (18 with the restricting subtype [AN-R] and 12 with the binge/purge subtype [AN-B/P]), 48 women with bulimia nervosa (BN), and 32 healthy control women completed a survey of frequency and amount of consumption of chewing gum, artificially sweetened low-calorie beverages, and packets of artificial sweetener in the previous month. RESULTS: A greater proportion of women with AN-B/P and BN reported use of each product, compared with women with AN-R and control participants. Among product users, patients with eating disorders reported using greater amounts than controls. Among patients who reported binge eating and/or purging, the quantity of each product used was inversely correlated with body mass index (BMI). CONCLUSION: These data suggest an increased drive for sweet orosensory stimulation in women with AN and BN.     

Epidemiology and risk factors of eating disorders: a two-stage epidemiologic study in a Spanish population aged 12-18 years

OBJECTIVE: The authors studied the prevalence rates of eating disorders (ED) and their risk factors in a Spanish population aged 12-18 years. METHOD: A two-stage epidemiologic study was conducted in the province of Valencia. Educational centers, classrooms, and individuals were selected randomly. The initial sample comprised 544 subjects. During Stage 1, subjects were screened with the 40-item Eating Attitude Test and a sociodemographic questionnaire that evaluates risk factors. During Stage 2, a semistandardized clinical interview was conducted with each participant. A random control group was paired by class, age, and sex. Comorbid psychiatric disorders and partial and subclinical forms were detected using criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). RESULTS: Using DSM-IV criteria, the morbidity rate was 2.91%, women comprised 5.17% of the sample, men comprised 0.77% of the sample, and the sex ratio was 6.71. Using DSM-IV criteria, including subclinical forms, the morbidity rate was 5.56%, women comprised 10.3% of the sample, men comprised 1.07% of the sample, and the sex ratio was 9.63. Six risk factors were isolated: psychiatric comorbidity, friend on a diet in the last year, desire to lose weight, desire to be less corpulent, sentimental problems, and diet in the last year. DISCUSSION: This is the first Spanish two-stage epidemiologic study to include a control group and to investigate risk factors.     

Self-recognition of disordered eating among women with bulimic-type eating disorders: A community-based study

OBJECTIVE: Self-recognition of eating-disordered behavior was examined in a community sample of young adult women (n = 158) with bulimic eating disorders. METHOD: A vignette was presented describing a fictional person meeting diagnostic criteria for bulimia nervosa. Participants were asked whether they might currently have a problem such as the one described. Scores on measures of eating disorder psychopathology, functional impairment and general psychological distress were compared between participants who recognized a problem with their eating and those who did not. RESULTS: Participants who recognized a problem with their eating (n = 86, 51.9%) had higher levels of eating disorder psychopathology and general psychological distress, were more likely to engage in self-induced vomiting, and tended to be heavier, than those who did not (n = 72, 48.1%). In addition, participants who recognized a problem were more likely to have received treatment for an eating or weight problem. In multivariate analysis, the occurrence of self-induced vomiting and higher body weight were the only variables significantly associated with recognition. CONCLUSION: Poor recognition of eating-disordered behavior may be conducive to low or inappropriate treatment seeking among individuals with bulimic- type eating disorders. The perception that only disorders involving self-induced vomiting are pathological may need to be addressed in prevention programs.     

Comorbidity between eating disorders and anxiety disorders: a review

OBJECTIVE: We conducted a critical literature review on studies assessing the prevalence of anxiety disorders (AD) in subjects with eating disorders (ED) (anorexia nervosa and bulimia nervosa). In the first part, we discuss methodological issues relevant to comorbidity studies between ED and AD. In the second part, taking into account these methodological considerations raised, we summarize the findings of these studies. METHOD: We performed a manual and computerized search (Medline) for all published studies on comorbidity between ED and AD, limiting our search from 1985-2001 to get sufficiently homogeneous diagnostic criteria for both categories of disorders. RESULTS: Too few studies include control groups and few studies have compared diagnostic subgroups of ED subjects, with scarce or conflicting results. DISCUSSION: We discuss the results taking into account the methodological problems observed. We give guidelines for reviewing the results of published studies and planing future research.