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Objective: Models of treatment for adults with severe and enduring eating disorders focus on harm reduction and improving quality of life. However, there is a notable gap in the pediatric literature in this area. The current study set out to assess the perspectives of health professionals regarding clinical care for young people (e.g., ages 10–25 years) with severe and enduring eating disorders, and to explore perceptions about appropriate treatment options for these presentations. Methods: Health professionals were invited to complete a two-stage online survey about their experiences with clinical care for pediatric eating disorders through Canadian and Australian professional eating disorder networks. Survey 1 included questions about their experiences in supporting individuals with severe and enduring presentations. Participants who completed Survey 2 reviewed clinical vignettes and shared their perspectives about treatment recommendations and models of care, including for a severe and enduring presentation. Results: A total of 85 clinicians responded to questions on Survey 1 about severe and enduring eating disorder presentations. A portion of these respondents (n = 25) also participated in Survey 2. The majority of respondents to Survey 1 reported providing clinical care for pediatric severe and enduring eating disorder presentations. Amongst respondents to Survey 2, there was low consensus amongst respondents for the clinical care that would be most appropriate for young people with a severe and enduring eating disorder presentation. Numerous challenges in models of care for severe and enduring presentations in pediatric settings were raised in responses on Survey 2, with clinicians sharing their awareness of models focusing on quality of life, while also raising concerns about the appropriateness of these models for young people. Conclusions: The preliminary results of this study demonstrate that the majority of clinicians report that they have provided care to young people with severe and enduring presentations. There is a clear need for establishing guidance for clinicians working in pediatric eating disorder settings around models of care focused on quality of life. Engagement with interested parties, including those with lived experience, can clarify the development of terminology and clinical pathways for severe and enduring presentations of pediatric eating disorders. Plain English Summary: Treatment models focusing on harm reduction and quality of life (as opposed to eating disorder recovery) are available for adults with severe and enduring eating disorders. However, these models are not widely available for young people. In fact, there is very limited research on severe and enduring eating disorder presentations in pediatric populations. We assessed the views of health professionals regarding clinical care for young people with severe and enduring eating disorder presentations, and asked professionals about what treatment options might be most appropriate for these presentations. Most participants reported providing clinical care for pediatric severe and enduring eating disorder presentations. However, clinicians had diverse views about the treatment that would be most appropriate for a severe and enduring eating disorder presentation in a young person. Further research and engagement with clinicians and those with lived experience is needed to clarify the terminology and clinical pathways for severe and enduring presentations of pediatric eating disorders. [ABSTRACT FROM AUTHOR]

Background: The impact of the COVID-19 pandemic on young people with eating disorders (EDs) and their families was profound, with surging rates of hospitalizations and referrals reported internationally. This paper provides an account of the additional health and social costs of ED care for young people living in Canada incurred during the COVID-19 pandemic, drawing attention to the available data to inform these estimates while noting gaps in data capacities to account for a full view of the ED system of care. Methods: Three methodologies were used to capture costs: (1) provincial administrative data holdings available at the Canadian Institute of Health Information (CIHI) were used by Deloitte Access Economics to conduct analyses on costs related to hospitalizations, emergency room visits, outpatient visits with physicians and loss of well-being from being on a waitlist. These were examined across three fiscal years (April 1 to March 31, 2019–2022) to compare costs from one year before to two years after the onset of the pandemic, (2) data collected on support-based community ED organizations and, (3) costs identified by young people, caregivers and health care professionals. Results: Estimates of additional health care costs and social costs arising from ED care waitlists were estimated to have increased by 21% across the two years after the onset of the pandemic and is likely to represent an underestimate of costs. Costs related to some standard ED care services (e.g. day treatment programs) and support-based community ED organizations that saw a 118% increase in services during this time, are some examples of costs not captured in the current cost estimate. Conclusions: This paper provides a first account of the additional health and social ED care costs associated with the pandemic, which indicate at minimum, a 21% increase. The results invite discussion for more investments in ED services for young people in Canada, as it is unclear if needs are expected to remain elevated. We suggest a call for a national surveillance strategy to improve data holdings to aid in managing services and informing policy. A robust strategy could open the door for much-needed, data-informed, system transformation efforts that can improve ED care for youth, families and clinicians. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to an unprecedented rise in rates and symptoms of eating disorders among Canadian youth. To date, there is a lack of national surveillance and costing data in Canada to inform policymakers and healthcare leaders on how to best address the surge in new and existing cases. This has resulted in the Canadian healthcare system being unprepared to adequately respond to the increased needs. Therefore, clinicians, researchers, policymakers, decision-makers, and community organizations across Canada are collaborating to compare pre-and post-pandemic costing data from national and province-level healthcare systems in an effort to address this gap. Results from this economic cost analysis will be an important first step in informing and guiding policy on possible adaptations to services to better fulfill the needs of youth with eating disorders in Canada. We highlight how gaps in surveillance and costing data can impact the field of eating disorders in an international context. [ABSTRACT FROM AUTHOR]

Objectives: The current study was conducted to further understand the experiences of youths with an eating disorder with accessing services and receiving treatment. Participants' perceptions of the role of gender in eating disorder treatment was also assessed. Design: A prospective mixed methods design was used, with the current report focusing on qualitative interviews. Methods: Youths who were receiving services in a specialized paediatric eating disorder program completed a semi-structured interview in combination with a visual lifeline upon their discharge. A process of interpretative induction was employed to derive high-level concepts from the interviews. Results: A total of 28 youths (15 males and 13 females) completed an interview. Four high-level concepts were identified: (1) unwanted/non-collaborative support, (2) conflicting views, (3) dynamics in relationships (with subconcepts relating to peers and health professionals), and (4) changing mindset. Although many participants viewed treatment as universal, a subset of participants noted that treatment was tailored towards females. Conclusions: Youths shared several challenges that they encountered in their journey to accessing specialized eating disorders treatment, including disagreement with their parents/caregivers and health professionals about treatment plans. Interactions with peers and health professionals represented both a facilitator (e.g., feeling supported and inspired by peers) and a challenge (e.g., negative interactions with professionals). Some youths shared concerns about the female-centric nature of treatment. The results of this study highlight the importance of collaborative care for paediatric eating disorders, and consideration for gender inclusivity in eating disorders treatment. [ABSTRACT FROM AUTHOR]

