OBJECTIVE:This study examined differences in mental health and well-being, risk behaviors, suicidality, and social functioning across a proposed eating disorder (ED) spectrum, ranging from no ED symptoms to clinically diagnosed EDs. METHODS:We examined 44,303 participants in the 18-year follow-up in the Danish National Birth Cohort (DNBC-18) with cross-sectional data on self-reported ED symptoms and indicators of mental health and well-being. National register data was linked to identify hospital-diagnosed EDs. The ED spectrum comprised mutually exclusive categories ranging from no symptoms, through disordered eating behaviors (DEBs) and self-reported diagnosis-like subthreshold and threshold ED symptoms to diagnosed EDs. We compared sex-specific weighted proportions and 95% confidence intervals (CIs) of impaired mental health and well-being by spectrum category. RESULTS:Among 25,974 females and 18,329 males, 73.3% and 80.3%, respectively, had no ED symptoms, while 12.7% of females and 1.5% of males had at least subthreshold ED symptoms, with milder DEBs constituting the largest proportion of the ED spectrum, particularly in males. Diagnosed EDs showed the highest co-occurrence of other psychiatric disorders, self-injury, and suicidality, whereas threshold ED symptoms were associated with the poorest mental health across most self-reported measures and, among females, several risk behaviors. Compared with no ED symptoms, females across the ED spectrum showed higher co-occurrence of impaired mental health and well-being. In males, differences were small, but omitting muscle dysmorphia showed substantially poorer mental health among males with other DEBs. CONCLUSIONS:Poor mental health and well-being co-occurred across the full ED spectrum, particularly in females, with substantial difficulties in both diagnosed EDs and those with threshold ED symptoms.
Avoidant/restrictive food intake disorder is marked by patterned undereating that is driven by sensory sensitivity, fear of aversive consequences, and/or a lack of interest in eating or food. We, among others, hypothesized that aberrant neurobiological processes underlie and maintain these eating patterns. Over the last decade, research testing the neurobiological mechanisms of ARFID has begun, and emerging data suggest that eating behavior in ARFID may be a problem related to anticipation of eating, rather than the experience of actual food consumption, highlighting the potential therapeutic value of exposure therapy. In this narrative review, we summarize the nascent literature on the neurobiology and treatment of ARFID with focus on key questions and research directions to help advance knowledge of this condition.
OBJECTIVE:For multiple disorders, DSM-5-TR criteria include "recurrent" engagement in behaviors-for example, in the criteria for binge-eating disorder (BED), "binge eating is not associated with the recurrent use of inappropriate compensatory behavior."-without operationalizing how frequently a behavior needs to occur to be considered "recurrent." This lack of specificity may be particularly problematic in diagnosing BED; BED shares features with bulimia nervosa (BN) but is differentiated based on lack of "recurrent" ICB engagement. Some treatments (e.g., behavioral weight loss) may be recommended for BED but are contraindicated for BN, making accurate diagnosis critical. We sought to determine what frequency of past-month inappropriate compensatory behaviors (ICBs) best distinguishes BED from BN. METHOD:850 treatment-seeking adolescents and adults (76% female, Mage = 29) completed eating disorder and comorbid symptom questionnaires at program admission from 2020 to 2024. Structural Equation Modeling (SEM) Trees derived which ICB frequencies best distinguished diagnoses. RESULTS:SEM Tree analyses yielded four subgroups: past-month ICB frequency 0 (ICB0; n = 349); frequency 1-25 (ICB1; n = 307); frequency 26-55 (ICB2; n = 143); and frequency > 56 (ICB3; n = 51). ICB0 differed from higher frequency groups on 11/12 clinical characteristics, ICB1 differed from higher frequency groups on 11/12 characteristics, and ICB2 differed from ICB3 on 1/12 characteristics. DISCUSSION:Findings suggest one past-month ICB may appropriately distinguish between BED and BN, though it remains unclear how fasting may impact this categorization. While more research is needed, DSM's diagnostic criteria may require revision to specify that the presence of any past-month vomiting, laxative use, or maladaptive exercise should preclude a BED diagnosis.
