Tuesday, July 3, 2018

Prevalence and Correlates of DSM-5–Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults.

Background: Few population-based data on the prevalence of eating disorders exist, and such data are especially needed because of changes to diagnoses in the DSM-5. This study aimed to provide lifetime and 12-month prevalence estimates of DSM-5–defined anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions. Methods: A national sample of 36,306 U.S. adults completed structured diagnostic interviews (Alcohol Use Disorder and Associated Disabilities Interview Schedule-5). 

Results: Prevalence estimates of lifetime AN, BN, and BED were 0.80% (SE 0.07%), 0.28% (SE 0.03%), and 0.85% (SE 0.05%), respectively. Twelve-month estimates for AN, BN, and BED were 0.05% (SE 0.02%), 0.14% (SE 0.02%), and 0.44% (SE 0.04%). The odds of lifetime and 12-month diagnoses of all three eating disorders were significantly greater for women than for men after adjusting for age, race and/or ethnicity, education, and income. Adjusted odds ratios (AORs) of lifetime AN diagnosis were significantly lower for non-Hispanic black and Hispanic respondents than for white respondents. AORs of lifetime and 12-month BN diagnoses did not differ significantly by race and/or ethnicity. The AOR of lifetime, but not 12-month, BED diagnosis was significantly lower for non-Hispanic black respondents relative to that of non-Hispanic white respondents; AORs of BED for Hispanic and non-Hispanic white respondents did not differ significantly. AN, BN, and BED were characterized by significant differences in age of onset, persistence and duration of episodes, and rates of current obesity and psychosocial impairment. Conclusions: These findings for DSM-5–defined eating disorders, based on the largest national sample of U.S. adults studied to date, indicate some important similarities to and differences from earlier, smaller nationally representative studies. https://doi.org/10.1016/j.biopsych.2018.03.014

Prevalence and Correlates of Disordered Eating Behaviors Among Young Adults with Overweight or Obesity.

Clinical and community samples indicate that eating disorders (EDs) and disordered eating behaviors (DEBs) may co-occur among adolescents and young adults at a weight status classified as overweight or obese. Objective: To determine the prevalence of EDs and DEBs among young adults at a weight status classified as overweight or obese using a nationally representative sample and to characterize differences in prevalence by sex, race/ethnicity, sexual orientation, and socioeconomic status. Design: Cross-sectional nationally representative data collected from Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants: Young adults ages 18–24 years old. Main Measures: ED diagnosis and DEBs (self-reported binge eating or unhealthy weight control behaviors including vomiting, fasting/skipping meals, or laxative/diuretic use to lose weight). Covariates: age, sex, race/ethnicity, sexual orientation, weight status, and education. Key Results: Of the 14,322 young adults in the sample, 48.6% were at a weight status classified as overweight or obese. Compared to young adults at a weight status classified as underweight or normal weight, those at a weight status classified as overweight or obese reported a higher rate of DEBs (29.3 vs 15.8% in females, 15.4 vs 7.5% in males). Logistic regression analyses demonstrated that odds of engaging in DEBs were 2.32 (95% confidence interval 2.05–2.61) times higher for females compared to males; 1.66 (1.23–2.24) times higher for Asian/Pacific Islander compared to White; 1.62 (1.16–2.26) times higher for homosexual or bisexual compared to heterosexual; 1.26 (1.09–1.44) times higher for high school or less versus more than high school education; and 2.45 (2.16–2.79) times higher for obesity compared to normal weight, adjusting for all covariates. Conclusions: The high prevalence of DEBs particularly in young adults at a weight status classified as overweight or obese underscores the need for screening, referrals, and tailored interventions for DEBs in this population. Journal of General Internal Medicine June 11, 2018
New Research shows that…

• 0.80% of adults meet diagnostic criteria for anorexia at some point in their lives.
• 0.05% of adults experience anorexia in a given 12-month period.
• Hispanic adults and non-Hispanic black adults are much less likely than white adults to be diagnosed with anorexia during their lifetimes.

• 0.28% of adults meet diagnostic criteria for bulimia at some point in their lives.
• 0.14% of adults experience bulimia in a given 12-month period.
• The lifetime and 12-month prevalence rates for bulimia do not significantly differ by ethnicity or race.

Binge Eating (BED)
• 0.85% of adults meet diagnostic criteria for binge eating at some point in their lives.
• 0.44% of adults experience binge eating in a given 12-month period.
• The lifetime prevalence rates for BED are lower for black adults than for white or Hispanic adults.