Certain presentations of Avoidant/Restrictive Food Intake Disorder (ARFID) and Somatic Symptom and Related Disorders (SSRDs) have conceptual overlap, namely, distress and impairment related to a physical symptom. This study compared characteristics of pediatric patients diagnosed with ARFID to those with gastrointestinal (GI)-related SSRD. A 5-year retrospective chart review at a tertiary care pediatric hospital comparing assessment data of patients with a diagnosis of ARFID (n = 62; 69% girls, M age = 14.08 years) or a GI-related SSRD (n = 37; 68% girls, M age = 14.25 years). Patients diagnosed with ARFID had a significantly lower percentage of median BMI than those with GI-related SSRD. Patients diagnosed with ARFID were most often assessed in the Eating Disorders Program, whereas patients diagnosed with an SSRD were most often assessed by Consultation-Liaison Psychiatry. Groups did not differ on demographics, psychiatric diagnoses, illness duration, or pre-assessment services/medications. GI symptoms were common across groups. Patients diagnosed with an SSRD had more co-occurring medical diagnoses. A subset (16%) of patients reported symptoms consistent with both diagnoses. Overlap is observed in the clinical presentation of pediatric patients diagnosed with ARFID or GI-related SSRD. Some group differences emerged, including anthropometric measurements and co-occurring medical conditions. Findings may inform diagnostic classification and treatment approach. [ABSTRACT FROM AUTHOR]

Background: To address the gaps in the literature examining eating disorders among males and gender minority youths, a prospective study was designed to assess gender differences in eating disorder symptom presentation and outcomes. Muscularity concerns may be particularly relevant for male youths with eating disorders, and were included in assessment of eating disorder symptom presentation. Methods: All cisgender male youths who presented for specialized eating disorder treatment at one of two sites were invited to participate, along with a group of matched cisgender females, and all youths who did not identify with the sex assigned to them at birth. Youths completed measures of eating disorder symptoms, including muscularity concerns, and other psychiatric symptoms at baseline and end of treatment. Results: A total of 27 males, 28 females and 6 trans youths took part in the study. At baseline, Kruskal–Wallis tests demonstrated that trans youths reported higher scores than cisgender male and female youths on measures of eating pathology (Eating disorder examination-questionnaire (EDE-Q) and the body fat subscale of the male body attitudes scale (MBAS)). These analyses demonstrated that there were no differences between cisgender male and female youths on eating disorder symptoms at baseline. However, repeated measures ANOVA demonstrated that males had greater decreases in eating pathology at discharge than did females, based on self-reported scores on the EDE-Q, MBAS, and Body Change Inventory. Conclusions: Gender differences in eating pathology appeared at baseline, with trans youths reporting higher levels of eating pathology than cisgender youths, though no differences between cisgender males and females emerged at baseline for eating disorder symptom presentation. Contrary to expectations, there were no gender differences in measures of muscularity concerns. Males demonstrated greater eating disorder symptom improvements than females, suggesting that male adolescents may have better treatment outcomes than females in some domains. Plain English summary: Research in the field of eating disorders has focused on females, and less is known about the symptom presentation and treatment outcomes in males and gender minority youths. This prospective study set out to assess gender differences in eating pathology and treatment outcomes. Muscularity concerns may be particularly relevant for male youths with eating disorders, yet there is limited research on gender differences in muscularity concerns in treatment-seeking youths with eating disorders. Participants include cisgender male youths, matched cisgender females, and gender diverse youths who did not identify with the sex assigned to them at birth. Youths completed measures of eating disorder symptoms, including muscularity concerns, and other psychiatric symptoms at baseline and end of treatment. Some gender differences in eating pathology appeared at baseline, with trans youths reporting higher levels of eating pathology than cisgender youths. There were no differences between cisgender males and females in eating disorder symptom presentation at baseline, and contrary to expectations, there were no gender differences in measures of muscularity concerns. However, males demonstrated greater eating disorder symptom improvements than females. [ABSTRACT FROM AUTHOR]

