A review of eating disorders research in Mexico

The objective of this paper is to summarize research findings on eating disorders and the current state of the field in Mexico. Papers published in indexed journals and graduate dissertations were retrieved, using “eating disorders,” “anorexia nervosa,” “bulimia nervosa,” “body image,” “binge eating,” “restrained eating,” “weight and shape concern,” and “dieting” as keywords. These were combined with the Boolean operator “AND” with “Mexico” and “Latin America.” Findings are presented for epidemiology, the validity of assessment instruments, comorbidity, and risk factors. A national representative survey found a prevalence of 1.8% for bulimia nervosa, and no cases of anorexia nervosa. However, the lack of studies with confirmatory clinical interview and other national or regional representative samples makes it difficult to reach conclusions about the actual prevalence. A number of instruments for the detection of eating disorders and disordered eating have been validated for the Mexican population. The comorbidity of eating disorders in Mexico includes drug and alcohol abuse, obesity, and borderline personality disorder. Risk factors found included body weight and cultural pressure to be thin. Future lines of research should include epidemiological studies with representative samples and diagnosis confirmation, longitudinal studies, and the exploration of protective and risk factors specific to this population.     

Overweight or obesity management by therapists of the obesity and overweight think thank group (G.R.O.S.). Pilot study comparing its effects with standard nutritional management

IntroductionCurrently, international recommendations for obese and overweight people that explicitly target weight loss and are based on qualitative and/or quantitative nutritional counseling and increased physical activity do not appear to be effective in the long term. In contrast, intuitive eating seems to be an interesting alternative to dieting. The G.R.O.S., a French non-profit organization, offers tri-axial management that would enable overweight or obese individuals to acquire this flexible and adaptive behavior that consists of eating naturally according to one's physiological and emotional needs.ObjectiveAfter describing the three axes of management by G.R.O.S., a pilot study is presented to evaluate the efficacy of this management type in overweight or obese subjects compared to a standard diet (DIET).MethodThirty-five subjects were divided into two groups (G.R.O.S. and DIET), and their weight, body mass index, cognitive restraint scores, emotional eating, intuitive eating, and depressive symptomatology were measured at the beginning of the study and three months later.ResultsThis pilot study showed the positive effect of weight management, body mass index, intuitive eating, and emotional eating compared with standard dietary management, which only affects the depressive symptomatology.ConclusionsThe G.R.O.S. management style seems to be an interesting and effective alternative to slimming diets. However, this study presented a number of limitations, including the sample size, nonrandomization of subjects in groups, and non-standardization of care.     

Characteristics of Dieting and Nondieting Adolescents in a Psychiatric Inpatient Setting

  The clinical and psychosocial characteristics of 239 dieting and nondieting adolescents (61% female; mean age=15.3) recruited from an inpatient psychiatric setting were examined. Dieting adolescents were compared to nondieting adolescents on exercise frequency, weight control behaviors, risky behaviors, psychiatric comorbidity and distress, eating disorder symptomatology, smoking, coping, and family factors. While dieters did not statistically differ from nondieters on scores of body mass index, dieting youth reported greater levels of self-reported distress, poorer coping, greater eating disorder symptomatology, and were more likely to engage in extreme weight control behaviors. In addition, dieting was associated with higher rates of major depression (58% vs 34%) and eating disorders (14% vs 1%). Among adolescent smokers, dieters endorsed smoking as a weight control behavior. Engaging in risky behaviors or familial factors did not differentiate dieters from nondieters. Given the number of negative correlates associated with dieting in adolescents, identifying dieting and weight control behaviors in clinical settings may prove to be an effective strategy in the development of prevention and intervention efforts for youth.     

