Last year, I worked with two colleagues at the University of Minnesota (Jayne Fulkerson, PhD of the School of Nursing and Dianne Neumark-Sztainer, PhD, MPH, RD of the Division of Epidemiology and Community Health, School of Public Health) to understand the probable prevalence of full threshold and subthreshold eating disorders, as well as body image concerns, among teenagers. Using the Project EAT (Eating Among Teens) dataset which includes 4,746 students from Minnesota public middle and high schools, we found that 43% of girls and 34% of boys reported some significant level of disordered eating and/or body image concerns.

Even though the rates of full threshold eating disorder diagnoses were low (2.3% for girls and 0.5% for boys), an alarmingly high percentage of youth reported binge eating, self-induced vomiting, laxative use and/or excessive exercise (16.0% girls, 15.4% boys) not meeting criteria for a full threshold eating disorder. An even higher proportion reported severe body disparagement without disordered eating behaviors (25.1% girls and 17.7% boys).

Our findings are concerning. There are many youth who report disordered eating behaviors and body disparagement severe enough to warrant treatment but not (yet) meeting criteria for an eating disorder, and who may have difficulty accessing treatment due to how diagnostic criteria inform insurance coverage and access to specialized treatment. We are missing a substantial opportunity to provide primary prevention, and certainly early intervention, to these vulnerable youth because it is currently difficult for them to access specialized care. As a revision to the Diagnostic and Statistical Manual is underway and anticipated to be published in 2011, we hope that these findings will be taken into consideration so that more affected individuals can access specialized treatment before developing a full threshold eating disorder.

This article can be accessed through the International Journal of Eating Disorders (Int J Eat Disorder 2007; 40: 409-417).

I was recently informed of two opportunities for support groups for those struggling against eating disorders. One is offered in Minneapolis, the other in St Paul, and both are sponsored by The Joy Project. Individuals who are currently affected by an eating disorder or body image issues are encouraged to attend.

Mondays, 6:30 - 8:00 pm
University Lutheran Church of Hope
601 - 13th Avenue SE
Minneapolis MN 55414-1437

Thursdays, 6:30 - 8:00 pm
Central Park United Methodist Church
639 Jackson Street
St Paul, MN 55101

The following research opportunities were listed at the University of Minnesota Powell Center for Women's Health website:

ANOREXIA NERVOSA DIARY STUDY

Female volunteers ages 18 and older with symptoms of Anorexia Nervosa are needed for a study at the University of Minnesota. This is not a treatment study. Compensation up to $200. For more information please call Nora Sandager/Recruitment line 612-627-1993 or email sand0692@umn.edu.

EATING DISORDER RESEARCH STUDY

Women ages 18 and older who struggle with binge eating and purging are needed for a research study providing free therapy.  For more information about this University of Minnesota Study, please call 612-627-1991.

Thursday night, 28 February from 7 - 10pm, Macalester College (1600 Grand Avenue, St Paul 55105) will show the HBO Documentary Film "Thin" and host a discussion about the pervasiveness of the problem of eating disorders and efforts that the Macalester College community can take in providing support to those struggling against eating disorders. You do not need to be a Macalester student, staff, or other affiliate to attend - all are welcome.

With the new year comes resolutions for many people, and one of the most common is related to weight. When we combine our knowledge bases for prevention of eating disorders (e.g., anorexia and bulimia nervosa) and prevention of obesity and overweight, we generally come up with the same list of strategies for long-term, methodical weight management. Combining regular treatment strategies for individuals suffering against eating disorders with the results from the National Weight Control Registry, a longitudinal study of over 4000 overweight adults who have successfully maintained a healthier weight for multiple years, we know that successful weight management at a healthy weight incorporates the following strategies:

• eating breakfast every day, and eating regularly (4-5 times) throughout the day
• limiting the frequency of eating out at fast food establishments
• eating a lower-fat, higher-carbohydrate diet
• watching less than 10 hours of television per week
• exercising, on average, about 1 hour per day at a moderate level (e.g., walking, aerobics class, biking, swimming)
• self-monitoring weight, portion sizes, and meal practices

These practices may be appropriate for individuals who are overweight by medical standards or who seek to maintain a current healthy weight. Note that extreme measures, such as overexercising, skipping meals, or using harmful measures such as laxatives or diet pills were not listed as successful strategies. In fact, the use of extreme measures may affect basal metabolic rate in such a manner that weight is gained over time! So, treat your body well with a daily, methodical, and moderate weight management plan.