Background: Parents are integral in the treatment of pediatric eating disorders. The current study was conducted to further understand the barriers and facilitators that parents experience in accessing specialized, tertiary level eating disorder treatment for children and adolescents. The goals of the study were to understand the processes leading to diagnosis and treatment, perceived barriers and facilitators to accessing care, and parents' experiences over the course of their child's eating disorder treatment. Methods: Ten parents whose children were admitted to a Canadian tertiary level specialized pediatric eating disorders program took part in an exit interview upon their child's completion of treatment in the program. In-depth semi-structured interviews were combined with a visual timeline. Interpretive induction was performed to generate high-level concepts that emerged from the interviews. Results: Five high-level concepts were identified: (1) delays in identifying eating disorder symptoms, (2) challenges in accessing eating disorder services, (3) the right treatment at the right time, (4) emotional impact on parents, and (5) parental expertise and involvement. Conclusions: Several barriers were identified by parents that interfered with treatment, including system-related challenges when accessing specialized eating disorder treatment, concerns about a lack of appropriate mental health support for their child, and difficulties with transitioning between community and tertiary level care. Negative emotions, including guilt and self-blame, were common early in the treatment journey. Themes of parental involvement throughout treatment, and parents taking charge of their child's recovery, emerged across interviews. The results of this study suggest the importance of early identification of eating disorder symptoms, facilitating smoother transitions between levels of care (e.g., community services and hospital-based eating disorder care), and improving clinical decision-making to ensure children and adolescents with eating disorders receive the most appropriate treatment based on their clinical presentation. Plain English summary: Parents play a central role in pediatric eating disorder treatment. To further understand parents' experiences over the course of their child's eating disorder treatment, interviews were conducted with ten parents whose children were admitted to a specialized pediatric eating disorders program. Five major themes emerged across the interviews with parents: delays in identifying eating disorder symptoms, challenges with accessing eating disorders care, the right treatment at the right time, emotional impact on parents, and parental expertise and involvement. Parents shared several barriers that interfered with their child's treatment, including challenges with transitions between their home community and specialized eating disorder treatment. Parents also commonly spoke about guilt and self-blame when their child was first diagnosed with an eating disorder, though many parents felt relief and improved confidence after being connected with specialized eating disorder treatment. Research is needed to understand how to provide the right treatment at the right time for each child and adolescent with an eating disorder, to ultimately improve clinical care and reduce the barriers experienced by families. [ABSTRACT FROM AUTHOR]

Objective: The current study explored the experience and familiarity of pediatric health professionals with avoidant/restrictive food intake disorder (ARFID), and assessed the application of diagnostic criteria in a series of clinical vignettes. Method: Pediatric health professionals were invited to complete an online survey. Data from 93 health professionals from medical and allied health roles who completed the survey were analyzed. Results: Respondents providing care for pediatric feeding/eating disorders were more likely to report familiarity with ARFID than those not typically providing care for feeding/eating disorders. Clinicians who had provided care for pediatric ARFID reported more confidence in clinical management of ARFID than did those who had not yet provided care for ARFID, though there were overall relatively low levels of confidence in providing care for ARFID. Respondents to the clinical vignettes were more likely to confer a diagnosis of ARFID when there were symptoms of both psychosocial impairment and weight loss than when there was psychosocial impairment alone. Discussion: The results suggest variability in current application of diagnostic criteria for ARFID, low confidence in clinical management of ARFID, and ambiguity in clinicians' judgments regarding whether psychosocial impairment is sufficient to meet a diagnosis of ARFID. [ABSTRACT FROM AUTHOR]

Objective: A wealth of evidence indicates that self‐compassion is linked with positive psychological outcomes; however, little is known about the process through which self‐compassion exerts its effect. The primary purpose of this research was to investigate the direct and indirect impact of self‐compassion on body satisfaction and eating pathology in adolescents. Method: Two hundred and thirty‐eight students were recruited from three local high schools (Mage = 16.49, 43.7% boys). All participants completed the Self‐Compassion Scale (SCS), Hopkins Symptom Checklist (SCL‐5), Body Areas Satisfaction Scale (BASS), and Eating Disorder Examination Questionnaire ‐ Adolescent Version (EDE‐Q) at baseline. The SCL‐5, BASS, and EDE‐Q were completed 4 months later. Results: Self‐compassion was positively associated with body satisfaction and negatively associated with psychological distress and eating pathology in boys and girls at both time points. Longitudinal conditional process analyses revealed that self‐compassion predicted changes in body satisfaction and eating pathology through changes in psychological distress for girls only. Notably, self‐compassion was higher in boys than in girls. Discussion: Results underscore how self‐compassion may be an important factor to target in fostering a positive body image and preventing disordered eating in adolescents. [ABSTRACT FROM AUTHOR]

The article looks at the clinical utility of short treatment allocation tool for eating disorders (STATED), focusing on the need for evidence-based tools for assisting healthcare providers in allotting patients to the cost-effective level of care. It highlights guideline recommendations for treatment of eating disorders as well as discusses the role of engagement and readiness in the context of a treatment allocation tool. An overview of the STATED is provided.

Background and Objectives: It has been shown that exposure to female thin ideals in media has minimal to moderate direct effects on body image satisfaction (BIS), mood and dysfunctional eating in healthy young women. Evidence has been found for several intervening variables such as social comparison processes. Accordingly it is assumed, that cognitive processing (rather than mere media exposure) is crucial. Consequently, vivid imagination of thin ideals after exposure to a fashion magazine was induced in order to trigger cognitive processes. Changes in mood, BIS and resulting bodyrelated cognitive distortions (Thought-Shape Fusion Body, TSF-B) were assessed.Methods: A total of 91 healthy women (mean age 21.9 years, SD = 2.0) were exposed to either a fashion magazine (thin-ideal group) or a nature magazine (control group) in a waiting room design. Afterwards they were instructed to vividly imagine either the thin ideals or landscapes.Results: When exposed to thin ideals, a significant decrease in mood and BIS emerged after vivid imagination, but not after mere magazine exposure. Imagining thin ideals triggered body-related cognitive distortions (TSF-B). A higher degree of eating disorder (ED) symptomatology amplified this effect.Limitations: These findings apply to young healthy females and cannot be generalized to samples with obesity, EDs or males. Internal validity is limited since the intensity of the exposure has not been systematically controlled.Conclusions: Vivid imagination of thin ideals promoted by magazines results in impaired mood and BIS and moreover in body-related cognitive distortions (TSF-B) in healthy women, especially, for those with stronger ED symptomatology. [ABSTRACT FROM AUTHOR]