Problematic Obesity Thoughts: An Attempt to Identify Unsuccessful Dieters Prior to Treatment

Abstract

This paper describes a 21-item cognitive self-statement inventory (Problematic Obesity Thoughts, POT). Before entering a behavioral weight reduction program, the POT was completed by 34 subjects. For the 25 subjects available at the 1 year followup, attempts were made to classify the subjects as successful or unsuccessful dieters (based on the weight loss expressed as percent decrease in pretreatment BMI) using the scores on the POT inventory and four POT subscales. The inventory had a high internal consistency (α = .91). A logistic regression analysis of the total POT score identified 77% of the unsuccessful dieters, but two of the subscales, reflecting self-blame and overeating due to negative mood, respectively, were able to correctly identify 85% of the unsuccessful dieters. Conceivably, after further refinement and cross-validation, the POT might be a valuable part of a multifactorial screening and counceling tool for obesity treatment.     

Étude de validation de la version française de l’Échelle d’Estime Corporelle (Body Esteem Scale) chez les adolescentes et les jeunes adultes

IntroductionThe literature of body image suggests that many women and young women suffer from body dissatisfaction and this dissatisfaction is an important risk factor for the development of eating disorders.ObjectiveThe aim of the study was to validate the French female version of the Body Esteem Scale (BES; Mendelson et al., 2001).MethodThis self-administered questionnaire assesses body esteem and includes three subscales: “Weight”, “Appearance” and “Attribution”. The questionnaire was given to a sample of 835 adolescent girls and young adults (mean age = 16.62 ± 1.50).ResultsExploratory factorial analysis yielded three factors “Weight”, “Appearance” and “Desire to modify and negative affect associated with the general appearance”, somewhat similar to those of the original validation study. The goodness-of-fit of the three factors model was satisfactory. Correlations were found between the three subscales of the BES, BMI and general self-esteem.ConclusionThe French version of the BES shows satisfactory psychometric properties and provides a useful tool for better understanding the psychological aspects of attitudes towards one's body. In France, very few questionnaires are available to measure body attitudes, despite the fact that the body dissatisfaction affects many adolescent girls and represents a risk factor for the development of eating disorders.     

Development and preliminary validation of the body satisfaction scale (BSS)

Abstract

This paper describes the development of a simple paper-and-pencil test designed to measure satisfaction/dissatisfaction with 16 body parts. It is based on the body-cathexis scale of Secord and Jourard (1953) but takes only 2–3 minutes to complete. The factorial structure of the scale is described together with the three summative scales (“general,” “head parts” and “body parts” dissatisfaction) which are derived. The internal consistency of the scales was found to be acceptable. Significant positive correlations are also reported with the Body Shape Questionnaire (Cooper et al., 1987). The paper reports data for female comparison groups (college students, nursing students and female volunteers) and for samples of eating disorder patients and overweight subjects. The latter two groups report significantly higher body dissatisfaction than the comparison groups. Finally, it is argued that the scale is useful for work in health related fields and some current applications are briefly described.     

Prevalence and correlates of disordered eating in female figure skaters

ObjectivesThe purposes of this study were to (a) examine the prevalence of disordered eating among female figure skaters, (b) compare levels of disordered eating between skaters and their same-age peers, (c) compare levels of disordered eating between elite skaters and their sub-elite counterparts, and (d) examine general and sport-related correlates of disordered eating (i.e., four sport-related weight pressures, general and sport-related body dissatisfaction, positive and negative perfectionism, self-esteem, and athletic identity).DesignThis study employed a cross-sectional design.MethodsParticipants completed paper–pencil surveys, including measures for disordered eating, four sport-related weight pressures, general and sport-related body dissatisfaction, positive and negative perfectionism, self-esteem, and athletic identity. Participants included 272 female figure skaters ages 12–25 (M = 15.63) across five US states.ResultsThirteen percent of participants scored within range of problematic eating attitudes and behaviors but were no more symptomatic than their same-age peers when compared to existing normative data. Levels of disordered eating did not significantly differ between those competing at the elite and sub-elite level. After controlling for body mass index and age, disordered eating was significantly predicted by self-consciousness of weight and appearance, general and sport-related body dissatisfaction, and positive perfectionism.ConclusionsDisordered eating occurs in female figure skaters across competitive levels. Concern over weight and appearance, dissatisfaction with one's body in general and in sport, and positive perfectionism may serve as important tools in the prevention and detection of disordered eating in female figure skaters.     

Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial

BackgroundWomen reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.AimsTo adapt and evaluate the effects of the Internet-based prevention program “Student Bodies?” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies?+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies?” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.ResultsAt 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.ConclusionThe adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.     

Végétarisme,végétalisme,véganisme : des comportements (alimentaires) au service de l’identité ? Une étude qualitative en population française

IntroductionThese last years have been marked by an evolution as to how people feed themselves, highlighting a growing interest for vegetarian food. Vegetarianism at large refers to several types of food that are characterized by the partial or total exclusion of animal foods. This study aims at relating various elements associated to vegetarianism, such as eating motives, behaviors, self-perception and others’ perception, in relation with the notion of identity.MethodParticipants were recruited via vegetarian and vegan (for food and for lifestyle) groups on Facebook, once their agreement was obtained. Six interviews were conducted by a clinical psychologist around the notion of being and identity related to food, as well as the food history of the individual and his/her family. The use of retrospective investigation makes possible to establish a continuity between the past and the current eating behavior. These interviews, once manually transcribed, were the subject of a complex semantic analysis via TROPES software (version 8.4).ResultsThe results showed a major use of state's and identity's verbs (being, becoming, “I”) and the personal pronoun “we”, referring to a construction of both individual and collective identity around the diet. The commitment to vegetarian/vegan diet has been primarily motivated by ethical concern. And, positive feelings have emerged following the adoption of this type of diet, such as pride, inner purity and a sense of being healthy and holy. Despite the fact that their diet is ethically focused, participants spontaneously addressed the issue of weight and body image.Discussion/conclusionWhatever the food's history of participants, identifications to disorders related to body image or identifications to weight categories have preceded the identification to a specific diet. And the following of a vegetarian/vegan diet appears at the base of positive feelings toward oneself and a better self-esteem. So, we can assume that adopting a vegetarian/vegan diet could improve self-perception. Otherwise, the ethical choice mentioned by the participants, may be an acceptable sociable justification to control more or less the fate of their body (inside and outside). More research is needed to better understand the underlying mechanisms of vegetarian/vegan diet, to explore the personality profiles of individuals and their relation to the body.     

Thoughts about eating, weight and shape in anorexia nervosa and bulimia nervosa.

Concurrent verbalisation and a self-report questionnaire were used to investigate self-statements in patients with anorexia nervosa, patients with bulimia nervosa, two groups of dieters and non-dieting controls. Thoughts were collected while subjects performed three behavioural tasks, looking at themselves in a full-length mirror, weighing themselves and eating a chocolate covered mint. Both groups of patients had more negative thoughts related to eating, weight and shape than those in the three control groups. In addition, patients with anorexia nervosa showed a greater concern with eating while patients with bulimia nervosa showed a greater concern with weight and appearance. Differences were found between the patients and non-dieting controls using both methods but the self-report questionnaire was less sensitive than concurrent verbalisation to differences between the patients and dieters. Implications of the findings for cognitive-behavioural treatments of the two disorders are discussed.     

Protecting Women from the Negative Effects of Body Dissatisfaction: The Role of Differentiation of Self

ABSTRACT

Body dissatisfaction is a prevalent and concerning issue among college age women. Due to its strong association with eating pathology, identification of moderating variables is a crucial line of inquiry. The present study investigated the ability for an intrapersonal differentiation-of-self variable (“I” position) to attenuate the impact of body dissatisfaction on anorexia and bulimia symptoms among college women participants. Study findings indicated that an “I” position moderated the body dissatisfaction-bulimia relationship and the body dissatisfaction-anorexia relationship. These findings signified the protective influence of a high “I” position for women with high levels of body dissatisfaction. Research and therapeutic implications are discussed.     