Prevalence of eating disorders taken from largest sample in the United States.

A new study in Biological Psychiatry provides updated estimates of the lifetime and 12-month prevalence of eating disorders. Biological Psychiatry has published a new study revising the outdated estimates of the prevalence of eating disorders in the United States (US). The new estimates were based on a nationally-representative sample of 36,309 adults--the largest national sample of US adults ever studied. The findings estimate that 0.80 percent of US adults will be affected by anorexia nervosa in their lifetime; 0.28 percent will be affected by bulimia nervosa; and 0.85 percent will be affected by binge eating disorder. Importantly, the study provides the first prevalence estimates using the current definitions of eating disorders. Although the diagnostic criteria for several common eating disorders were changed with the 2013 publication of the "Diagnostic and Statistical Manual of Mental Disorders (DSM)-5", the rates of eating disorders hadn't been studied since 2007. "Our study confirms that eating disorders are common, are found in both men and women and across ethnic/racial groups, occur throughout the lifespan, and are associated with impairments in psychosocial functioning," said first author Tomoko Udo, PhD, of University at Albany, New York. May 30, 2018 Read the full study here: https://www.biologicalpsychiatryjournal.com/article/S0006-3223(18)31440-9/fulltext

Seven reasons not to compliment someone on weight loss — and what to say instead

By Carrie Dennett of the Washington Post (05/24/18). 

It's a compliment that rolls easily off the tongue: "You look great. ... You've lost weight!" While some people welcome such observations, there are a number of reasons it's better to take a different approach when you're tempted to praise someone's weight loss. 1. They may be ill or experiencing a crisis. Because thinness is valued in our society, when someone loses weight, the assumption is that it's intentional and healthful — but that's not always the case. Recent research, funded by the National Institutes of Health and published in the British Journal of General Practice, found that unintended weight loss is an early sign of several forms of cancer, including prostate, ovarian, lung, pancreatic and colorectal. Also, while many people respond to intense stress and anxiety by eating, others have the opposite reaction, because part of the body's normal "fight, flight or freeze" response is to shut down digestion. That noticeably thinner co-worker could be coping with a personal crisis — a painful divorce, a serious illness in the family — and losing weight unintentionally. If you are not privy to that information and offer what seems like an innocent compliment, you may add to their pain. 2. They may have an eating disorder. In her 2015 book "Body of Truth," author Harriet Brown writes about how women would approach her then-14-year-old, praise her thin body and ask for diet tips. That's really not appropriate in any circumstance, but it was especially unfortunate in this case: The teenager was grappling with anorexia nervosa, which severely threatened her health. For someone who is working on recovering from anorexia or bulimia nervosa — another life-threatening eating disorder characterized by binging and compensatory behaviours like self-induced vomiting — weight loss compliments can be problematic in several ways. Although anorexia, like other eating disorders, is complex and multifaceted, one factor that can encourage the progression of the disease is positive reinforcement. By praising someone for losing weight when — unknown to you — they have anorexia, you are rewarding them for a behaviour that could eventually kill them. And you can't tell who has an eating disorder by looking at them. People of all body sizes can have anorexia — the term "atypical anorexia" refers to people who engage in severe food restriction but are not low-weight. 3. They may have a history of trauma. Read more at the following link including what you should say… https://www.thespec.com/living-story/8628265-seven-reasons-not-to-compliment-someone-on-weight-loss-and-what-to-say-instead/

The history of the term Anorexia Nervosa.

The earliest medical descriptions of anorexic illnesses are generally credited to English physician Richard Morton, in 1689. However it was not until 1868, Sir William Gull, one of Queen Victoria’s personal physicians, published a seminal paper which established the term anorexia nervosa and provided a number of detailed case descriptions and treatments. The 1868 paper was titled Anorexia nervosa (apepsia hysterica, anorexia hysterica) and the reference is here: https://www.ncbi.nlm.nih.gov/pubmed/9385628. The term anorexia is of Greek origin: an- (ἀν-, prefix denoting negation or without) and orexis (ὄρεξις, "appetite"), thus translating to "nervous absence of appetite". Read more here: https://www.karger.com/Article/Abstract/82033.