A retrospective chart review was conducted to elucidate the clinical and medical characteristics of male youth admitted to a tertiary inpatient treatment center for eating disorders. A total of 23 male youth were identified who had received treatment between January 2003 and February 2014, and for whom charts were available. The majority of the sample (n= 19; 82.6%) received a diagnosis of anorexia nervosa, and the data suggest that these male youth were significantly medically compromised. The patterns in this data will be discussed in the context of previous published research on male youth with eating disorders. [ABSTRACT FROM PUBLISHER]

Background: Thought-Shape Fusion (TSF) and Thought-Action Fusion (TAF) are cognitive distortions that are associated with eating and obsessional pathology respectively. Both involve the underlying belief that mere thoughts and mental images can lead to negative outcomes. TSF involves the belief that food-related thoughts lead to weight gain, body dissatisfaction, and perceptions of moral wrong-doing. TAF is more general, and involves the belief that merely thinking about a negative event (e.g., a loved one getting into a car accident) can make this event more likely to happen, and leads to perceptions of moral wrong-doing. However, the shared susceptibility across related cognitive distortions-TAF and TSF-has not yet been studied. Method: The effects of TSF and TAF inductions in women with an eating disorder (n = 21) and a group of healthy control women with no history of an eating disorder (n = 23) were measured. A repeated-measures design was employed, with all participants exposed to a TSF, TAF and neutral induction during three separate experimental sessions. Participants' cognitive and behavioral responses were assessed. Results: Individuals with eating disorders were more susceptible to TSF and TAF than were control participants, demonstrating more neutralization behavior after TSF and TAF inductions (i.e., actions to try to reduce the negative effects of the induction), and reporting higher levels of trait TAF and TSF than did controls. Conclusions: Individuals with eating disorders are particularly susceptible to both TAF and TSF. Clinical implications of these findings will be discussed. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Over-evaluation of food, shape and weight is a multi-faceted component of cognitive-behavioral models of eating disorders. One specific aspect of over-evaluation of food is a cognitive distortion known as thought-shape fusion (TSF). TSF is purported to be specific to eating pathology; however, research has not yet elucidated whether individuals across the subtypes of eating disorders are differentially susceptible to this phenomenon. Furthermore, it remains unclear whether susceptibility to TSF decreases over the course of treatment. Method TSF, eating pathology, and generalized psychopathology were assessed in 76 individuals with eating disorders. Changes in TSF from pre- to post-treatment were assessed in a subset of participants ( n = 24). Results Individuals with the binge/purge subtype of anorexia nervosa were more susceptible to TSF than were individuals with bulimia nervosa or the restrictive subtype of anorexia nervosa. Increased TSF corresponded with higher levels of eating pathology, depression, and impulsivity. In addition, there were decreases in TSF over the course of treatment. Discussion The observed differences in TSF susceptibility across eating disorder subtypes suggests that subtypes may be differentially prone to over-evaluation of thoughts about food, which represents a facet of one of the core maintenance mechanisms in cognitive-behavioral models of eating disorders. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:302-309) [ABSTRACT FROM AUTHOR]

Objective: Thought-shape fusion (TSF) is a cognitive distortion that has been linked to eating pathology. Two studies were conducted to further explore this phenomenon and to establish the psychometric properties of a French short version of the TSF scale. Method: In Study 1, students ( n = 284) completed questionnaires assessing TSF and related psychopathology. In Study 2, the responses of women with eating disorders ( n = 22) and women with no history of an eating disorder ( n = 23) were compared. Results: The French short version of the TSF scale has a unifactorial structure, with convergent validity with measures of eating pathology, and good internal consistency. Depression, eating pathology, body dissatisfaction, and thought-action fusion emerged as predictors of TSF. Individuals with eating disorders have higher TSF, and more clinically relevant food-related thoughts than do women with no history of an eating disorder. Discussion: This research suggests that the shortened TSF scale can suitably measure this construct, and provides support for the notion that TSF is associated with eating pathology. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) [ABSTRACT FROM AUTHOR]

Abstract: Poor response inhibition has been associated with obesity, excessive food intake, and other consumptive behaviours, including alcohol use. However, the correlation between obesity and addictive behaviours like alcoholism is low: people who are obese appear to have a specific problem in restraining food intake. This would imply that obese people have more difficulties in inhibiting responses towards food, compared to other rewarding stimuli. In the present study 89 children (ages 7–9) were tested with the stop signal task, in which responses towards food pictures or toy pictures had to be inhibited. Results showed that children were less effective in inhibiting responses towards food and percentage overweight predicted a lower ability to inhibit responses in general. When dichotomizing the sample in overweight and lean children, it appeared that overweight children were specifically less effective in inhibition towards food cues, compared to lean children. In conclusion: The results confirm weight related inhibitory problems and might explain the increased overeating to food cues in overweight children, as reported in the literature. [Copyright &y& Elsevier]

Abstract: Thought–shape fusion (TSF) is a cognitive distortion that has been linked with eating pathology; however, the specificity of this distortion to eating disorders has not yet been examined. The current study set out to investigate the effects of a TSF induction on susceptibility to TSF in three groups of women: individuals with an eating disorder (n = 33), individuals with obsessive-compulsive disorder (OCD; n = 24), and control women with no history of either an eating disorder or obsessive-compulsive disorder (n = 26). Participants were assigned to receive either a TSF induction or a neutral induction, and their cognitive, emotional, and behavioral responses were assessed. As expected, the results demonstrated that individuals with eating disorders were more susceptible to TSF than were women with OCD and control participants, reporting higher state TSF, more negative affect, and more neutralization behavior. The results also supported the specificity of this distortion by demonstrating that individuals with OCD were not particularly susceptible to TSF. In fact, control participants demonstrated an increased susceptibility to TSF relative to women with OCD, as evidenced by their higher levels of trait TSF, and increased self-reported distress/difficulty in imagining a food-related situation. [Copyright &y& Elsevier]

