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Research undertaken among patients admitted for laxative withdrawal to the Toronto Hospital, Toronto, Canada, inpatient eating disorders programme between 1993 and 1995 indicates that short to medium-term abstinence can be achieved in a large proportion of patients with severe and chronic laxative abuse. Most patients were able to remain abstinent from laxatives after a short intervention, even though they were still suffering from other symptoms of an eating disorder. This is significant in the light of the serious morbidity linked with laxative abuse.

Background: Individuals with eating disorders have a high mortality risk. Few population-based studies have estimated this risk in eating disorders other than anorexia nervosa.Aims: To investigate all-cause mortality in a population-based cohort of individuals who received hospital-based care for an eating disorder (anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified) in Ontario, Canada.Method: We conducted a retrospective cohort study of 19 041 individuals with an eating disorder from 1 January 1990 to 31 December 2013 using administrative healthcare data. The outcome of interest was death. Excess mortality was assessed using standardised mortality ratios (SMRs) and potential years of life lost (PYLL). Cox proportional hazards regression models were used to examine sociodemographic and medical comorbidities associated with greater mortality risk.Results: The cohort had 17 108 females (89.9%) and 1933 males (10.1%). The all-cause mortality for the entire cohort was five times higher than expected compared with the Ontario population (SMR = 5.06; 95% CI 4.82-5.30). SMRs were higher for males (SMR = 7.24; 95% CI 6.58-7.96) relative to females (SMR = 4.59; 95% CI 4.34-4.85) overall, and in all age groups in the cohort. For both genders, the cohort PYLL was more than six times higher than the expected PYLL in the Ontario population.Conclusions: Patients with eating disorders diagnosed in hospital settings experience five to seven times higher mortality rates compared with the overall population. There is an urgent need to understand the mortality risk factors to improve health outcomes among individuals with eating disorders. [ABSTRACT FROM AUTHOR]

A study was conducted to assess the utility of the Children's Eating Attitudes Test (cEAT) questionnaire in a school population of preteen girls. Eating disturbances were found to be common but mild in the preteen group but cEAT was not found to be an effective screening tool.

A case of weight restoration is reported in a patient with anorexia nervosa, end-stage renal disease (ESRD) requiring dialysis and cardiac insufficiency, reviewing the technical challenges and ethical issues in clinical management. Although the weight gain of patients undergoing dialysis could not be monitored, a patient was successfully weight restored while on renal dialysis after progressing from renal insufficiency to renal failure while in treatment for anorexia nervosa.

Objective: Eating disorders are common and have a high public health burden. However, existing clinically relevant data sources are scarce, limiting the capacity to accurately measure the burden of eating disorders. This study tests the feasibility of generating a large clinically relevant cohort of individuals with eating disorders using health administrative data.Methods: We developed 3 clinically relevant eating disorder prevalence cohorts using health administrative data from Ontario, Canada, between 1990 and 2014. Cohort 1 included patients with a hospitalization where an eating disorder diagnosis was the primary diagnosis, cohort 2 included patients with a hospitalization where an eating disorder diagnosis was any diagnosis, and cohort 3 included cohort 2 plus any patient with an emergency department visit with an eating disorder diagnosis.Results: Cohort 1 had 7268 patients, cohort 2 had 13,197 patients, and cohort 3 had 17,373 patients. As cohort size increased, the proportion of eating disorder patients with diagnoses of bulimia nervosa and eating disorder not otherwise specified increased. Although the cohorts differed according to demographic and clinical characteristics, these differences were small compared to the degree to which they differed from the Ontario population.Discussion: It is feasible to use health administrative data to measure the clinically relevant burden of eating disorders. The cohorts differed significantly in the eating disorder diagnostic composition. Eating disorders have a high burden, but poor data availability has resulted in fewer public health-related eating disorders studies in comparison to other mental disorders. The use of administrative data can address this evidence gap. [ABSTRACT FROM AUTHOR]

