The authors are grateful to the many individuals who worked on this project. We would like to ack... more The authors are grateful to the many individuals who worked on this project. We would like to acknowledge Dr. Adele Harrell at the Urban Institute who was instrumental in conducting the expert panel meetings and in developing data collection procedures. The authors would especially like to thank the following individuals, listed below in no particular order, for promoting the implementation of the study in their respective locations:
Purpose Eating disorder recovery is a poorly defined concept, with large variations among researc... more Purpose Eating disorder recovery is a poorly defined concept, with large variations among researchers' definitions. Weight maintenance is a key aspect of recovery that remains relatively underexplored in the literature. Understanding the role of weight maintenance may help guide the development of treatments. This paper aims to address this by (1) investigating the factors predicting long-term weight maintenance in anorexia nervosa (AN) patients; (2) exploring differences in predictive factors between adolescent and adult populations; and (3) exploring how weight maintenance is conceptualised in the literature. Methods: We conducted a systematic review following PRISMA guidelines to address our research questions. Five databases were searched and filtered according to our exclusion criteria. Results From the search, 1059 studies were yielded, and 13 studies were included for review. A range of weight, biological and psychological factors were found to predict weight maintenance among these papers. BMI at admission and discharge from inpatient treatment was the most common predictor among the papers. Few studies investigated biological factors and mixed evidence was found for psychological factors. We found no observable differences between adult and adolescent populations. Finally, weight maintenance was defined and measured differently across studies. Conclusion This review's findings can help contribute to a well-rounded understanding of weight maintenance, and ultimately, of recovery. This can help support clinicians in tailoring interventions to improve long-term outcomes in AN. Future research should aim to replicate studies to better understand the relationship between the factors identified and weight maintenance. Level I Systematic review.
Purpose The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspi... more Purpose The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspicion that a person might have an eating disorder. It is over 20 years since the creation of the SCOFF, during which time it has been widely used. Considering this, we wish to review the use of the SCOFF in peer-reviewed scientific journals, and to assess whether it is being used appropriately in the manner in which it was originally devised and tested. Methods The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were followed, and all search strategies and methods were determined before the onset of the study. PubMed and Wiley Online Library were searched using the terms SCOFF and eating. Two reviewers were involved in the reviewing process. Criteria for appropriate use of the SCOFF were formalised with the tool's original authors. Results 180 articles were included in the final review. 48 articles had used the SCOFF appropriately, 117 articles inappropriately and 15 articles had been mixed in the appropriateness of their use. Conclusion This systematic review highlights the inappropriate use of the SCOFF in diverse languages and settings. When used correctly the SCOFF has made a significant contribution to the understanding of eating disorders and its simplicity has been applauded and led to widespread use. However in over two-thirds of studies, the use of the SCOFF was inappropriate and the paper highlights how and in what way it was misused, Guidelines for the appropriate use of the SCOFF are stated. Future validation and avenues of research are suggested. Level of evidence Level I.
Twenty-four 16 to 17 year-old grammar school girls completed daily dietary histories (for eight w... more Twenty-four 16 to 17 year-old grammar school girls completed daily dietary histories (for eight weeks), and recorded details of mood, appetite and menstrual cycle. Marked daily variation in energy intakes was noted: on average an individual's highest daily intake was nearly four times her lowest intake, one subject having a nearly tenfold difference. Fluctuations were not related to mood, suggesting that this has less influence on dietary patterns than is generally supposed. While sitting examinations, energy intake was reduced by an average of 11.85%. It was not significantly changed during a field trip or by menstruation. This study suggests that dietary patterns previously considered to be abnormal or unusual are exhibited by and firmly entrenched in normal school girls.
The carpal bones of 18 anorexia nervosa patients were radiographed and the X-ray age assessed by ... more The carpal bones of 18 anorexia nervosa patients were radiographed and the X-ray age assessed by 2 different standard methods The study demonstrates that skeletal development in anorexia nervosa patients is delayed such that there is no association between radiological assessment of age and chronological age. It is strongly suggested that bony development actually ceases when body weight falls sufficiently to stop menstruation. There was a highly significant (P=0.001) linear relationship between radiological age and the sum of the age of onset of the illness plus any period(s) of re-feeding. Weight gain seems to rekindle the bone maturing mechanisms: the role of weight thresholds and associated hormone activity being discussed. The findings of this study strongly support the existing evidence that the anorexia nervosa patient is biologically and psychologically immature.
