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This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders.Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these.We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.

Several psychosocial models have been proposed to explain the etiology of eating disorders (EDs) and obesity separately despite research suggesting they should be conceptualized within a shared theoretical framework. The objective of the current study was to test an integrated comprehensive model consisting of a host of common risk and protective factors (socio-environmental, psychological, and behavioral) expected to explain both eating and weight disorders simultaneously in a large school-based sample of adolescents. Data were collected from 3,043 youth (60% female, 14.00 ± 1.61) from 41 schools in the Ottawa region, Canada. Working with interested school staff, validated self-report scales in the form of a questionnaire booklet were administered to participating students to assess several understood risk and protective factors common to both eating disorders and obesity. Anthropometric measurements of weight and height were taken at the end of the questionnaire administration period by trained research staff. Structural equation modeling with cross-validation was used to test the hypothesized model. Findings demonstrated that dysregulated eating was associated with both eating disorder and weight status with diet culture and emotion dysregulation directly associated with some of these disordered eating patterns. It equally pointed to how lifestyle made up of high sedentary behaviors, low vigorous exercise and varied eating patterns contributed to both emotion dysregulation and poor body image which subsequently affected eating issues and weight status simultaneously, signaling the complex interplay of psychosocial factors that underlie these concerns. This study provides evidence for an integrated psychosocial model consisting of socio-environmental, psychological, and behavioral factors may best explain the complex interplay of risk and protective factors influencing eating disorders and obesity. It equally highlights understanding the direct and indirect effects of some of the most salient risk factors involved in eating and weight-related concerns, including the strong effects of diet culture and stressors such as weight-based teasing, providing interventionalists evidence of important risk factors to consider targeting in eating disorder and weight-based prevention efforts.

Study Objective There is a paucity of research on body image in pregnant and parenting youth (PPY). Study objectives were to examine: (1) profiles of PPY regarding body image, depression, and eating behaviors and any effects of age and pregnancy status on results; and (2) PPY perceptions of body image. Design, Setting, Participants, Interventions, and Main Outcome Measures Demographic data and scores from measures related to self-esteem, body esteem, eating behaviors, and depression were collected from 101 PPY from 2 urban centers. Two focus group sessions were held to further explore survey findings. Sessions were audio-recorded and transcribed verbatim for analysis. Results Participants (mean age, 19.8 years) reported a history of depression (79/101; 78.2%), anxiety (75/101; 74.3%), drug/alcohol abuse (45/101; 44.6%), and eating disorder (32/101; 31.7%). Parenting (nonpregnant; n = 64) participants had lower body esteem (P = .041) and more eating disorder behaviors (P = .026) compared with pregnant (n = 37) participants. A history of depression or eating disorder both independently increased risk for lower body esteem and self-esteem and higher depressive symptoms in pregnant youth. Four dominant themes emerged from qualitative data: (1) adapting to rapidly changing bodies; (2) inter-relationship between body image and mood; (3) added attention and perceptions of pressure to return to prepregnancy body size; and (4) reconciling change and striving to find a new normal. Conclusion This study highlights the importance of exploring past and current body image, mood, and eating disorder behavior in PPY for risk of current mental health issues. Future research exploring prepregnancy depression, eating disorder, body esteem, and depression in pregnant youth are needed.