Abstract: Food-scented products are widely available, yet it is unclear whether they influence eating behavior. Food-related cues can increase intake; therefore, it was anticipated that conscious exposure to food-scented products (e.g., body lotion) could also influence consumption. Female participants (n =58) were randomly assigned to an exposure condition (labeled chocolate lotion, unlabeled chocolate lotion, or unscented lotion), and their subsequent intake of chocolate-chip cookies was measured. A significant effect of condition on intake emerged. Those who knew that they were evaluating a chocolate-scented lotion ate more than did those exposed to the same (unlabeled) lotion, suggesting that conscious exposure to chocolate-related products may increase food intake. [Copyright &y& Elsevier]

Abstract: Thought-shape fusion (TSF) is a cognitive distortion that can be induced by imagining eating high-caloric foods, and involves increased guilt, feelings of fatness, and perceptions of weight gain and moral wrong-doing. Two studies were conducted to further elucidate this phenomenon. Study 1 investigated whether merely being exposed to fattening foods (without being asked to think about these foods) could induce a TSF-like experience. Study 2 investigated the relationship between negative affect and TSF-like experiences. The results suggested that TSF is specific to thinking about eating fattening foods, as mere exposure to high-caloric foods did not increase state TSF scores in healthy females relative to a neutral control condition. Furthermore, susceptibility to TSF is associated with negative affect. Healthy females with low levels of negative affect appear to be protected against TSF, medium negative affect is associated with susceptibility to TSF inductions, while those with high levels of negative affect appear to be particularly vulnerable to TSF-like experiences (even after imagining a neutral situation). Overall, the studies suggest that negative affect is associated with a TSF-like experience, and that TSF is a phenomenon that is experienced (to at least some extent) by females in the general population. [ABSTRACT FROM AUTHOR]

Abstract: Research suggests that caloric restriction (CR) is beneficial; however, the effects of CR in the context of food cues are unclear. A 2 (food cue vs. no cue)×2 (CR vs. ad lib) between-subjects design was employed to test these effects in 40 rats. It was predicted that cue exposure and CR would induce stress, and that these factors might interact synergistically. The results demonstrated that cue-exposed CR rats weighed less than did non-exposed CR rats. A blunted stress response was evident in CR rats relative to ad lib rats. Finally, cue-exposed rats had higher corticosterone levels and body weight during ad lib feeding than did non-cued rats. These results suggest that both CR and chronic food-cue exposure can be stressful, and the implications of this research are discussed in the context of humans’ ‘obesigenic’ environment. [Copyright &y& Elsevier]

Abstract: Few factors have been identified that bolster self-control processes and prevent overeating in restrained eaters; however, research on counteractive-control theory suggests that exposure to food cues may represent such a protective factor. To further investigate the effects of food-cue exposure, restrained and unrestrained eaters were randomly assigned to either a food-cue or no-cue condition, and their intake was measured. The results indicated that food-cue-exposed restrained eaters ate less than did non-exposed restrained eaters. The possible role of incidental food-cue exposure as a means for inhibiting intake in restrained eaters is explored. [Copyright &y& Elsevier]

Abstract: Thought–shape fusion (TSF) is a cognitive distortion that can be induced experimentally and is associated with eating pathology. The current study was conducted in order to elucidate the effects of TSF induction in females with eating disorders (n=35), as well as in restrained eaters (n=38) and unrestrained eaters (n=39). It was hypothesized that TSF induction would result in anxiety, guilt, increased feelings of fatness, perceived weight gain and feelings of moral wrong-doing relative to an anxiety and control induction. It was further hypothesized that restrained eaters and individuals with eating disorders would exhibit a stronger reaction to a TSF induction than would unrestrained eaters. The results indicated that, as predicted, TSF can be induced in individuals both with and without eating disorders, and individuals with eating disorders reported the highest levels of “state” TSF after the induction relative to the non-clinical controls. However, contrary to expectations, restrained eaters reported higher levels of perceived weight gain and moral wrong-doing after the anxiety induction (but not the TSF induction) relative to the control induction. Potential mechanisms for this pattern of results are discussed, and the clinical implications of research on TSF are also considered. [Copyright &y& Elsevier]

Abstract: This study investigates the effects of peer influence on the food intake of overweight and normal-weight children. A mixed factorial design was employed, with children''s weight status (overweight vs. normal-weight) as a between-subjects factor, and social context (alone vs. group) as a within-subjects factor. A total of 32 children (n =17 overweight and n =15 normal-weight) between the ages of 6–10 years participated in this study. Findings from the random regression model indicated that overweight children ate more when with others than when alone, while in contrast normal-weight ate more with others than they did when alone. Therefore, social context differentially impacts the eating behavior of overweight and normal-weight children. This study underscores differences in responses to the social environment between overweight and non-overweight youths, and suggests that social involvement may be an important tool in treatment and prevention programs for overweight and obesity. [Copyright &y& Elsevier]

Abstract: In order to determine the effects of selective food restriction on subsequent food intake and cravings, participants were randomly assigned to one of three conditions: carbohydrate-restriction, protein-restriction, or control (no restriction). Participants in the restriction conditions were asked to restrict their intake of either complex carbohydrates or animal proteins for 3 days, before coming to the laboratory for an experimental session. During the experimental session, participants’ food intake, cravings, and affect were measured. The results indicated that selective food restriction resulted in selective behavioural consequences. Specifically, carbohydrate-restricted participants consumed more of a high-carbohydrate food than did controls or protein-restrictors, in addition to reporting more cravings for high-carbohydrate foods over the restriction period. Protein-restricted participants reported more cravings for high-protein foods over the restriction period, in comparison to controls and carbohydrate-restrictors; however, protein-restricted participants did not consume more of the particular high-protein food presented to them in the laboratory. The roles of dietary restraint and negative affect in influencing cravings and food intake are discussed. Overall, selective food restriction is demonstrated to have negative psychological and behavioural consequences. [Copyright &y& Elsevier]