ABSTRACT The dexamethasone suppression test (DST) was investigated in 45 female anorectic out‐pat... more ABSTRACT The dexamethasone suppression test (DST) was investigated in 45 female anorectic out‐patients (cross sectional study) nine of whom were followed serially as in‐patients (longitudinal study). DST non‐suppression was strongly associated with negative energy balance (low body weight and low Ponderal Index) but there was no significant association with the presence of affective or neurotic disturbance in these patients. These findings cast doubt on the value of the DST in the management of depressive illness.
Journal of the institute of health education, 1978
Obesity is one of the health problems in the last century. The aim of this study is to compare mi... more Obesity is one of the health problems in the last century. The aim of this study is to compare mindfulness, body consciousness and stress in obese and normal-weight people. The population of the study included all obese people who visited diet and weight loss centers in Rasht city and normal-weight people. Two hundred individuals (100 obese and 100 normal-weight people) were selected using convenience sampling method. Research data was collected using mindfulness questionnaire by Baer, Smith & Allen (2004), body consciousness questionnaire by Miller et al (1981), and depression, anxiety, and stress questionnaire by Lovibond & Lovibond (1995), and was analyzed using independent t-test. The results revealed significant difference in mindfulness scores between two groups, that is, obese people have lower mindfulness and more stress than normal-weight people. However, no significant difference was observed between two groups in terms of body consciousness. Increase mindfulness and managing stress, as two influential factors on obese patients, can improve their physical and mental health, and reduce their weight.
Hyperinsulinaemia has a role in the development of hyperandrogenism and polycystic ovary syndrome... more Hyperinsulinaemia has a role in the development of hyperandrogenism and polycystic ovary syndrome in women of normal weight. Polycystic ovaries are common in women with bulimia nervosa and this study aimed to determine whether women with bulimia nervosa are insulin resistant and to examine the relation between insulin sensitivity and ovarian morphology. A short intravenous insulin tolerance test was used as a direct measure of insulin sensitivity in a group of women with bulimia nervosa and a control group. A series of 12 women with bulimia nervosa and normal weight was compared with a control group of 9 healthy women who had no clinical signs of eating disorder or hyperandrogenism and did not have polycystic ovaries. Bulimic behaviour was assessed using the BITE (Bulimia Investigation Test, Edinburgh) questionnaire and clinical interviews. Ovarian morphology was assessed using transabdominal ultrasonography. Insulin sensitivity and serum insulin, fasting glucose, LH, FSH, prolactin, testosterone, androstenedione and sex hormone binding globulin (SHBG) were measured and compared between the two groups. Ten of the 12 women with bulimia nervosa underwent ovarian ultrasound examination and they all had polycystic ovaries. There was no difference in serum LH, FSH, testosterone, androstenedione of SHBG concentrations between the women with bulimia nervosa and the non-bulimic control group. Fasting blood glucose concentrations were normal in all the women studied and did not differ between the women with bulimia nervosa and the control women. There was also no difference in fasting serum insulin or insulin sensitivity between the women with bulimia nervosa and the nonbulimic women. Bulimia nervosa is not associated with insulin resistance and chronic hyperinsulinaemia.
Background. There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-A... more Background. There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN. Method. Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 outpatient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6-and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes. Results. Thirty-one participants were randomized to CBT-AN and 32 to SSCM with a retention rate of 85% achieved at the end of the study. At EOT and follow-up, both groups showed significant improvement. There were no differences between treatment groups at EOT. At the 6-month follow-up, CBT-AN participants had higher scores on the Weissman Social Adjustment Scale (WSAS; p = 0.038) and at 12 months they had lower Eating Disorder Examination (EDE) global scores (p = 0.004) and higher readiness for recovery (p = 0.013) compared to SSCM. Conclusions. Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.
... A comparative study of menarchal age and weight of bulimic patients and their sisters. Profes... more ... A comparative study of menarchal age and weight of bulimic patients and their sisters. Professor J. Hubert Lacey MD, M.Phil., FRCPsych., Dip.Obs., RCOG. ... Correspondence: Professor J. HubertLacey MD, M.Phil., FRCPsych., Dip.Obs., RCOG, Division of General Psychiatry, St. ...