Weight Loss Is Not the Answer: A Well‐being Solution to the “Obesity Problem”

Americans have been gaining weight in recent decades, prompting widespread concern about the health implications of this change. Governments, health practitioners, and the general public all want to know: What is the best way to reduce the health risks associated with higher body weight? The dominant weight‐loss solution to this “obesity problem” encourages individuals to lose weight through behavior change. This solution rests on the assumptions that higher body weight causes health problems, that permanent weight loss is attainable, and that weight loss improves health. But comprehensive reviews of the scientific evidence find mixed, weak, and sometimes contradictory evidence for these premises. We suggest that a different solution to the “obesity problem” is needed – a solution that acknowledges both the multifaceted nature of health and the complex interaction between person and situation that characterizes the connection between weight and health. Thus, we use the lens of social psychological science to propose an alternative, well‐being solution to the “obesity problem”. This solution has the potential to improve health by encouraging eating and exercising for optimal health rather than weight loss, by developing interventions to reduce weight stigma and discrimination, and by helping higher body‐weight people cope with the stress of stigma and discrimination.     

Identifying and preventing disordered eating among athletes: Perceptions of track and field coaches

ObjectiveThis study aimed to identify the strategies employed by coaches when identifying disordered eating (DE) among track and field athletes.DesignThis was a qualitative study and an inductive thematic analysis was conducted.MethodSemi structured interviews were conducted with eleven track and field coaches, with experience of coaching at national and international level. The interviews were recorded, transcribed verbatim and analysis was conducted.ResultsTrack and field coaches reported using physical, social and performance indicators to identify disordered eating in their athletes. Coaches also monitored their athletes' eating attitudes and behaviors. Weight loss (both observed and objectively monitored) was considered to be a key indicator of disordered eating. Coaches placed a high level of importance on weight for performance, and an “ideal” female athlete body. Previous experiences of detecting disordered eating and a close relationship with the athlete facilitated the identification of disordered eating. Athlete secrecy and masking behaviors, difficulties in communication and coaches' stereotypical beliefs were found to complicate the identification process.ConclusionsThis study highlights the need for additional information, advice and guidance for track and field coaches to improve their knowledge and confidence in identifying disordered eating among their athletes.     

Bulimia,dietary restraint,and concern for dieting

The concept of dietary restraint has recently been used to explain binge-eating in dieters. It has been proposed that the violation of various restraint rules typically leads to hinging in individuals exhibiting high dietary restraint. This study examined the role of dietary restraint in a clinical sample of bulimics. After eating a preload to break dietary restraint, bulimic binge-eaters (those who binge but do not purge) were found to eat significantly more than bulimics who binged and purged (bulimia nervosa) and significantly more than normals. In addition, purging bulimics were found to have more concern about dieting than binge-eaters, while normals were found to have less concern about dieting and less anxiety about eating than both bulimic groups. These data suggest that the psychopathology of bulimia nervosa and bulimia (binge-eating) may be substantially different. It was proposed that the most distinguishing characteristic may be the preoccupation with dieting, weight, and body size, which is more extreme in bulimia nervosa.     

A daily diary study of internalised weight bias and its psychological,eating and exercise correlates

Objective: The current investigation extends ecological momentary assessment (EMA) and daily diary weight stigma research in internalised weight bias (IWB). This investigation used daily diaries to examine the relationship between IWB, mood, coping, body appreciation, exercise behaviours and eating behaviours. Design: The study sample consisted of individuals who were overweight or obese (85% female) with M_BMI?=?36.0, SD_BMI?=?6.2. Participants completed a daily diary each evening and wore a Fitbit for 30 days. Main Outcome Measures: Participants reported on IWB, mood, coping, body appreciation, exercise behaviours and eating behaviours.

Results: Both within- and between-subjects IWB were significantly related to positive affect, negative affect, several coping responses, body appreciation, eating behaviours and the urge to avoid exercise. Exploratory analyses indicated that positive and negative affect mediated many of the associations between IWB and coping responses, body appreciation, and eating and exercise behaviours.

Conclusion: This investigation provides evidence that IWB experiences have daily impacts on psychological well-being, body appreciation, coping, eating and exercise behaviours. Also, this study raises awareness about IWB and its potential impact on psychological well-being and health behaviours.     