OBJECTIVE:Eating disorders (EDs) have long been viewed as disorders affecting higher socioeconomic groups, yet recent evidence shows they occur across all backgrounds. This systematic review and meta-analysis aims to evaluate the relationship between parental socioeconomic status (SES) and ED symptoms in adolescents in the general population. As a secondary aim, we will study how parental SES is measured in community-based studies and identify which SES indicators are most relevant for understanding adolescent ED risk. METHOD:A PRISMA search was carried out via Web of Science, Scopus, MEDLINE, Embase, PsycINFO, and ProQuest to identify quantitative studies examining the relationship between parental SES and adolescent ED symptoms in Western countries. The search produced 56,653 records, and 51 articles published from January 2000 onwards met inclusion criteria. RESULTS:Parental education was the most used SES measure across the included studies (> 50%). Our meta-analysis revealed a significantly lower likelihood of ED symptoms in adolescents of parents with higher educational backgrounds (OR = 0.83, 95% CI: 0.72-0.95, p = 0.007). Household income was generally negatively associated with ED symptoms in adolescents, particularly with binge eating behaviors. Findings related to SES indexes and other proxies were inconsistent. DISCUSSION:Adolescents from lower education and lower income households are more likely to present with ED symptoms. Findings highlight the influence of socioeconomic disadvantage on ED presentations, underscoring the need for targeted prevention and intervention efforts that address socioeconomic disparities. Future research should incorporate multidimensional SES measures to better capture the complex nature of socioeconomic disadvantage.
OBJECTIVE:Psychotherapy is the first-line treatment for eating disorders (EDs), yet only about half of patients benefit long-term. Bulimia nervosa (BN), Binge-Eating-Disorder (BED), and non-underweight EDs with regular binge eating (> 2 binge-eating episodes per month within the last 3 months) (OSFED/UFED) form a transdiagnostic group characterized by elevated impulsivity. Inhibitory control training (ICT) approaches targeting impulsivity may be relevant. However, the role of feedback within ICT remains insufficiently understood. METHOD:MIND BINGES is a prospective randomized controlled proof-of-principle trial including 67 patients with regular binge-eating behavior. ICT was a food-modified antisaccade paradigm and comprised six sessions over 2 weeks. Patients were randomized to one of three conditions: (a) ICT with task performance feedback (TF), (b) ICT without feedback (TNF), or (c) control group without ICT. The primary outcome was the reduction of binge-eating frequency 4 and 12 weeks after ICT. Secondary outcomes included ED psychopathology, inhibitory control performance, impulsivity, and self-efficacy. RESULTS:All three groups reduced binge-eating frequency 4 and 12 weeks after ICT compared to the baseline. Four weeks after ICT, TF resulted in significantly greater reductions in binge-eating episodes compared to TNF and CG. These differences washed out after 12 weeks. Across secondary outcomes, all groups improved over time. DISCUSSION:Feedback contributes to short term reductions in binge-eating behavior and may inform development of mechanism-based interventions for ED. Further, reductions of the control group in binge-eating episodes imply unspecific effects of study participation and demand further investigation of low-threshold interventions. TRIAL REGISTRATION:DRKS00033023.
OBJECTIVE:This study examines the factor structure, measurement invariance, and discriminative ability of the Eating Disorder-15 (ED-15) questionnaire in a large transdiagnostic clinical population of treatment-seeking adults. METHOD:The sample consisted of 2015 participants aged 17-79 (Mage = 30.73 years; 77.0% women; 71.1% in Australia) seeking mental health treatment across different settings of routine clinical practice. After initial completion of the ED-15, subsamples completed additional measures within ±365 days of the initial ED-15 and/or repeated the ED-15 at least 7 days later. RESULTS:Confirmatory factor analysis supported both the hypothesized two-factor and a bi-factor model (with a general factor), with the two-factor model retained as the preferred structure, consistent with theory and prior research. The ED-15 also demonstrated strong internal consistency and test-retest reliability. In subsamples, there was preliminary evidence of measurement invariance across gender, time, country, and to a lesser extent age group. Correlations supported good concurrent validity with eating disorder pathology and eating-related impairment, while convergent validity was mixed, with moderate associations with psychological distress and maladaptive perfectionism, but weak or negligible associations with personal standards perfectionism and autism-related traits. Receiver operating characteristic analyses deriving an optimal diagnostic cut-off indicated good discriminative validity, with the ED-15 discriminating probable eating disorder caseness. DISCUSSION:Findings add to the growing evidence on the ED-15's latent structure and provide preliminary support for measurement invariance, supporting its use as a brief, psychometrically sound tool in routine clinical practice. Future research should evaluate its intended use for session-by-session monitoring of eating disorder symptom change.