Abstract: The effects of pre-exposure to high- versus low-caloric foods on fruit intake were investigated. A total of 56 children participated in this study, and were randomly assigned to an exposure condition: high-caloric food, low-caloric food, or control. Children who were pre-exposed to a high-caloric food ate more fruit than did those pre-exposed to a low-caloric food. These findings suggest that pre-exposure to high-caloric foods stimulates subsequent intake, including intake of foods that were not previously exposed, while pre-exposure to low-caloric foods does not appear to arouse appetite. [Copyright &y& Elsevier]

Abstract: The present study investigated the effects of exposure to a food cue on the self-reported importance of dieting in those with low, medium, and high levels of dietary restraint. The results indicated that exposure to a food cue bolstered dieting-related goals in those who were low in dietary restraint but had no effect on the importance of dieting-related goals for those with medium or high levels of dietary restraint. The results demonstrate that exposure to temptations may differentially affect self-control processes depending on an individuals’ level of dietary restraint. [Copyright &y& Elsevier]

Background: The onset of the COVID-19 pandemic has had an adverse impact on children, youth, and families with eating disorders (EDs). The COVID-19 pandemic exacerbated pre-existing personal and financial costs to youth, caregivers, and health professionals accessing or delivering ED services. The objectives of this mixed methods study were to (1) understand the indirect, direct medical and non-medical costs reported by youth, caregivers, and clinicians; (2) understand how the COVID-19 pandemic may have impacted these costs, and (3) explore implications of these costs with regards to barriers and resources to inform future decisions for the ED system of care. Methods: Youth (aged 16–25 years) with lived/living experience, primary caregivers, clinicians, and decision-makers were recruited with support from various partners across Canada to complete group specific surveys. A total of 117 participants responded to the survey. From those respondents, 21 individuals volunteered to further participate in either a discussion group or individual interview to provide additional insights on costs. Results: Youth and primary caregivers reported costs relating to private services, transportation and impacts of not attending school or work. Additionally, primary caregivers reported the top direct medical cost being special food or nutritional supplements (82.8%). In discussion groups, youth and caregivers elaborated further on the challenges with long waitlists and cancelled services, impact on siblings and effect on family dynamics. Clinicians and decision-makers reported increased work expectations (64.3%) and fear/isolation due to COVID-19 in the workplace (58.9%). Through discussion groups, clinicians expanded further on the toll these expectations took on their personal life. Approximately 1 in 3 health professionals reported contemplating leaving their position in 1–2 years, with greater than 60% of this group stating this is directly related to working during the pandemic. Conclusions: Findings demonstrate the need for increased support for youth and caregivers when accessing ED services both during crisis and non-crisis times. Additionally, attention must be given to acknowledging the experience of health professionals to support better retention and resource management as they continue to navigate challenges in the health care system. Plain English summary: The COVID-19 pandemic has had significant impacts for children, youth and families with eating disorders (EDs) and those who care for them. The objective of this study was to understand the impacts on financial and personal costs to youth, caregivers and clinicians when either accessing or delivering ED services during the pandemic. This study consisted of an online survey and discussion groups with youth (16-25 years old) with lived experience of an ED, primary caregivers, clinicians and decision-makers delivering ED services to understand the costs they experienced. Although many reported costs were financial, including direct medical costs (i.e. private therapy) and direct non-medical costs (i.e. transportation, accommodation costs), there were also significant personal costs to individuals and their families. Healthcare professionals also reported extensive challenges with resources and increased work expectations due to the pandemic context. Acknowledging the costs experienced by young people, families and healthcare professionals during the pandemic allows for the discussion of how we can better support those accessing or delivering ED services in times of crisis and non-crisis. [ABSTRACT FROM AUTHOR]

Background: The growing body of research on eating disorders among male adolescents reveals some sex differences in clinical presentation. The current study set out to replicate and extend recent research on the clinical and medical characteristics of male youth with eating disorders, and examine sex differences between biological males and females in a tertiary pediatric eating disorder treatment setting. Methods: A retrospective chart review was conducted with all biological males who were admitted to the Eating Disorders Programs at British Columbia Children's Hospital (2003–2015) or the Looking Glass Residence (2011–2015). Clinical data, including demographics, percentage of median body mass index (% mBMI), and psychiatric diagnoses, were recorded along with medical data (i.e., vital signs, basic biochemistry investigations, and bone mineral density). A comparison group of females with eating disorders who received treatment at British Columbia Children's Hospital in the inpatient or outpatient streams (2010–2015) were included, to examine sex differences with males who were admitted during the same period. Results: A total of 71 male youth were included in the chart review. Males had significant medical complications, with 26.5% of the sample presenting with a heart rate of less than 50 beats per minute and 31.4% presenting with a bone mineral density z-score for the lumbar spine ≤ − 1. Sex differences between the subset of males who were treated between 2010 and 2015 (n = 41) and the females (n = 251) were examined. Females were more likely than were males to have a diagnosis of anorexia nervosa or bulimia nervosa, and to be underweight (< 95% mBMI) at admission. Males were younger than females, but no differences emerged in the duration of the eating disorder symptoms. No sex differences emerged relating to medical instability (e.g., bradycardia). Conclusions: A large proportion of male children and youth with eating disorders are medically compromised at admission. Males were younger than females, and were less likely than females to have a diagnosis of anorexia nervosa or bulimia nervosa. Males who were underweight at admission had also lost a lower percentage of body weight in comparison to females. The current study replicates previous sex differences reported in pediatric samples. [ABSTRACT FROM AUTHOR]