Background There is a noticeable lack of evidence regarding the impact of COVID-19 and the associated lockdown on young people with eating disorders. The goals of this study were 1) to examine characteristics of adolescents presenting for eating disorder (ED) assessment since the onset of the COVID-19 pandemic; 2) to compare adolescents presenting for ED assessment since the onset of the COVID-19 pandemic to those that presented for assessment 1 year previously; 3) to examine implications of the pandemic on the system of care. Methods A retrospective chart review was completed on all patients assessed at a pediatric tertiary care ED program during the pandemic between April 1 and October 31, 2020, and on youth assessed during the same time frame 1 year previously. Data including body measurements and results of psychological measures was extracted from patients’ charts. Clinician reports were utilized for accounts of ED symptoms. Referrals to our program were also compared for the two time periods. Results Of the 48 youth assessed between April and October 2020, average age was 14.6 years and average percentage of treatment goal weight was 77.7%. 40% cited the pandemic as a trigger for their ED; of these youth, 78.9% were medically unstable compared to 55.2% of those whose ED was not triggered by the pandemic. When comparing the 2020 cohort to those assessed in 2019, youth who presented for assessment during the pandemic trended towards having lower percentage of goal weights and higher rates of self-reported impairment, and were significantly more likely to be medically unstable (p = 0.005) and to require hospitalization (p = 0.005). Higher rates of inpatient admissions, emergency room consultation requests and outpatient referrals deemed “urgent” were likewise associated with the pandemic period. Conclusions During the COVID-19 pandemic, youth assessed for an ED presented with high rates of medical instability and need for hospitalization. Caring for these youth may be more challenging during the pandemic, when access to services may be limited. Further research is required to better understand the impact of the pandemic on the clinical course and outcomes of EDs in adolescents., Plain English summary The objective of this study was to examine characteristics of adolescents presenting for eating disorder (ED) assessment during the COVID-19 pandemic, and also to compare them to a similar group assessed 1 year previously. A review of medical charts was completed on patients assessed at a pediatric ED program between April 1 and October 31, 2020 and on patients assessed between April 1 and October 31, 2019. Forty-eight adolescents were assessed during the pandemic-specific timeframe and 43 were assessed during the same timeframe the year previously. Forty percent of those in the 2020 cohort cited pandemic effects as a trigger for their ED; these youth had a shorter course of illness and were somewhat more likely to be medically compromised compared to those whose ED was not triggered by the pandemic. Compared to those seen in 2019, adolescents assessed for an ED in 2020 exhibited higher rates of nutritional restriction and functional impairment, were significantly more likely to be medically unstable, and required more hospitalizations or urgent consultations. Further research is required to better understand the impact of COVID-19 on the clinical course and outcomes of EDs in youth.

Objective:This study investigated whether the duration and type of screen time (ST) (TV viewing, recreational computer use, video gaming) is longitudinally associated with z-BMI and if these relationships are mediated by disordered eating (emotional, restrained).Design:At baseline, participants were n 1197 (T1; 60 % female) adolescents (mean age = 13·51 years) who completed surveys over 2 years. ST was assessed by a self-reported measure created by the investigative team, while emotional and restrained eating was measured by the Dutch Eating Behaviour Questionnaire (DEB-Q). Height and weight were objectively measured to quantify z-BMI.Setting:Thirty-one public and two private schools from the region of Ottawa, Canada.Participants:Students in grades 7–12.Results:Parallel multiple mediation analyses revealed that more time spent watching TV at baseline is associated with higher z-BMI at T3 (total effect; B = 0·19, se = 0·07, P = 0·01, 95 % CI 0·05, 0·34), but no relationships were observed for total ST exposure or other types of ST and z-BMI. Disordered eating did not mediate the positive association between baseline TV viewing and z-BMI at T3.Conclusions:TV viewing was longitudinally associated with higher z-BMI in a community-based sample of adolescents, but disordered eating behaviours did not mediate this relationship. However, other non-pathological eating behaviours may mediate the association between ST and obesity and warrant further investigation. Finding suggests that targeting reduction in youth’s TV viewing may be an effective component in the prevention of childhood obesity.

Background To date, very little research has explored the impact that the newly articulated diagnosis Avoidant restrictive food intake disorder (ARFID) has had on feeding and eating disorder program service organization and delivery. The purpose of this paper is to provide a descriptive overview of a single-center, ARFID-specific pilot clinic that sought to better understand the specific needs of patients with ARFID and gain insight into treatment requirements. Methods A retrospective cohort study was completed on patients with ARFID admitted to a specialized pilot clinic within a tertiary care hospital. Results Over an 18 month period, a total of 31 patients were assessed, with 26 patients completing follow-up assessments. Patients presented with heterogeneous manifestations of ARFID, with treatment plans tailored to meet individual needs at assessment and over the treatment period. A multidisciplinary approach was most often administered, including a combination of administered individual therapy, family therapy, medical monitoring, and prescribed medications. Only 30% of patients were treated exclusively by therapists on the eating disorder team. Conclusions The experiences gained from this pilot study highlight the need for specialized resources for assessment and treatment of patients with ARFID, the importance of a multidisciplinary approach to treatment, and the necessity of utilization of ARFID-specific measures for program evaluation purposes.