Group of 51 Bipartisan Senators and Members of Congress Urge HHS for Full-Scale Implementation of Education and Training on Eating Disorders Provisions from the 21st Century Cures Act

Group of 51 Bipartisan Senators and Members of Congress Urge HHS for Full-Scale Implementation of Education and Training on Eating Disorders Provisions from the 21st Century Cures Act
WASHINGTON, D.C. (July 2, 2018) - Recently a bipartisan group of fifty-one Senators and Members of Congress, led by Sen. Amy Klobuchar [D-MN], Shelley Moore Capito [R-WV], Tammy Baldwin [D-WI] and Rep. Ted Deutch [D-FL] and Ileana Ros-Lehtinen [R-FL], sent a House and Senate letter to the U.S. Department of Health & Human Services Secretary Azar, urging the full-scale implementation of Section 13006 "Education and Training on Eating Disorders" for health care professionals authorized by the Anna Westin Act through 21st Century Cures (P.L. 114-255). This letter was sent after hundreds of advocates stormed and called Washington, D.C. on April 23rd, urging their Members of Congress' assistance in implementing these life-saving provisions. View the Senate champions' joint press release here and the House of Representatives' joint press release here.
"Passage of the 21st Century Cures Act was a major bipartisan accomplishment, and now we are asking the Department to utilize all necessary resources to implement these health programs," said Congressman Deutch"We need to train our health professionals to learn how to detect, prevent, and treat eating disorders among their patients. With 30 million Americans affected by these illnesses over their lifetime, this demands the full attention and appropriate resources of our federal health agency."
Congress passed the 21st Century Cures Act in December 2016, which included key provisions from the bipartisan, bicameral Anna Westin Act of 2015 (S. 1865 / H.R. 2515), including Section 13006 for the early identification and intervention of eating disorders trainings for health professionals. Unfortunately, since the passage, the U.S. Department of Health & Human Services has taken little to no action to implement these provisions.

"Eating disorders are a leading cause of further illness and sometimes death in our nation. However, it is unfortunate that programs to train health professionals to identify and treat these disorders have not been forthcoming from the Department of Health and Human Services," Congresswoman Ros-Lehtinen said. "Along with my friend and colleague, Ted, I urge Secretary Azar to implement programs that will help those with eating disorders get the help they need."
Senate signatories of this letter include the following Senators: Amy Klobuchar [D-MN], Shelley Moore Capito [R-WV], Tammy Baldwin [D-WI], Sherrod Brown [D-OH], Tammy Duckworth [D-IL]. Richard Blumenthal [D-CT], Debbie Stabenow [D-MI], Elizabeth Warren [D-MA], Edward Markey [D-MA], Mark Warner [D-VA], Chris Murphy [D-CT], Kirsten Gillibrand [D-NY] and Corey Booker [D-NY].

House of Representatives signatories of this letter include the following Members of Congress: Rep. Ted Deutch [D-FL], Ileana Ros-Lehtinen [R-FL], David Price [D-NC], Eleanor Holmes Norton [D-DC], Peter King [R-NY], Zoe Lofgren [D-CA], John Larson [D-CT], Grace Napolitano [D-CA], Betty McCollum [D-MN], Federica Wilson [D-FL], C.A. Dutch Ruppersberger [D-MD], G.K. Butterfield [D-NC], Debbie Wasserman Schultz [D-FL], Doris Matsui [D-CA], Kathy Castor [D-FL], Steve Cohen [D-TN], Tim Walz [D-MN], Erik Paulsen [R-MN], Chellie Pingree [D-ME], Paul Tonko [D-NY], Lou Barletta [R-PA], Donald Payne, Jr. [D-NJ], Rodney Davis [R-IL], Lois Frankel [D-FL], Mark Pocan [D-WI], Keith Rothfus [R-PA], Kyrsten Sinema [D-AZ], Eric Swalwell [D-CA], Debbie Dingell [D-MI], John Katko [R-NY], Seth Moulton [D-MA], Val Demings [D-FL], Brian Fitzpatrick [R-PA], Brian Mast [R-FL], Jamie Raskin [D-MD], Lloyd Smucker [R-PA], Gus Bilirakis [R-FL], and Don Young [R-AK].
Eating disorders affect over 30 million Americans during their lifetime and have the highest mortality rate out of any psychiatric illness. Given the high prevalence and severity of these disorders, specialized training in early identification and treatment of eating disorders is needed.

The Eating Disorders Coalition (EDC) is a Washington, D.C.-based, federal advocacy organization comprised of treatment providers, advocacy organizations, academics, parents of children with eating disorders and people experiencing eating disorders nationwide. Additional resources can also be found at www.eatingdisorderscoalition.org.