OBJECTIVE:Patients with eating disorders (EDs) are often ill for many years before receiving treatment, a problem that may be addressed in part via improved screening. Given high rates of comorbidity with nearly all other psychiatric conditions, screening all patients in outpatient mental health settings provides an opportunity for detection and intervention. A very brief (i.e., 1-2 item) screener may be useful for determining who would benefit from additional query. METHOD:A chart review was conducted to explore the utility of two ED screening items that were administered alongside SCOFF items as part of routine clinical care. RESULTS:Over a quarter (26.3%) of patients reported either eating or body image problems at a level of at least "Moderate/more than half" of days; 42.9% reported these problems at a level of at least "Mild/Some of the days"; 14.2% had a SCOFF score ≥ 2. Equal proportions of men and women were captured by both screeners. Utilizing "Mild/Some of the days" as a cutoff, over 90% of individuals with a SCOFF score ≥ 2 were captured by the 2-item screener. DISCUSSION:Outpatients receiving mental health treatment report high rates of concerns with eating and body shape/weight. It may be possible to identify individuals in need of additional assessment via a very brief screener querying eating concerns and preoccupation with body shape/weight. Additional testing across settings, with more diverse individuals, comparison with a validated ED diagnostic assessment, and addressing other aspects of the screening process (i.e., next steps for positive screens), are critical for developing an effective screening procedure for outpatient mental health.
OBJECTIVE:This study examined the role of autistic traits in patients with anorexia nervosa receiving an intensive, focused form of enhanced cognitive behavior therapy (CBT-E). The aim was to assess changes in these traits during treatment and their predictive value for outcomes. METHOD:In this prospective cohort study, 81 patients aged 16-65 years were admitted for intensive CBT-E. Body mass index (BMI), eating disorder psychopathology, general psychopathology, and functional impairment were assessed at baseline, end of intensive treatment (EOIT), and 20-week follow-up. Autistic traits were evaluated using the Autism Spectrum Quotient (AQ) at baseline and EOIT. RESULTS:Sixty-nine patients (85.2%) completed treatment, and 59 among completers (85.5%) attended follow-up. AQ scores decreased significantly from baseline to EOIT, although the magnitude of the change was small. The AQ global score did not predict dropout. In both intention-to-treat and completers' analyses, the AQ global score measured at baseline and at EOIT did not predict eating disorder psychopathology and BMI at EOIT and at follow-up, respectively. CONCLUSIONS:In this prospective cohort study, AQ scores decreased significantly over the course of intensive CBT-E, and autistic traits did not predict treatment outcomes. These findings suggest that intensive CBT-E produces significant improvements across the main clinical outcomes of anorexia nervosa without requiring systematic adaptations for autistic traits.