We examined changes in sexual drive during weight restoration in patients with anorexia nervosa. ... more We examined changes in sexual drive during weight restoration in patients with anorexia nervosa. Methods: Eleven women with anorexia nervosa prospectively completed the Sexual Daydreaming Questionnaire (SDQ) and the Hospital Anxiety and Depression Scale (HADS) at five time points during inpatient treatment involving weight restoration. SDQ and HADS scores were recorded every 4 weeks until 8 weeks after subjects had reached the mean matched population weight (MMPW), which was monitored against body mass index (BMI). Histories were taken for purging, self-cutting, childhood sexual abuse, and number of sexual partners. Repeatedmeasures analysis of variance, regression analyses, and t tests were performed. Results: BMI and sexual daydreaming were closely associated (p Ͻ .001). BMI and depression also achieved a statistically significant association (p ϭ .046), with "caseness" for anxiety disorder throughout. Higher levels of sexual drive at MMPW seemed to be associated with purging, self-cutting, and childhood sexual abuse but not at low weight. Levels of sexual drive did not reflect previous sexual behavior. Conclusions: An increase in sexual drive accompanies weight restoration in patients with anorexia nervosa, which is consistent with psychological and physiological explanations of altered sexuality. Transient depression is also associated with weight gain. Changes in sexuality should be considered in both recovery and treatment failure.
Drugs can sometimes be helpful within the overall treatment and management of anorexia nervosa. I... more Drugs can sometimes be helpful within the overall treatment and management of anorexia nervosa. In this study we have examined the impact of clomipramine on food and activity in anorectics engaged in a treatment programme enabling them to regain normal body weight. Consumption of the drug was associated with increased appetite, hunger and calorie consumption during the early stages of treatment. There was no impact on ultimate outcome. In this study it was evident that the drug was unnecessary for weight gain, but it may be helpful in other programmes, both short and long term, where the patient has sufficient trust (to tolerate the enhanced hunger experience) but is not involved in the same behavioural constraints. However, its possible value in such programmes has not been proven here. Meanwhile, we take our findings as further evidence that clomipramine increases drive behaviour and appetite in humans and may be beneficial in the treatment of affective disorders because of this e...
Body image perception was measured in 50 women with bulima nervosa and 19 age and weight matched ... more Body image perception was measured in 50 women with bulima nervosa and 19 age and weight matched female controls, using a visual size estimation apparatus. Both groups overestimated body widths, but not the width of a neutral object, and whilst there was a trend for bulimics to overestimate more than controls this did not reach significance. The part of the body most overestimated corresponded to the part most disliked in only a third of both groups. The bulimics without a previous history of anorexia nervosa overestimated body width more than those with such a history; this may be related to the fact that the former had a significantly greater weight index. Bulimics who were within 5% of mean-matched population weight overestimated body width less than the others, this difference reaching significance when compared with the heavier groups; a similar, but non-significant, trend was demonstrated in controls. This may be linked to a greater dissatisfaction with body size. Duration of ...
The authors are grateful to the many individuals who worked on this project. We would like to ack... more The authors are grateful to the many individuals who worked on this project. We would like to acknowledge Dr. Adele Harrell at the Urban Institute who was instrumental in conducting the expert panel meetings and in developing data collection procedures. The authors would especially like to thank the following individuals, listed below in no particular order, for promoting the implementation of the study in their respective locations:
Purpose Eating disorder recovery is a poorly defined concept, with large variations among researc... more Purpose Eating disorder recovery is a poorly defined concept, with large variations among researchers' definitions. Weight maintenance is a key aspect of recovery that remains relatively underexplored in the literature. Understanding the role of weight maintenance may help guide the development of treatments. This paper aims to address this by (1) investigating the factors predicting long-term weight maintenance in anorexia nervosa (AN) patients; (2) exploring differences in predictive factors between adolescent and adult populations; and (3) exploring how weight maintenance is conceptualised in the literature. Methods: We conducted a systematic review following PRISMA guidelines to address our research questions. Five databases were searched and filtered according to our exclusion criteria. Results From the search, 1059 studies were yielded, and 13 studies were included for review. A range of weight, biological and psychological factors were found to predict weight maintenance among these papers. BMI at admission and discharge from inpatient treatment was the most common predictor among the papers. Few studies investigated biological factors and mixed evidence was found for psychological factors. We found no observable differences between adult and adolescent populations. Finally, weight maintenance was defined and measured differently across studies. Conclusion This review's findings can help contribute to a well-rounded understanding of weight maintenance, and ultimately, of recovery. This can help support clinicians in tailoring interventions to improve long-term outcomes in AN. Future research should aim to replicate studies to better understand the relationship between the factors identified and weight maintenance. Level I Systematic review.
