Dietary Restraint: Restriction by Another Name?

Please excuse me while I nerd out all over your computer screen. I recently turned a corner on my appreciation of the value of quantitative social science, having taken a structural equation modelling class last winter, and today I’m going to share a little of that with you. While I’m still a qualitative researcher through and through, this course taught me that there is great value in understanding how scales are constructed and what that means about how we can interpret results from survey-takers.

What, you might ask, does any of this have to do with eating disorders? Plenty. A while back, Shiran wrote a post about the issues with the Eating Disorders Examination Questionnaire. Her post didn’t focus on the scale psychometrics – that is, how well the scale measures what it is supposed to measure and how consistent it is – but still reveals how questionnaires … Continue reading →

Does Body Dissatisfaction in Children Predict Eating Disorder Symptoms?

Identifying risk factors for eating disorder symptoms may help us develop more evidence-based prevention mentions. Personally not convinced that prevention is really possible with the types of individual-focused programs we have today, I would argue that identifying risk factors may at least help us determine which individuals should be screened in subsequent years. If they do develop eating disorders, they will hopefully be more likely to receive early intervention and treatment.

To identify predictors of eating disorder symptoms, Elizabeth Evans and colleagues (2016) conducted a longitudinal study that measured various putative risk factors at ages 7, 9, and 12 in a group of boys and girls. The authors also wanted to identify correlates of eating disorder symptoms at 12 years of age. They measured eating attitudes and dietary restraint, BMI, body dissatisfaction, and depressive symptoms.

THE STUDY

  • 516 participants; 262 girls and 254 boys
  • all individuals were residents of Gateshead, located
Continue reading →

Behind the Journal Article: Thinking Critically about Research Evidence and Eating Disorders

There’s been a fair bit of talk lately (ok, always) about evidence in eating disorders. In addition to the evidence for certain types of treatment, there’s talk about evidence for causes of eating disorders, evidence for whether recovery is possible, and more. The framing I generally see advanced is that we need to be using evidence-based practice only; presumably, this evidence comes from scientific research. I don’t disagree, but in this post I’ll be writing about how science is never wholly objective and is situated in social context.

Let the record show that I love science. I love all kinds of science: biological science, genetic science, neuroscience, social science, you name it, I think learning and research and scientific methods are interesting. I can’t do all kinds of science; as Tetyana says, this blog itself has moved away from “science” as she originally intended it as I continue to dominate … Continue reading →

On the Efficacy of Self-Induced Vomiting (Purging)

A single in-lab assessment of caloric consumption, loss, and retention during binge-purge episodes in individuals with bulimia nervosa (BN) is frequently cited as evidence that purging via self-induced vomiting is an ineffective strategy for calorie disposal and weight control (Kaye, Weltzin, Hsu, McConaha, & Bolton, 1993). These findings have been widely interpreted to mean that, on average, purging  rids the body of only about half of the calories consumed, regardless of total quantity.

However, a closer examination of the study does NOT support the notion that purging is an ineffective compensatory behavior. Indeed, the findings of Kaye et al. (1993) would appear to have been both misunderstood and overgeneralized in the subsequent decades. This has important implications for therapeutic alliance in clinical practice as well as for understanding the nature of symptoms, metabolic processes, and physiological alterations in EDs.

THE STUDY

The study included 17 individuals, all of … Continue reading →

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 6

I thought about writing a post about the factor structure of popular eating disorder scales to celebrate my completion of an advanced statistics course in structural equation modelling. When I sat down to read some articles about that, though, I found myself side-tracked– and thoroughly uninterested in deconstructing scale psychometrics. So with a promise to do that at some point, I return to a favourite topic of mine: culture and eating disorders.