OBJECTIVE:Restrictive eating disorders are characterized by abnormalities in both HRV and interoception, yet the extent to which transient physiological changes are related to interoceptive sensibility in this population remains unclear. The present study examines the association between HRV and interoceptive sensibility among individuals with anorexia nervosa and atypical anorexia (i.e., Anorexia Nervosa Spectrum Disorders) in real-time using a combination of biosensor and ecological momentary assessment data. METHOD:Seventy-five adults with Anorexia Nervosa Spectrum Disorders and current or lifetime suicidality completed 21 days of ecological momentary assessment while wearing a sensor band that passively collected HRV data. Multilevel models examined the association between HRV and interoceptive sensibility at the within- and between-person levels. RESULTS:HRV was positively associated with interoceptive sensibility at the between-person level, such that individuals with higher HRV demonstrated greater interoceptive sensibility. However, temporary changes in HRV (i.e., deviations from one's average) were not associated with corresponding changes in interoceptive sensibility. DISCUSSION:Within Anorexia Nervosa Spectrum Disorders with co-occurring suicidality, alterations in autonomic function are accompanied by differences in interoceptive sensibility at the trait, but not state, level. Both heightened HRV and irregularities in interoceptive sensibility may arise as a consequence of prolonged caloric restriction. Physiological processes distinct from HRV may be responsible for driving momentary fluctuations in interoceptive sensibility in this population. Further research is needed to continue parsing potential differences in physiological processes across specific diagnoses and illness stage.
OBJECTIVE:Eating disorders (EDs) are complex conditions with medical and psychosocial implications. Social media (SM) exposure has been associated with increased body image concerns and maladaptive eating behaviors. Pro-eating disorder (pro-ED) communities exist across SM platforms and often perpetuate ED-related identities and behaviors. As Ozempic gains prominence as a weight-loss medication, online discourse surrounding its use has grown considerably. This study aims to characterize attitudes and perspectives toward Ozempic within the pro-ED community on X. METHOD:Using netnography, publicly available tweets containing the terms "Ozempic" and "edtwt" posted between August 2024 and July 2025 were retrieved. Content analysis was conducted by two independent reviewers using an iterative, consensus-based approach to analyze naturally occurring online discourse without direct user engagement. RESULTS:The initial search yielded 451 tweets; after applying exclusion criteria, 255 were included in the analysis. Three main categories were identified: personal narrative, information sharing and risk warning, and attitudes and perceptions. Personal narratives reflected curiosity and information seeking (19.2%), desire or intent to use (11.8%), access (9.0%), and active use or experimentation (11.4%). Information sharing and risk warnings accounted for 3.5% of posts. Attitudes and perceptions included ethical and moral judgments (8.2%), normalization and cultural saturation (28.6%), and rejection and critique (8.2%). DISCUSSION:The findings demonstrate that Ozempic is actively integrated within pro-ED discourse on X, where discussions often normalize its use for weight loss and express sustained interest in its use. This highlights the need for greater awareness of how these medications are circulated within vulnerable online communities.
OBJECTIVE:This study aimed to evaluate the feasibility of implementing 10-session group cognitive behavioural therapy (CBT-Tg) in routine outpatient eating disorder care and to descriptively examine outcomes of CBT-Tg and individual CBT-T (CBT-Ti). METHOD:Using a naturalistic, non-randomised, mixed-methods design, this implementation study was conducted in a publicly funded outpatient eating disorder service. Adults eligible for outpatient eating disorder services selected CBT-Tg or CBT-Ti following intake. Feasibility outcomes included acceptability (treatment satisfaction, qualitative interviews, dropout), demand (uptake over time) and practicality (estimated clinician time). Effectiveness outcomes included eating-disorder psychopathology, measured by the eating disorder examination questionnaire (EDE-Q), and secondary outcomes assessing eating disorder symptoms, impairment and mood/anxiety during treatment and follow-up. RESULTS:Of 157 referred patients, 116 consented and initiated treatment. Satisfaction was high in both formats. Premature termination from CBT-Tg was 44.7%. Demand supported offering CBT-Tg in 8 of 9 three-month intervals. Estimated clinician time per enrolled patient was 4.3-5.7 h for CBT-Tg versus 8.0 h for CBT-Ti. EDE-Q global scores improved with very large within-group effects at end of therapy and were maintained through 6-month follow-up in both formats (CBT-Tg: g = -1.57 at end of therapy; g = -1.63 at follow-up; CBT-Ti: g = -1.97; g = -2.14). DISCUSSION:CBT-Tg appears feasible and acceptable in real-world outpatient care, with large and sustained improvements in eating disorder psychopathology and potential efficiency advantages relative to individual delivery. Findings support further evaluation in comparative and cost-effectiveness studies.