Purpose The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspi... more Purpose The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspicion that a person might have an eating disorder. It is over 20 years since the creation of the SCOFF, during which time it has been widely used. Considering this, we wish to review the use of the SCOFF in peer-reviewed scientific journals, and to assess whether it is being used appropriately in the manner in which it was originally devised and tested. Methods The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were followed, and all search strategies and methods were determined before the onset of the study. PubMed and Wiley Online Library were searched using the terms SCOFF and eating. Two reviewers were involved in the reviewing process. Criteria for appropriate use of the SCOFF were formalised with the tool's original authors. Results 180 articles were included in the final review. 48 articles had used the SCOFF appropriately, 117 articles inappropriately and 15 articles had been mixed in the appropriateness of their use. Conclusion This systematic review highlights the inappropriate use of the SCOFF in diverse languages and settings. When used correctly the SCOFF has made a significant contribution to the understanding of eating disorders and its simplicity has been applauded and led to widespread use. However in over two-thirds of studies, the use of the SCOFF was inappropriate and the paper highlights how and in what way it was misused, Guidelines for the appropriate use of the SCOFF are stated. Future validation and avenues of research are suggested. Level of evidence Level I.
Twenty-four 16 to 17 year-old grammar school girls completed daily dietary histories (for eight w... more Twenty-four 16 to 17 year-old grammar school girls completed daily dietary histories (for eight weeks), and recorded details of mood, appetite and menstrual cycle. Marked daily variation in energy intakes was noted: on average an individual's highest daily intake was nearly four times her lowest intake, one subject having a nearly tenfold difference. Fluctuations were not related to mood, suggesting that this has less influence on dietary patterns than is generally supposed. While sitting examinations, energy intake was reduced by an average of 11.85%. It was not significantly changed during a field trip or by menstruation. This study suggests that dietary patterns previously considered to be abnormal or unusual are exhibited by and firmly entrenched in normal school girls.
The carpal bones of 18 anorexia nervosa patients were radiographed and the X-ray age assessed by ... more The carpal bones of 18 anorexia nervosa patients were radiographed and the X-ray age assessed by 2 different standard methods The study demonstrates that skeletal development in anorexia nervosa patients is delayed such that there is no association between radiological assessment of age and chronological age. It is strongly suggested that bony development actually ceases when body weight falls sufficiently to stop menstruation. There was a highly significant (P=0.001) linear relationship between radiological age and the sum of the age of onset of the illness plus any period(s) of re-feeding. Weight gain seems to rekindle the bone maturing mechanisms: the role of weight thresholds and associated hormone activity being discussed. The findings of this study strongly support the existing evidence that the anorexia nervosa patient is biologically and psychologically immature.
ABSTRACT The dexamethasone suppression test (DST) was investigated in 45 female anorectic out‐pat... more ABSTRACT The dexamethasone suppression test (DST) was investigated in 45 female anorectic out‐patients (cross sectional study) nine of whom were followed serially as in‐patients (longitudinal study). DST non‐suppression was strongly associated with negative energy balance (low body weight and low Ponderal Index) but there was no significant association with the presence of affective or neurotic disturbance in these patients. These findings cast doubt on the value of the DST in the management of depressive illness.
Journal of the institute of health education, 1978
Obesity is one of the health problems in the last century. The aim of this study is to compare mi... more Obesity is one of the health problems in the last century. The aim of this study is to compare mindfulness, body consciousness and stress in obese and normal-weight people. The population of the study included all obese people who visited diet and weight loss centers in Rasht city and normal-weight people. Two hundred individuals (100 obese and 100 normal-weight people) were selected using convenience sampling method. Research data was collected using mindfulness questionnaire by Baer, Smith & Allen (2004), body consciousness questionnaire by Miller et al (1981), and depression, anxiety, and stress questionnaire by Lovibond & Lovibond (1995), and was analyzed using independent t-test. The results revealed significant difference in mindfulness scores between two groups, that is, obese people have lower mindfulness and more stress than normal-weight people. However, no significant difference was observed between two groups in terms of body consciousness. Increase mindfulness and managing stress, as two influential factors on obese patients, can improve their physical and mental health, and reduce their weight.
Hyperinsulinaemia has a role in the development of hyperandrogenism and polycystic ovary syndrome... more Hyperinsulinaemia has a role in the development of hyperandrogenism and polycystic ovary syndrome in women of normal weight. Polycystic ovaries are common in women with bulimia nervosa and this study aimed to determine whether women with bulimia nervosa are insulin resistant and to examine the relation between insulin sensitivity and ovarian morphology. A short intravenous insulin tolerance test was used as a direct measure of insulin sensitivity in a group of women with bulimia nervosa and a control group. A series of 12 women with bulimia nervosa and normal weight was compared with a control group of 9 healthy women who had no clinical signs of eating disorder or hyperandrogenism and did not have polycystic ovaries. Bulimic behaviour was assessed using the BITE (Bulimia Investigation Test, Edinburgh) questionnaire and clinical interviews. Ovarian morphology was assessed using transabdominal ultrasonography. Insulin sensitivity and serum insulin, fasting glucose, LH, FSH, prolactin, testosterone, androstenedione and sex hormone binding globulin (SHBG) were measured and compared between the two groups. Ten of the 12 women with bulimia nervosa underwent ovarian ultrasound examination and they all had polycystic ovaries. There was no difference in serum LH, FSH, testosterone, androstenedione of SHBG concentrations between the women with bulimia nervosa and the non-bulimic control group. Fasting blood glucose concentrations were normal in all the women studied and did not differ between the women with bulimia nervosa and the control women. There was also no difference in fasting serum insulin or insulin sensitivity between the women with bulimia nervosa and the nonbulimic women. Bulimia nervosa is not associated with insulin resistance and chronic hyperinsulinaemia.