Siblings’ appearance-related commentary,body dissatisfaction,and risky eating behaviors in young women

IntroductionNegative feedback on appearance is a risk factor for the development of problems related to one's body image.ObjectiveThe present research aimed to analyze the relationship among siblings’ positive and negative appearance-related feedback, dissatisfaction with one's body and risky eating behaviors among young women. The mediational role of body-related social comparison has been investigated.MethodTwo hundred and eight young women living in Italy, with a mean age of 23.15 years, filled in a questionnaire containing the Italian version of the Verbal Commentary on Physical Appearance Scale – Siblings, the Physical Appearance Comparison Scale, the Body Shape Questionnaire-14, and the Eating Disorder Examination-Questionnaire.ResultsDissatisfaction with one's body shows a significant link with risky eating behaviors. Weight and shape-related positive comments made by siblings were significantly and negatively related to social comparison, which in turn was associated with women's dissatisfaction with their body image. Negative comments were directly linked to body dissatisfaction; the mediation role of social comparison with respect to negative comments was not confirmed.ConclusionsThese findings underline the significant role of siblings in the development of females’ body image. Programs aimed to prevent or reduce body dissatisfaction and risky eating behavior could be implemented; these programs should be concerned with not only negative feedback on appearance but also positive comments because of their relevant role.     

Dysmorphic concern and behavioural impairment related to body image in adolescents

This study examined a moderated mediation model testing whether dysmorphic concern is related to behaviour altered to change appearance. This relationship is potentially mediated by depressive symptomatology (dysphoria and self-esteem) and ideas of reference about “laughing, commenting” and “attention, appearance,” and each mediated relationship moderated by sex. The sample was made up of 3377 adolescents from 12 to 18 years old (M_age = 14.52; SD = 1.65, 56.5% girls). The results showed that dysphoria and ideas of reference about “laughing, commenting” and “attention, appearance” partially mediated the relationship between dysmorphic concern and behavioural impairment related to body image. The relationship with dysphoria was moderated by sex, such that the mediation effect was stronger in girls than in boys. This result implies that girls who are worried about some characteristic of their appearance and show dysphoria are at greater risk of altered behaviour involving avoidance or controlling their appearance than boys. In addition, a possible risk of body dysmorphic disorder (3.45% of the sample) was found, with very prominent hiding behaviour using clothing or control behaviours, such as frequent weighing and looking at oneself in the mirror too much. Implications of these findings are discussed.     

The moral career of the reformed compulsive eater: A study of conversion to charismatic conformity

This paper reports the findings of an intensive study of participants in a “self‐help” weight control group. The objective of the study was to investigate the development of deviant identity among the obese and the process by which the group of reformed deviants effected changes in the eating behavior of its members. Participant observation and interviews revealed successful members experience a radical conversion and that these converts to conformity (self‐controlled eating) shared common biographical characteristics, i.e., moral careers. Theoretical implications of such conversions from deviance to conformity are then discussed.     

A structural equation model of intuitive eating with adolescents

IntroductionThe tendency to eat by paying attention and respecting the body's hunger and satiety cues is called intuitive eating. This eating behavior has been linked to positive health and well-being outcomes.ObjectiveThe purpose of this study was to test a global model linking intuitive eating with self-esteem, body esteem, media influence and including fear of negative appearance evaluation in adolescents’ boys and girls.MethodIn total, 740 adolescent high school students (51.5% girls; M age = 14, SD = 1.5) completed self-report questionnaires with measures of intuitive eating, body esteem, self-esteem, media influence and fear of negative appearance evaluation.ResultsStructural equation modeling revealed an overall excellent fit for the final four-variable model excluding the fear of negative appearance evaluation variable. Mediation analyses showed an indirect relationship between intuitive eating and body esteem via media influence, for girls but not for boys. Body esteem mediated the relationship between intuitive eating and self-esteem, for girls and boys.ConclusionA new model is proposed where intuitive eating is associated with self-esteem through body esteem and media influence. These findings suggest that regulating attitudes and behaviors toward food may be related to higher psychological well-being.