Collaborations with my colleagues at the University of Minnesota have allowed us to investigate several factors on problems associated with sexual and physical abuse (emotional abuse and neglect are likely associated with the same problems, but weren't included in the survey).

In 2001, we were discouraged when we learned that 18.1% of girls and 11.9% of the boys studied reported being physically and/or sexually abused. Abuse was significantly associated with binge-eating and purging behavior. It was further upsetting to learn that less than a third of abused youth chose to talk with someone about the abuse. Our findings suggested a trend toward those who talked with someone being less likely to engage in binge-eating and purging behavior. Of those who did decide to discuss their abuse, they most often turned to a close friend, a parent, or another trusted adult.

Sexual and physical violence have multiple negative effects, including but certainly not limited to eating disorder behaviors. Talking about the abuse may reduce shame and lessen emotional distress related to the abuse, however it's essential to find safe, trusting, and accessible environments and persons to approach about these difficult issues. If you or someone you know has been abused, please seek help from someone you trust.

Unfortunately, families have been an easy target for blame when it comes to mental and behavioral health problems among youth. Regardless of whether families are part of the problem, they can be part of the solution. In 2001, we published a paper on the associations between family meal frequency and symptoms of bulimia nervosa among 560 college-aged females. Results were clear - the more frequently families ate dinner together, the lower the scores on measures of bulimic symptoms. In part, this reflects a broader picture, in that those families who ate together more frequently were also those that were more cohesive, more likely to promote individuals being self-sufficient, and less focused on achievement in a competitive manner than those families who ate together less frequently.

What are the recommendations based on these findings?
Families should be encouraged to eat together, taking into account barriers such as specific family environments and time factors. In families where frequent family meals are not feasible or could be detrimental due to the overall family functioning (e.g., in cases of violent families or families in which there is another member with an active eating disorder), children may benefit from spending time and eating meals with more appropriate role models.

We already know that puberty is a difficult time for all adolescents, given the myriad of physical changes, social peer pressures, and academic challenges. We can help adolescents navigate these rough waters by providing them safe and open arenas for airing their concerns, de-emphasizing the importance of weight and shape, educating them on strategies to challenge the media's portrayal of thinness as the ideal body shape for females and muscularity as the ideal body type for males, and promoting healthy eating and regular exercise as part of an overall positive lifestyle.

I am perpetually interested in the factors that serve to protect from, as well as those that increase risk toward, the development of psychological problems. While I believe that psychological diagnoses are a combination between genetic predispositions and environmental stressors, certain individuals and/or populations may be at increased risk.

In 2001, my colleagues and I conducted a retrospective recall study of the effect of pubertal timing and perception of weight prior to puberty on eating disorder risk among more than 200 college-age females. We found that the perception of being overweight prior to entering puberty, but not age at onset of puberty, may be a risk factor for the later development of disordered eating concerns and behaviors, body image dissatisfaction, and related psychological problems. However, both age at onset of puberty and prepubertal weight perception were associated with greater emphasis on the importance of appearance and stronger drive for thinness, and poorer impulse control. Early maturers or those perceiving their prepubertal weight as overweight were more symptomatic.

Because of my clinical work in eating disorders, which predominantly affect younger individuals, I have had the joy of working with many adolescents. Yet I have been alarmed in hearing of numerous unhealthy dating experiences, either their own or those of their friends. Subsequently, one of my primary areas of focus has been on adverse dating experiences among adolescents.

• In 2002, we published the largest study to date on adolescent dating violence. In a survey of over 81,247 Minnesota youth, we found that a worrisome 9% of girls and 6% of boys had experienced either physical or sexual violence by a dating partner. Of further concern, dating violence was found to be associated with higher rates of disordered eating behaviors (such as binge-eating, fasting or skipping meals, taking diet pills, self-induced vomiting, and taking laxatives) and suicidal thoughts and attempts, and lower scores on measures of emotional well-being and self-esteem. Visit the American Psychological Association's press release for this article.
• In 2003, we published a follow-up study of over 3,000 youth who completed the Commonwealth Fund Survey of the Health of Adolescent Boys and Girls. With this nationally representative population-based sample, and using a different definition of physical or sexual violence by a dating partner, our findings showed that an alarmingly high 17% of girls and 9% of boys reported adolescent dating violence. Dating violence was found to be associated with a broad range of behavioral and mental health risks, including dieting, binge-eating and purging behaviors, cigarette smoking, alcohol consumption, drug use, suicidal thoughts, depression, and poorer self-esteem for both girls and boys. Of particular concern was our finding that approximately 50% of girls and boys who had experienced physical and sexual dating violence also reported staying in relationships out of fear of physical harm.