OBJECTIVE:The role of the therapeutic alliance (TA) in treatment outcomes of anorexia nervosa (AN) appears to be less substantial than in other disorders. However, the therapeutic process is a complex trajectory with many variables influencing each other. Hence, investigating motivation to change in the bidirectional interplay between TA and outcome among patients with AN may enhance the understanding of these processes. METHOD:In an exploratory analysis of longitudinal data from 173 inpatients with AN assessed at four time points in a specialized in-patient clinic, the interplay of TA and its subscales with motivation was investigated using cross-lagged panel models. Additionally, motivation was tested as a possible moderator and mediator of previously examined relationships between outcome and TA. RESULTS:Autoregressive paths of TA and motivation were highly stable over the course of treatment, while residual covariances varied. Motivation showed moderate but significant cross-lagged effects on subsequent TA, while TA had no effect on subsequent motivation. These associations were observed only when motivation was assessed with an exploratory measure of motivation. No mediation and moderation effect of motivation on relationships between TA and outcome was found. DISCUSSION:Cross-lagged analyses suggested that motivation preceded subsequent levels of TA, whereas TA did not predict subsequent motivation. Given the exploratory nature of the study, these findings should be considered hypothesis-generating and require replication. Future research using more fine-grained methodologies may help to further elucidate the longitudinal interplay between motivation and TA in patients with AN.
OBJECTIVE:Leptin and thyroid hormones are interrelated regulators of energy homeostasis that are altered during starvation, yet their within-subject trajectories during early nutritional rehabilitation in severe restrictive eating disorders (EDs) remain poorly understood. This study examined how leptin and thyroid hormones change with initial weight gain in severely malnourished inpatients with an ED. METHOD:Data from 62 adult inpatients admitted to a specialized medical unit were analyzed. Blood samples measuring leptin, triiodothyronine (T3), thyroxine (T4), and reverse T3 (RT3) were obtained at admission, each 1.5 kg/m2 increase in BMI, and discharge. Receiver operating characteristic (ROC) curves identified optimal BMI thresholds for clinically abnormal hormone levels, and multilevel models examined hormonal trajectories over BMI change. RESULTS:At admission, leptin was undetectable in 74.2% of patients, T3 was low in 96.8% of patients, T4 was normal in all patients, and RT3 was low-to-normal in most patients. By discharge, most patients still remained underweight. Leptin remained undetectable in 24.2% of patients, and T3 normalized in only 22.6%. No BMI thresholds were clinically significant for identifying abnormal lab levels. Leptin increased linearly with BMI gain, while thyroid hormones demonstrated a biphasic pattern: T3 rose exponentially before plateauing, while T4 and RT3 declined sharply before rebounding, all around +2.0 kg/m2. CONCLUSIONS:T4 and RT3 did not demonstrate expected trajectories for severe malnutrition, while T3 and leptin trajectories were proportional to weight gain but incomplete. Additional follow-up through complete weight restoration is needed to fully understand the interrelation of these hormones, and how and when they normalize.
OBJECTIVE:Prolonged waiting times for eating disorder treatment are common in Australian public services and are associated with high attrition. Qualitative evidence suggests waiting may worsen symptoms and treatment credibility and expectancy beliefs; however, quantitative evidence is limited. METHOD:This study examined whether waitlist duration was associated with eating disorder symptom severity, psychological distress, interpersonal problems, treatment beliefs, or treatment completion at a specialist outpatient service. Data from 168 clients (98% female; Mage 25 years) were analyzed. RESULTS:Mean waitlist duration was 132 days (SD = 73.4). Waitlist duration was not significantly associated with symptom severity, depression, anxiety, stress, interpersonal problems, treatment credibility, or expectancy, or treatment completion (all ρs ≤ 0.11, p > 0.05). DISCUSSION:Regardless of wait time, clients presented with substantial symptom severity and elevated distress at intake. Although longer waits were not associated with outcomes among those who reached intake, prolonged delays in the context of significant clinical need highlight the importance of rapid treatment responsiveness and closer attention to engagement and attrition processes.