Background Family-based treatment (FBT), an outpatient treatment which is typically offered for 6-12 months by specially trained therapists, is currently the first line treatment for adolescent anorexia nervosa and bulimia nervosa. The success of FBT for adolescents with moderate to severe eating disorders indicates a potential use for a short course of modified FBT which could be offered as an early intervention by nonspecialized community mental health counselors to adolescents with mild or subsyndromal eating disorders. Methods In 2016, seven adolescents with mild eating disorders underwent a brief intervention in the form of five FBT-inspired therapy sessions (called 'DREAMS' sessions). The DREAMS sessions consisted of five replicable family sessions given over 6 weeks, each with a specific area of focus for treatment, such as nutrition and eating disorder symptoms, mood, relationships and anxiety. Charts of these seven patients were reviewed in 2019 to determine whether this treatment might be worthy of further study. Results Based on a review of the progress notes, all seven patients reported an improvement in intake, a decrease in ED symptoms and an improvement in mood by the end of the sessions. All seven families reported that the sessions had been beneficial. Conclusion Early intervention is recommended for adolescents who present in the early stages of an eating disorder, yet there are no guidelines to recommend which treatment should be offered to this population. Further research is required to determine whether a short course of modified FBT, such as these five FBT-inspired 'DREAMS' sessions, may be an effective intervention to offer to youth who present with mild eating disorders.

This manuscript describes the rationale, design and methods of the Research on Eating and Adolescent Lifestyles Study (REAL), which from 2006-2013, aimed to test an integrative biopsychosocial model of cross-sectional and longitudinal predictors and developmental mechanisms for both eating disorders (EDs) and obesity in a large sample of Canadian youth. The present study examined predictors from four main areas of risk: biological (e.g. weight status, pubertal stage), environmental (e.g. societal influences), individual (e.g. self-perception), and eating and weight specific behaviors (e.g. disordered eating) to test direct and indirect paths for both ED and obesity simultaneously as outcomes. Participants were recruited based on a convenience sample from 43 urban and rural public schools, and data collection ran from 2006-2013. The cross sectional sample consisted of 3043 males and females in grades 7-12. The longitudinal sample was comprised of 1197 students in grades 7 and 9 who completed annual follow ups for 7 years. The REAL study is unique as it proposes a biopsychosocial model to explain EDs and obesity in adolescents under parallel processes within a single model, and is more integrative and comprehensive than previous models. Findings from this study were intended to inform prevention initiatives and further the understanding of the etiological similarities amongst EDs and obesity in a large sample of both male and female youth across adolescence.

Background To date, little research has examined the effectiveness of either modified Family-Based Therapy or psychopharmacological treatments for patients diagnosed with avoidant/restrictive food intake disorder (ARFID), and there is little evidence to guide clinicians treating children and adolescents with ARFID. This case series describes the clinical presentations, treatments and outcomes of six patient diagnosed with ARFID who were treated sequentially by a child psychiatrist and adolescent medicine physician in a hospital-based eating disorder program. Case Presentations Five out of six cases were female and median age of patients at assessment was 12.9 (SD = 1.13) years. On average, patients’ percentage of treatment goal weight was 80.5% at initial assessment (SD = 8.56) and 81.9% (SD = 7.08) when family therapy began. Cases 1, 2 and 3 were admitted to a specialized inpatient unit at assessment due to medical instability (2) or failed outpatient treatment (1), and all six cases presented with severe co-morbid anxiety. All patients were treated using a combination of medical monitoring, family therapy, medication (including olanzapine, fluoxetine and in two cases cyproheptadine), and cognitive behavioural therapy. At treatment termination, all six patients had achieved their goal weight. Conclusion These cases illustrate the complex ways in which young patients with ARFID can present, the illness’ effect on development and mental health, and the positive outcomes associated with weight gain and concurrent treatment for co-morbid anxiety disorders.