Background: Eating disorders, specifically anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified, represent a substantial burden to the health care system. Our goal was to estimate the economic burden of patients who received specialized inpatient care for an eating disorder out of country. Method: We conducted a cost-of-illness study evaluating health care costs among patients in Ontario who received specialized inpatient care for an eating disorder out of country from 2003 to 2011, from the public third-party payer perspective. Using linked administrative databases, we estimated net costs of eating disorders for 2 patient groups: those who received specialized inpatient care both out of country and in province (n = 160), and those who received specialized inpatient care out of country only (n = 126). Results: Patients approved for specialized out-of-country inpatient care were mostly girls and young women from high-income, urban neighbourhoods. Total net costs varied annually and were higher for patients treated both out of country and in province (about $11 million before 2007, $6.5 million after) than for those treated out of country alone (about $5 million and $2 million, respectively). The main cost drivers were out-of-country care and physician services. Interpretation: Costs associated with eating disorder care represent a substantial economic burden to the Ontario health care system. Given the high costs of out-of-country care, there may be opportunity to redirect these funds to increase capacity and expertise for eating disorder treatment within Ontario. [ABSTRACT FROM AUTHOR]

The study’s objective was to identify systemic facilitators and barriers of transferring young adults (ages 17–21) with eating disorders from pediatric to adult health and mental health services. Qualitative interviews were conducted and three themes emerged: (a) difficulties navigating care during the transfer period; (b) challenges achieving and maintaining recovery due to systemic barriers after the transfer of care;and (c) recommendations for facilitating the transfer between systems of care. From the perspective of young adults with eating disorders our study shows that the transition to adult care services may be improved with increased coordination, communication, and collaborative partnerships between pediatric and adult providers. [ABSTRACT FROM PUBLISHER]

Objective: The purpose of this study was to identify predictors of the onset of disturbed eating behavior (DEB) in adolescent girls with type 1 diabetes.Research Design and Methods: In this prospective study, participants completed the Children's Eating Disorder Examination interview and self-report measures at baseline and at four follow-up assessments over 5 years. Participants were 126 girls with type 1 diabetes, aged 9-13 years at baseline. Of the 101 girls who did not have DEB at baseline, 45 developed DEB during the follow-up period; the 38 for whom data were available for the assessment before onset of DEB were compared with 38 age-matched girls who did not develop DEB. DEB was defined as dieting for weight control, binge eating, self-induced vomiting, or the use of diuretics, laxatives, insulin omission, or intense exercise for weight control.Results: Logistic regression indicated that a model including BMI percentile, weight and shape concern, global and physical appearance-based self-worth, and depression was significantly associated with DEB onset (chi(2) = 46.0, 5 d.f., P < 0.0001) and accounted for 48.2% of the variance.Conclusions: Even though scores on the measures were within the published normal range, the onset of DEB was predicted by higher depression and weight and shape concerns and lower global and physical appearance-based self-worth as well as higher BMI percentile 1-2 years earlier compared with those not developing DEB. Early interventions focused on helping girls with diabetes develop positive feelings about themselves, their weight and shape, and their physical appearance may have protective value. [ABSTRACT FROM AUTHOR]

Eating disorders that meet DSM-IV criteria, especially bulimia nervosa and EDNOS are more than twice as common in adolescent girls with Type 1 Diabetes (DM) than in their nondiabetic peers. The prevalence of subthreshold eating disorders is especially high in this group and may be found in 14% of girls with DM. Insulin omission is a common weight loss behavior in girls with DM and eating disorders. Insulin omission and binge eating inevitably contribute to the increased rate of hyperglycemia and increased risk of long-term diabetes related medical complications, including retinopathy and nephropathy. The weight gain and dietary restrictions associated with diabetes treatment and the ready availability of insulin omission to promote weight loss are most likely responsible for this increased prevalence of eating disorders. A high index of suspicion for eating disorders is recommended in the diabetes clinic setting to enable early identification of disordered eating attitudes and behavior before they progress to clinical eating disorders. Clinic-based psychoeducational programs may be effective for prevention or early intervention. Severe eating disorders require more intensive intervention, tailored to address the DM context.