Objective: Related to the cognitive‐behavioral theory of eating disorders, body checking has gained increasing recognition as both a maintaining factor for eating disorders and an important target for treatment. However, it is unclear whether body‐checking behaviors contribute to the development of disordered eating, or if these behaviors develop as a response to experiencing eating disorder thoughts and behaviors. This study aims to examine the relationships between body‐checking behaviors and eating disordered thoughts and behaviors in adolescent females and males in the community over time. Methods: Participants included 238 adolescents (n = 104 males, n = 134 females, Mage= 16.5 years) recruited from high schools in British Columbia, Canada, who completed the Eating Disorder Examination Questionnaire and Body Checking Questionnaire at baseline (T1) and again approximately 4 months later (T2). Results: After controlling for baseline levels of eating pathology and body mass index (BMI), body checking at T1 predicted increases in eating pathology for both males and females. In contrast, after controlling for baseline levels of body checking and BMI, eating pathology at T1 did not predict changes in body checking for females, but it did for males. Findings suggest that, among adolescents, engaging in body‐checking behaviors may increase risk for disordered eating. Discussion: If supported by further research, targeting body‐checking behaviors in prevention programs may be warranted. [ABSTRACT FROM AUTHOR]

Research in adults demonstrates a positive association among obsessive–compulsive symptoms, eating pathology, cognitive distortions, and comorbid depressive symptoms. Given that adolescence is characterized by unique and rapid changes in biopsychosocial processes, it is imperative to elucidate the relationship between these variables in youth. In this cross-sectional study, we explored whether obsessive–compulsive symptoms, thought–action fusion, thought–shape fusion, and eating pathology would be positively associated with and predict depressive symptoms in a school-based community sample of adolescents (n = 86; M age = 15.60). All study variables were positively correlated with depressive symptoms. Results indicated that obsessive–compulsive symptoms, thought–shape fusion, and eating pathology explained a significant proportion of variance in depressive symptoms, whereas thought–action fusion did not. In accordance with the cognitive behavioral model of psychopathology, these findings highlight the relationships between key interrelated correlates of depressive symptoms that may be pertinent targets for prevention and treatment efforts in adolescents. [ABSTRACT FROM AUTHOR]

Objective: To examine the psychometric properties of the Parent Eating Disorder Examination Questionnaire (PEDE‐Q), developed to improve eating disorder (ED) assessment among youth by including parents as informants. Methods: A multi‐site, transdiagnostic sample of 355 adolescents with EDs completed the Eating Disorder Examination Questionnaire (EDE‐Q) and their parents completed the PEDE‐Q. Results: The internal consistencies of the PEDE‐Q subscales were on par with established EDE‐Q ranges (.73 to.90), both when examined using the original four‐factor EDE‐Q subscales and the seven‐item, three‐factor subscales of the brief EDE‐Q. Statistically significant medium‐ to large‐sized correlations and poor to moderate levels of agreement were found between the corresponding EDE‐Q and PEDE‐Q subscales. Receiver‐operator characteristic (ROC) curves showed that the PEDE‐Q had a statistically significant area under the curve (AUC) to maximize sensitivity and specificity in diagnosing full‐syndrome AN, whereas the EDE‐Q did not. Based on chi‐square analyses, the PEDE‐Q identified a statistically significantly greater number of AN cases than the EDE‐Q. The EDE‐Q yielded a BN diagnosis more frequently than the PEDE‐Q, although this difference was not statistically significant. Discussion: Results suggest that the PEDE‐Q has good psychometric properties and provides incremental information that can aid in the assessment and diagnosis of adolescents with EDs, particularly those with AN. Public significance: There exist complex challenges to identifying clinically significant eating disorders among youth. The PEDE‐Q is a questionnaire measure that improves eating disorder assessment among children and adolescents by asking parents to report on the symptoms and behaviors they have observed in their child and that youth may not fully disclose. The PEDE‐Q can aid in the diagnosis of adolescents with eating disorders, particularly those with anorexia nervosa. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective We examined differences in treatment outcome associated with a 'self-directed'- versus 'external-incentive'-based day treatment protocol for individuals with eating disorders (EDs) with below normal body mass index. The self-directed protocol recommended a weekly 500 g weight gain, but allowed participants freedom to gain weight at their own rate; the 'external-incentive' protocol required a minimum weight gain of 500 g/week as a requirement for staying in the program. Method Weight outcome was available for 49 individuals who were treated with the recommended weight gain protocol, and 40 individuals who were treated with the required weight gain protocol. Results Post-treatment weight was significantly higher in patients treated in the required weight gain protocol compared to those treated in the recommended weight gain protocol. All patients, regardless of which program they completed, showed improvements in the measures of eating-disorder and comorbid-psychiatric symptoms. Discussion This study demonstrated the benefits of an alteration in protocol that required no additional financial or human resources. Further studies are needed to validate the effectiveness of various day treatment protocol parameters. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:500-506) [ABSTRACT FROM AUTHOR]

Abstract: A growing body of research on caloric restriction (CR) in many species of laboratory animals suggests that underfeeding leads to better health and longevity in the calorically-restricted animal (e.g., see [[34]. J.P. Pinel, S. Assanand and D.R. Lehman, (2000). Hunger, eating and ill health. Am Psychol, 55, 1105–1116.], for a review). Although some objections have been raised by scientists concerned about negative psychological and behavioral sequelae of such restriction, advocates of CR continue to urge people to adopt sharply reduced eating regimes in order to increase their longevity. Yet very few people are even attempting to reap the benefits of such restriction. The present paper explores one factor that may deter many humans from drastically reducing their food consumption—the presence of abundant, attractive food cues in the environment. Research on the influence of food cues on food-related behaviors is reviewed to demonstrate that the presence of food cues makes restriction of intake more difficult. [Copyright &y& Elsevier]

