Research on energy expenditure in individuals with eating disorders: a review

OBJECTIVE: This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHOD: Individual studies are reviewed and their results summarized. RESULTS: The most consistent finding is evidence of reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. DISCUSSION: The ability to reliably and cost-effectively measure REE may aid in the refeeding of patients with AN where REE is reduced. Changes in BN and BED subjects have yet to be identified consistently.     

Fluid Intake in patients with eating disorders

OBJECTIVES: The current study examined the fluid intake of patients with eating disorders and factors that may influence the amount and type of fluid consumed. Subjects comprised 81 inpatients with eating disorders. METHODS: A 7-day semi-standardized, retrospective fluid history was taken by a dietitian when the subjects were admitted to an eating disorder unit. Total fluid consumed per day was measured, which included all energy-free, energy-containing, and caffeine-containing fluids (all in milliliters per kilogram). Age, body mass index (BMI), and eating disorder behaviors (purging, binge eating, and excessive exercise) were also evaluated. RESULTS: Fluid intakes ranged from 250 ml to >6 L per day, with an average of 2.7 L. Only 17% of patients had fluid intakes in the recommended range. The most commonly consumed beverage was water followed by diet cola, coffee, juice, and tea. The lower the BMI and the older the patient, the greater the fluid intake. CONCLUSIONS: Fluid intake is variable and should be part of the clinical assessment of the eating disorder patient.     

High-protein meals may benefit fat oxidation and energy expenditure in individuals with higher body fat

Aim: Fat oxidation is impaired in obesity. The aim of the present study was to determine if fat oxidation, seen in a high‐protein meal response, was influenced by body composition. Methods: Subjects were provided with control (14% protein, glycaemic index, GI 65), high‐protein high‐GI (33% protein, GI 74) and high‐protein low‐GI (35% protein, GI 45) meals. Substrate oxidation and energy expenditure were measured in room calorimeters over eight hours in 18 subjects. Results were compared using a repeated‐measures anova with a customised post‐hoc analysis (to compare the protein diets averaged vs control and to compare the low‐ and high‐GI diets) and covariates in a linear model of the form: y = α + β₁ × fat‐free mass (kg) + β₂ × log_e fat mass (kg). Results: The full model found significant meal effects on fat oxidation (0.21 ± 0.21 kcal/minute high‐protein high‐GI, 0.34 ± 0.11 kcal/minute high‐protein low‐GI, 0.55 ± 0.2 kcal/minute control, F = 3.50, P = 0.007). The effect on energy expenditure (1.67 ± 0.07 kcal/minute high‐protein high‐GI, 1.61 ± 0.08 kcal/minute high‐protein low‐GI, 1.67 ± 0.08 kcal/minute control) approached significance (F = 2.45, P = 0.070). Post‐hoc analysis revealed a protein effect (P = 0.004 for fat oxidation and P = 0.030 for energy expenditure). Significant interactions indicated that meal response was influenced by body composition. The high‐protein meals eliminated the negative relationship between body fat and fat oxidation (α = ?4.7, β₂ = 2.23, P < 0.01) and between body fat and energy expenditure, which were evident in the control meal (α = ?1.5, β₂ = 0.63, P < 0.05). No effect of GI was evident. Conclusion: High‐protein intakes may ameliorate an obesity‐induced decline in fat oxidation.     

The interaction of personality disorders and eating disorders: a two-year prospective study of patients with longstanding eating disorders

OBJECTIVE: The current study aimed to investigate the relation between personality disorders and symptoms of both eating disorders and general psychopathology over time. METHOD: Seventy-four patients, with a mean age of 30 years and admitted to a hospital for treatment of a chronic eating disorder, were assessed using the Eating Disorder Inventory (EDI), the Eating Disorder Examination (EDE), the Symptom Check List-90-Revised (SCL-90-R), and the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) at admission, and after 1 and 2 years. RESULTS: At the 2-year follow-up, there was considerable reduction in both personality and symptoms (effect size = 0.83-0.94). Panel modeling using structural equation modeling techniques indicated that symptomatic changes generally preceded changes in the personality disorder. DISCUSSION: Eating disorder symptoms and general symptomatology had direct effects on a dimensional personality disorder index. Thus, personality disorders may be at least partially a consequence of general symptomatology in chronic eating disorders. Symptom improvement appears to precede changes in personality in this sample of patients with chronic eating disorders.     

Patterns of menstrual disturbance in eating disorders

OBJECTIVE: To describe menstrual disturbance in eating disorders (ED). METHOD: We describe menstrual history in 1,705 women and compare eating, weight, and psychopathological traits across menstrual groups. RESULTS: Menstrual dysfunction occurred across all eating disorder subtypes. Individuals with normal menstrual history and primary amenorrhea reported the highest and lowest lifetime body mass index (BMI), respectively. Normal menstruation and oligomenorrhea groups reported greater binge eating, vomiting, and appetite suppressant use. Amenorrhea was associated with lower caloric intake and higher exercise. Harm avoidance, novelty seeking, perfectionism, and obsessionality discriminated among menstrual status groups. No differences in comorbid Axis I and II disorders were observed. CONCLUSION: Menstrual dysfunction is not limited to any eating disorder subtype. BMI, caloric intake, and exercise were strongly associated with menstrual function. Menstrual status is not associated with comorbidity. Menstrual irregularity is an associated feature of all ED rather than being restricted to AN only.     

Body checking in the eating disorders: Associations between cognitions and behaviors

OBJECTIVE: Body checking behaviors appear to be a manifestation of the cognitive distortions that are central to the maintenance of the eating disorders. However, there is little understanding of the cognitions that drive these behaviors. This study validates a novel measure of such cognitions (Body Checking Cognitions Scale [BCCS]) and examines the association between body checking cognitions, body checking behaviors, and general eating pathology. METHOD: Eighty-four eating-disordered women and 205 non-eating-disordered women each completed measures of body checking behaviors, body checking cognitions and eating pathology. A further 130 nonclinical women completed the measures to provide an independent cross-validation sample for the BCCS. RESULTS: The BCCS was reliable and valid, and cross-validation with an independent sample confirmed the four-factor structure. Eating-disordered women were significantly more likely to experience body checking cognitions than healthy women. Those cognitions were associated with a significant proportion of variance in eating pathology, over and above the variance explained by checking behaviors. CONCLUSION: This study provides evidence for a range of beliefs underlying body checking behavior in eating-disordered women, suggesting that interventions addressing those beliefs might be pertinent in some cases.     

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.     

Never too old for eating disorders or body dissatisfaction: a community study of elderly women

OBJECTIVE: The aim of the study is to examine eating behavior and body attitude in elderly women. METHOD: A randomly selected nonclinical sample of 1,000 women, aged 60-70 years, was contacted for our questionnaire survey covering current eating behavior, weight history, weight control, body attitude, and disordered eating (DSM-IV). RESULTS: The 475 (48%) women included in our analyses had a mean BMI of 25.1 but desired a mean BMI of 23.3. More than 80% controlled their weight and over 60% stated body dissatisfaction. Eighteen women (3.8%; 95% confidence interval: 2.3-5.9%) met criteria for eating disorders (ED; N = 1 anorexia nervosa, N = 2 bulimia nervosa, and N = 15 EDNOS) and 21 (4.4%) reported single symptoms of an ED. CONCLUSION: Although EDs and body dissatisfaction are typical for young women, they do occur in female elderly and therefore should be included in the differential diagnosis of elderly presenting with weight loss, weight phobia, and/or vomiting.