Background. There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-A... more Background. There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN. Method. Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 outpatient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6-and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes. Results. Thirty-one participants were randomized to CBT-AN and 32 to SSCM with a retention rate of 85% achieved at the end of the study. At EOT and follow-up, both groups showed significant improvement. There were no differences between treatment groups at EOT. At the 6-month follow-up, CBT-AN participants had higher scores on the Weissman Social Adjustment Scale (WSAS; p = 0.038) and at 12 months they had lower Eating Disorder Examination (EDE) global scores (p = 0.004) and higher readiness for recovery (p = 0.013) compared to SSCM. Conclusions. Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.
... A comparative study of menarchal age and weight of bulimic patients and their sisters. Profes... more ... A comparative study of menarchal age and weight of bulimic patients and their sisters. Professor J. Hubert Lacey MD, M.Phil., FRCPsych., Dip.Obs., RCOG. ... Correspondence: Professor J. HubertLacey MD, M.Phil., FRCPsych., Dip.Obs., RCOG, Division of General Psychiatry, St. ...
We examined changes in sexual drive during weight restoration in patients with anorexia nervosa. ... more We examined changes in sexual drive during weight restoration in patients with anorexia nervosa. Methods: Eleven women with anorexia nervosa prospectively completed the Sexual Daydreaming Questionnaire (SDQ) and the Hospital Anxiety and Depression Scale (HADS) at five time points during inpatient treatment involving weight restoration. SDQ and HADS scores were recorded every 4 weeks until 8 weeks after subjects had reached the mean matched population weight (MMPW), which was monitored against body mass index (BMI). Histories were taken for purging, self-cutting, childhood sexual abuse, and number of sexual partners. Repeatedmeasures analysis of variance, regression analyses, and t tests were performed. Results: BMI and sexual daydreaming were closely associated (p Ͻ .001). BMI and depression also achieved a statistically significant association (p ϭ .046), with "caseness" for anxiety disorder throughout. Higher levels of sexual drive at MMPW seemed to be associated with purging, self-cutting, and childhood sexual abuse but not at low weight. Levels of sexual drive did not reflect previous sexual behavior. Conclusions: An increase in sexual drive accompanies weight restoration in patients with anorexia nervosa, which is consistent with psychological and physiological explanations of altered sexuality. Transient depression is also associated with weight gain. Changes in sexuality should be considered in both recovery and treatment failure.
Drugs can sometimes be helpful within the overall treatment and management of anorexia nervosa. I... more Drugs can sometimes be helpful within the overall treatment and management of anorexia nervosa. In this study we have examined the impact of clomipramine on food and activity in anorectics engaged in a treatment programme enabling them to regain normal body weight. Consumption of the drug was associated with increased appetite, hunger and calorie consumption during the early stages of treatment. There was no impact on ultimate outcome. In this study it was evident that the drug was unnecessary for weight gain, but it may be helpful in other programmes, both short and long term, where the patient has sufficient trust (to tolerate the enhanced hunger experience) but is not involved in the same behavioural constraints. However, its possible value in such programmes has not been proven here. Meanwhile, we take our findings as further evidence that clomipramine increases drive behaviour and appetite in humans and may be beneficial in the treatment of affective disorders because of this e...
Body image perception was measured in 50 women with bulima nervosa and 19 age and weight matched ... more Body image perception was measured in 50 women with bulima nervosa and 19 age and weight matched female controls, using a visual size estimation apparatus. Both groups overestimated body widths, but not the width of a neutral object, and whilst there was a trend for bulimics to overestimate more than controls this did not reach significance. The part of the body most overestimated corresponded to the part most disliked in only a third of both groups. The bulimics without a previous history of anorexia nervosa overestimated body width more than those with such a history; this may be related to the fact that the former had a significantly greater weight index. Bulimics who were within 5% of mean-matched population weight overestimated body width less than the others, this difference reaching significance when compared with the heavier groups; a similar, but non-significant, trend was demonstrated in controls. This may be linked to a greater dissatisfaction with body size. Duration of ...
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