Abstract: This study investigates the effects of peer and sibling influence on the cookie intake of normal-weight children. A total of 44 children (24 girls and 20 boys) aged 5–11 participated in this study. Children played a sorting task while being exposed to a large amount of cookies. Children were tested alone or with an unfamiliar peer or with a sibling. Results indicated that the social condition was related to the participants’ energy intake. Children eating with their siblings ate more cookies than did children eating with strangers and also consumed more cookies than did children eating alone. This pattern of results is consistent with previous research in adults indicating that familiarity between co-eaters influence how much one choose to eat. Furthermore, the degree of intake matching was extremely high among strangers, but low and not statistically significant in dyads of siblings. We conclude that matching effect is not ubiquitous and that familiarity affects the level of matching of eating in children. [Copyright &y& Elsevier]

Objective: The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. Methods: Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. Results: Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. Conclusions: Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals. [ABSTRACT FROM AUTHOR]

Thought–shape fusion (TSF) describes the experience of marked concerns about body weight/shape, feelings of fatness, the perception of weight gain, and the impression of moral wrongdoing after thinking about eating fattening/forbidden foods. This study sets out to evaluate the short version of the TSF trait questionnaire (TSF). The sample consists of 315 healthy control women, 244 women with clinical and subthreshold eating disorders, and 113 women with mixed mental disorders (mixed). The factor structure of the TSF questionnaire was examined using exploratory and subsequent confirmatory factor analyses. The questionnaire distinguishes between a Concept scale and a Clinical Impact scale. However, a lack of measurement invariances refers to significant differences between groups in terms of factor loadings, thresholds, and residuals, which questions cross‐group validity. Results indicate that the concept is understood differently in the 3 groups and refers to the suitability of the questionnaire primarily for individuals presenting with symptoms of eating disorders. [ABSTRACT FROM AUTHOR]

Purpose: Mid Upper Arm Circumference (MUAC) measurement is proposed as an adjunctive measure of re-nutrition progress in youth with eating disorders. We propose that MUAC is a clinically-useful measurement that can be used to inform clinicians about treatment progress. The aims of this study were twofold: 1) to test whether assessments of MUAC can track weight restoration in a similar pattern to direct measures of weight and 2) to examine adolescents' self-reported feelings in response to assessments of MUAC, weighing, and skinfolds (SF).Methods: The study involved two phases of data collection. Participants in both phases of the study were female patients who fulfilled DSM IV-TR diagnostic criteria for an eating disorder. In Phase 1, MUAC measurements and weight assessments were collected weekly to examine changes in these values during the first 8weeks of treatment. In Phase 2, participants reported their feelings towards three different anthropometric measures - weight, SF and MUAC.Results: Simple contrasts between the weekly weight and MUAC assessments prospectively collected in Phase 1 (N=40) reveal that MUAC and weight follow similar patterns over time. Phase 2 (N=30) data indicate that participants felt more relaxed, and less angry, scared or embarrassed during MUAC measurements than weighing and SF. MUAC also emerged as the measurement that was most preferred by participants.Conclusions: MUAC measurements are a useful adjunct to measurements of weight, and are perceived to be less distressing than routinely used measurement techniques of weight and SF. [ABSTRACT FROM AUTHOR]

Degree of ego-dystonicity in obsessions is clinically relevant to the conceptualization and treatment of eating disorders (EDs). Obsessive-compulsive disorder research has suggested that the transformation of intrusive thoughts into obsessions is linked to the degree to which intrusive thoughts threaten core perceptions of the self. This study aims to explore the relationship between the ego-dystonic nature of obsessions in ED patients and a fear of self, the link between ED symptom severity and ego-dystonicity in obsessions, and differences between non-clinical and individuals with EDs in the presence of ego-dystonic thoughts and a fear of self. Ego-dystonicity (Ego-dystonicity Questionnaire (EDQ)) and feared self (Fear of Self Questionnaire (FSQ)) degrees were measured in a clinical sample ( n = 57 with EDs) and a non-clinical sample ( n = 45). EDQ and FSQ scores were highly correlated in both samples. EDQ scores were not significantly correlated to ED symptom severity with the exception of the EDQ Irrationality subscale, which was strongly related to compulsion severity. Participants with an ED had significantly higher EDQ and FSQ scores compared with controls. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: The Short Treatment Allocation Tool for Eating Disorders (STATED) is a new evidence-based algorithm developed to match patients to the most clinically appropriate and cost-effective level of care (Geller et al., 2016). The objective of this research was to examine the extent to which current practices are in alignment with STATED recommendations. Method: Participants were 179 healthcare professionals providing care for youth and/or adults with eating disorders. They completed an online survey and rated the extent to which three patient dimensions (medical stability, symptom severity, and readiness) were used in assigning patients to each of five levels of care. Results: The majority of analyses testing a priori hypotheses based on the STATED were statistically significant (all p's <.001), in the direction of STATED recommendations. However, a strict coding scheme evaluating the extent to which ratings were fully consistent with the STATED showed inconsistency rates ranging from 17 to 55% across the five levels of care, with the greatest inconsistencies involving the use of readiness information, and the lowest involving the use of medical stability information. Discussion: Although practices were generally aligned with the STATED recommendations, readiness information was used least consistently in assigning patients to level of care. [ABSTRACT FROM AUTHOR]