OBJECTIVES:There is an increasing trend towards embedding consumer and community involvement in all health and medical research. The Executive Committee of the International Journal of Eating Disorders (IJED) disseminated a survey for eating disorder researchers investigating their practices and perspectives regarding Patient and Public Involvement (PPI) in research, with the goal of informing our procedures in future. METHOD:A survey was distributed globally via eating disorder organizations, professional networks, and individual researchers. Researchers (N = 119) of various career stages completed the survey. RESULTS:Three quarters of the researchers had consulted people with lived experience to inform their research; 45% said that they employed lived experience and/or peer researchers across all stages of their research, and 75% viewed PPI as improving the quality, relevance, feasibility, adoption, or implementation of research. Concerns were expressed about the challenges associated with PPI, including cost, time, expertise, disclosure of lived experience status, the need to maintain robust scientific principles, concern about the validity of results, and potential harm to the person with lived experience. Most did not want disclosure of PPI to be mandatory or to impact the review process. CONCLUSION:These insights informed the development of an approach to recognizing the involvement of PPI in our publishing. Rather than an obligatory statement, IJED encourages use of PPI and disclosures, with inclusion of a description and implications for the interpretation of the research detailed in manuscripts.
OBJECTIVE:Since the publication of our earlier systematic review (Walsh et al.), a substantial number of additional studies have examined the psychological and physical characteristics of atypical anorexia nervosa (AN) compared with AN and/or healthy controls. The purpose of the current study was to update and expand the prior systematic review and meta-analysis using newly available data. METHOD:A systematic review was conducted in accordance with PRISMA guidelines, including studies from the original review as well as studies published after July 17, 2022 (the final search date of the original review). Eligible studies compared clinical characteristics of individuals with atypical AN to those with AN and/or healthy controls. Meta-analyses were performed when at least three studies reported comparable outcome measures. RESULTS:Sixty-four publications met criteria for inclusion. Overall, findings indicate that individuals with atypical AN differ demographically from those with AN and demonstrate greater levels of eating disorder-related psychopathology. Non-eating disorder psychopathology is comparable between groups. Individuals with atypical AN experience many of the physiological complications associated with AN, notably menstrual disturbance and decreased bone mineral density, but less frequently. DISCUSSION:This updated review confirms and extends findings from the original review, demonstrating that individuals with atypical AN experience substantial psychological distress at levels comparable to those of individuals with AN and similar but less frequent physiological disturbances. These findings continue to support the similarities between atypical AN and AN in clinical and research settings, but underscore the need for specific diagnostic criteria for atypical AN and longitudinal studies to clarify illness course and outcomes.
AIMS:This research aims to explore the extent of socioeconomic inequities in hospital usage costs for individuals with eating disorders (EDs), analyze its trends, and identify associated factors using Queensland (QLD) administrative health linked data from 2013 to 2019. METHODS:We have utilized the horizontal inequity (HI) approach to quantify the extent of socioeconomic inequity. Outcome variables are public and private hospital admission costs and emergency department visit costs. Two-part regression models were estimated to identify factors associated with costs. RESULTS:There was significant socioeconomic inequity in public hospital admission costs of ED care in QLD in 2013 and 2017, concentrated among individuals from higher socioeconomic status (SES) (pro-rich inequity). In recent years (2018 and 2019), there was no evidence of inequity in public hospital admission costs. HI indices for private hospital admission costs were positive from 2014 to 2019, which suggested a pro-rich inequity in private hospital admission costs. On the other hand, emergency department visit costs were concentrated among individuals from lower SES from 2013 to 2019. Individuals living in regional/remote areas had higher annual emergency department visit costs (AUD 279). People from high SES had AUD 1020 higher annual private hospital admission costs due to EDs, on average, compared to those from low SES. CONCLUSIONS:Overall, findings call for more targeted policy and service delivery reforms to address unmet needs for people with EDs and promote more equitable access to hospital ED care, particularly for socioeconomically disadvantaged populations. Additionally, policymakers should continue to prioritize achievement of equitable access to hospital-based ED care.