To evaluate the effectiveness and safety of adjunctive olanzapine treatment for low weight adolescents with anorexia nervosa (AN).A non-randomized open-label trial was conducted between 2010 and 2014. Participants received standard treatment and were invited to take olanzapine at study enrollment. Participants could accept, continue, or discontinue olanzapine as treatment progressed. Weight and psychological outcomes were monitored.Of 239 adolescents assessed, 65 met inclusion criteria, 38 enrolled in the study, and 32 were retained for analysis. Twenty-two participants took olanzapine (Preliminary results suggest that olanzapine may help facilitate weight gain in adolescents with AN. The importance of medical monitoring over the course of treatment is discussed.Évaluer l’efficacité et l’innocuité d’un traitement d’appoint par olanzapine pour les adolescents de faible poids souffrant d’anorexie mentale (AM).Un essai ouvert non randomisé a été mené entre 2010 et 2014. Les participants ont reçu un traitement standard et ont été invités à prendre de l’olanzapine lors de l’inscription à l’étude. Les participants pouvaient accepter, continuer ou cesser l’olanzapine à mesure que le traitement progressait. Le poids et les résultats psychologiques ont été surveillés.Sur les 239 adolescents évalués, 65 satisfaisaient aux critères d’inclusion, 38 se sont inscrits à l’étude, et 32 ont été retenus pour analyse. Vingt-deux participants ont pris de l’olanzapine (Les résultats préliminaires suggèrent que l’olanzapine peut aider à faciliter la prise de poids chez les adolescents souffrant d’AM. L’importance de la surveillance médicale en cours de traitement est discutée.

OBJECTIVE To determine the prevalence of weight-based teasing, and evaluate its association with depression, anxiety and unhealthy eating behaviour in a large sample of adolescents in the Ottawa (Ontario) area. METHODS A total of 1491 adolescents from public and private middle schools and high schools in rural and urban areas of Ottawa responded confidentially to surveys. RESULTS More girls than boys reported that they experienced weight-based teasing (33% versus 18%). The prevalence of weight-based teasing by peers was significantly higher among overweight and obese youth than among normal weight youth (45% versus 22%). Teasing about body weight was consistently associated with anxiety, psychological distress and disordered eating, and these associations held for both boys and girls, and were independent of weight status. CONCLUSIONS Weight-based teasing is a common experience among Ottawa-area adolescents, especially among overweight girls, and was found to be associated with psychological morbidity. Effective interventions are needed to help victims cope with and prevent further weight-based teasing and its harmful psychological sequelae.

Background Healthy body weight (HBW) determination affects multiple aspects of eating disorder (ED) treatment. For example, it can inform patients and providers as to when return of menses (ROM), an objective determinant of health, can occur. Growth curves (GCs) are sensitive indicators of health in youth and when up to date provide critical information regarding normal and expected trajectories of growth. Although not widely recommended as a first line tool for HBW calculation, a GC guides providers selecting a HBW that is individualized to each patient. The primary aim of this paper was to assess availability and feasibility of utilizing GC data for HBW prediction in adolescents referred for an ED assessment. We also sought to determine how this calculation compared to the standardized HBW calculation that uses mean body mass index (BMI) for age and how each of these numbers compared to the actual weight at ROM. Methods A retrospective chart review was completed on outpatients assessed for EDs between January 2004 and December 2006. A total of 102 patients met inclusion criteria. Demographic information, GC data, HBW predictions, and menstrual history were analyzed. A comparison of predicted HBWs using the aforementioned calculations and weight at ROM was performed using t-test analyses. Results Eighty-one patients (79.4%) had GC data available at assessment although HBW prediction was possible in only 24 patients (23.8%) due to poor GC completion. Of those 24 patients, 9 had ROM data available; no significant difference between our predicted HBW and the weight at ROM was found in these patients. In cases where HBW predictions could be compared using GC data and the BMI method, we found the GC calculation to be overall superior. Conclusions We found overall rates of GC completion to be very low in our patients, which in turn limited the feasibility of relying on a GC for HBW calculation in ED patients. When complete, GCs provide accurate HBWs for most patients with EDs although it is clear that secondary methods of calculation are required given the gaps in data observed using this cohort.