When I was writing about culture and eating disorders for the blog last year, I received quite a few requests for articles about eating disorders in developing countries. I suspect that the desire for this kind of article stems from a need to highlight (for the doubters) that eating disorders are serious mental health issues that can impact anyone who is predisposed, regardless of whether they live in a media-saturated landscape or not. As I noted in … Continue reading →

Let’s Talk about Systems Level Change for Eating Disorders

This past Wednesday, January 27th, was Bell Let’s Talk day in Canada. In case you’re unfamiliar with the campaign, Bell Canada (a telecom company) donates 5 cents to mental health awareness initiatives for every social media post or text with the hashtag #BellLetsTalk. In general, the campaign has been lauded for its contribution to decreasing shame and stigma around mental illness, which is awesome. There are a number of critics, though, who point out that:

Continue reading →

The Stigma is Real: Self-Blame and Explanations for Eating Disorders

Stigma is a real thing. There you go, the most profound statement I’ve ever written. In all seriousness though, there’s a big stigma problem around eating disorders, and not all of it is imposed from the outside. Many people with eating disorders also self-stigmatize, feeling responsible for their disorder (Holliday, Wall, Treasure & Weinman, 2005 wrote more about this). Other stigma is externally imposed; for instance, the widely held (and erroneous) belief that eating disorders are only something vain young girls get or that they are a choice.

Stigma around eating disorders sometimes differs betweens diagnoses, and especially between eating disorders and other mental illnesses – for instance, Roehrig and McLean (2010) found that eating disorders (both anorexia nervosa and bulimia nervosa) were more stigmatized than depression, and that eating disorder stigma uniquely (and horribly) included a certain degree of envy. The stigma associated with AN is … Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 2

I previously looked at two retrospective studies of anorexia patients in Singapore, which primarily concerned female patients. In this study, Tan et al (2014) looked at 72 male-identified patients diagnosed with all forms of eating disorders.

  • 1% had anorexia nervosa (15.3% binge-purge subtype, 20.8% restrictive subtype)
  • 3% had bulimia nervosa (27.8% purge subtype, 5.6% non-purge subtype)
  • 5% had EDNOS
  • 9% had BED

The mean age at intake was 19.9 years old; patients were mainly students (41.7%) and national servicemen (41.7%). Compulsory army service (National Service) usually takes place in the two years after high school graduation, though some may defer until completing further studies. The typical age range for those in National Service is 19-24.

Of the patients in the study, 88.9% identified a precipitating factor for their eating disorder, including being overweight (59.7% reported pre-morbid obesity) and having people make comments about their body. 68.1% of patients … Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 1

Some previous posts on this blog have explored whether eating disorders might (or might not) be considered culture-bound, or in other words specific to or presenting specifically in certain cultures. If you consider eating disorders to be “culture bound,” they would present primarily in Western cultures, with non-Western cultures ‘receiving’ eating disorder pathology through Westernization. In this post, I explore eating disorders in the Singaporean context to continue to unpack the relationship between culture and eating disorders. Singapore is an interesting place in which to look at eating disorders (not just because I live there) because it complicates the idea of “culture-boundedness.”

Studies have been conducted in Asia; primarily in Hong Kong and to a lesser extent Japan. Most notably, Lee (1991) found non-fat-phobic presentations in Hong Kong supported by Ngai, Lee & Lee (2000) (see this post for more on the Ngai study). Singapore is … Continue reading →

Is the Doctor In? Eating Disorders Training Amongst Medical Professionals — Part 2

It is challenging for me to rein myself in when I start ranting about the poor state of affairs of eating disorder training for medical professionals. However, I reconcile my critical ranting with a paradoxical penchant for optimism. I figured, in my searching, that there must be something out there that gives us more to work with. Is there a functional model of providing training for medical professionals? At the very least, are the opportunities that do exist doing a good job at equipping healthcare providers with the skills they need to begin to navigate the complexity of eating disorders?

Building on part one, in which I highlighted 2 studies offering some challenging knowledge around how little is on offer within medical training environments, I will focus here on 2 studies about the outcomes of training. The first, a UK study, explores whether medical professionals are trained in eating … Continue reading →