OBJECTIVE:Changes in affect may precede or follow intuitive eating (IE) behaviors; however, few studies have examined these associations temporally. Affect-IE processes may also differ between sexual minority women (SMW) and heterosexual women (HW). The current study examined associations between positive and negative affect before and after IE, and whether they differed by sexual orientation. METHOD:Participants were 296 cisgender women (146 SMW, 150 HW) who binge eat aged 18-30 who completed 14 days of EMA measures. Data were analyzed using multilevel lagged models with sexual orientation as a moderator. RESULTS:Higher positive affect was associated with greater subsequent enjoyment of foods but not other IE behaviors. Lower negative affect was associated with greater subsequent enjoyment and permission to eat. Regarding prior IE and current positive affect, enjoyment of foods and trusting one's body were associated with higher positive affect across participants, while permission to eat demonstrated significant linear and cubic associations. Only HW demonstrated an association between prior performance-based eating and positive affect. For negative affect, higher prior eating to support performance, trusting one's body, and enjoyment of food were associated with lower negative affect among all participants, whereas the prior permission to eat-negative affect association was significant for only SMW. DISCUSSION:Affect is temporally linked with some IE behaviors, more often following than preceding them, with subsequent higher positive and lower negative affect potentially reinforcing IE over time. SMW and HW showed largely similar patterns with a few differences, warranting continued investigation into the underlying mechanisms.
OBJECTIVE:Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for weight management. Similar to the early implementation of metabolic and bariatric surgery (MBS), little is known about how GLP-1RAs affect individuals with eating disorders (EDs) or their potential to promote, mask, or exacerbate ED psychopathology. Lacking robust empirical data directly examining associations between GLP-1RAs and ED risk, we draw on lessons from the field of MBS to summarize current critical knowledge gaps and guide clinicians, educators, researchers, and advocates on interim decision-making. METHOD:As providers working at the intersection of EDs and obesity treatment, we integrate published findings with our clinical and research expertise to identify potential ED risks associated with GLP-1RA use and identify opportunities to screen and intervene. RESULTS:Initially in MBS practice, ED symptoms were underrecognized due to lack of standardized screening and monitoring protocols. Early concerns arose from patient reports and provider observations, followed by empirical and systematic research investigation leading to the development of structured assessment tools and protocols. Similar concerns are arising with GLP-1RA treatment, where changes in appetite and weight may, without prospective or ongoing screening, worsen existing or contribute to de novo ED behaviors and cognitions. CONCLUSION:ED providers are uniquely positioned to identify and address disordered eating occurring with GLP-1RA treatment that may be overlooked by providers with less ED training and experience. We highlight opportunities for ED professionals to engage in advocacy, education, and interdisciplinary collaboration to reduce harm and promote patient wellbeing as GLP-1RA use increases.
OBJECTIVE:The Body Project is a dissonance-based body image intervention that was originally developed to prevent the onset of eating disorders. The aim of this review is to provide an overview of the key scientific Body Project findings along with a discussion of implementation successes and approaches as well as ongoing questions. METHOD:This is an invited narrative review. RESULTS:The Body Project is backed by significant efficacy and effectiveness research and has been found to reduce internalization of the appearance-ideal, body dissatisfaction, negative mood, dieting, and continuous measures of eating disorder pathology. Some variants have also been found to reduce onset of eating disorders, thus making the Body Project a true eating disorders prevention program. Despite this, many communities choose to implement the Body Project primarily for its effectiveness at improving body image under a wide range of circumstances. DISCUSSION:Although the mental health field broadly has struggled to translate efficacy and effectiveness research into widespread adoption of evidence-based programs, an informal global village comprised of researchers, community partners, and clinicians has collectively worked together to successfully implement the Body Project on a very large scale. It offers numerous lessons about the importance of theory and research in intervention development as well as the potential of community participatory research. Future directions include novel and cultural adaptations to allow flexible Body Project implementation in new contexts.
