Colleagues (N now = 1209 in 48 countries),
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list.
Subscribe for free to receive new posts and support Eating Disorders Prevention.
ADVOCACY-IN-ACTION ANNOUNCEMENT
Progress in/as a Major Step for
Sea Waves
Founded and Directed by our own Ms. Leah Stiles (USA)
Received this morning (California time) via an everything-is-advocacy email from our own Ms. Leah Stiles (USA), founder and director of Sea Waves.
ML NOTE 1: As noted in the announcement below, Ms. Stiles and I would appreciate it if you would pass this announcement along to any and all who might be able to use the information directly and/or as a resource. For a press release to attach, contact her at the email address below, at the conclusion of Note 2.
ML NOTE 2: If you are U.S. Military Veteran, a family member of a current or former member of the military, and/or a mental health professional in any country who has resources for and/or experience in identifying and treating military personnel with eating disorders and/or prevention of same, Ms. Stiles, her colleagues, and I would appreciate it if you would reach out to her at leahstiles@sea-waves.org.
[Ms. Stiles writes: (link-in-bold added by ML; other bold-for-emphasis is in the original)]
I am excited to share that SEA WAVES, the nonprofit dedicated to addressing eating disorders within the military community, is now listed in Military OneSource’s Community Resource Finder!
Key Points:
• Significant Impact: One-third of women and one-fifth of men in the military report symptoms of eating disorders, a critical mental health issue that needs more attention.
• Preventive Action: Early intervention in eating disorders can prevent full-blown conditions that affect operational readiness, escalate healthcare costs, impact man-hours, and lead to lost productivity. Eating disorders can and do lead to suicide. The pervasive stigma and under-reporting of these issues necessitate proactive leadership to address them head-on.
• Unique Support: Of the 40,000 Veteran Service Organizations, SEA WAVES is the only one created to support eating disorders and the first eating disorder resource listed in the Military OneSource Community Finder.
• Bridging the Gap: This inclusion helps fill the existing void in support for eating disorders within the military, marking a critical step in improving access to specialized care for eating disorders, addressing a significant but often overlooked mental health issue.
• Growing Recognition: As eating disorders gain more recognition as a serious mental health issue, our listing in Military OneSource reflects a broader acknowledgment that cannot be overlooked. With the SERVE Act under legislative review, it is evident that this issue is attracting significant attention, underscoring the importance of proactive measures.
Your attention to this matter can help ensure that service members receive the necessary care and support they deserve. Together, we can lead the way in addressing this critical issue.
I kindly ask that you forward this information to the furthest distribution in your network to ensure that our service members and their families are aware of this vital resource and how they can access the help they need.
I would be delighted to discuss further how we can work together to make a meaningful impact.
Leah Stiles
Founder / CEO,SEA WAVES, Inc
www.sea-waves.org|leahstiles@sea-waves.org
“Be the lighthouse: BRAVE against the storms, STRONG against the waves, and a beacon of HOPE for those lost in the darkness.”
DIET CULTURE AND CULTURAL LITERACY
[our own] Ms. Rachelle Heinemann's (USA)
Understanding Disordered Eating Podcast - Episode #138:
Fertility and Nutrition
with Rachelle LaCroix Mallik, MA, RD, LDN (USA)
“Received” this morning (California time) via one of my periodic visits to the site of our own Ms. Rachel Heinemann’s (LMHC, LPC, CEDS; USA) Understanding Disordered Eating Podcast: Eating Disorder Recovery and Body Image Healing.
ML NOTE 3: All episodes in this podcast series can be found at: https://www.rachelleheinemann.com/podcast.
Episode 138: Fertility and Nutrition with Rachelle LaCroix Mallik, MA, RD, LDN (USA)
Listen (~38 min) at: https://tinyurl.com/29rbf3h7
[From the Podcast website] How many old wives’ tales have you heard about nutrition and fertility?
More importantly, how often have doctors told you that intentional weight loss will miraculously improve your IVF outcomes? If you’re even slightly “overweight” and experiencing fertility issues, it’s common for doctors to subtly (or not so subtly) suggest you “lose a little weight” as a solution.
In this episode, I’m joined by Rachelle LaCroix Mallik. We’ll take a deep dive into the limitations of studies claiming that weight loss boosts health. Spoiler alert: these studies often miss the mark by not considering other crucial factors like specific eating habits, physical activity, and improved glucose metabolism. Imagine that!
Rachelle (Rachel) LaCroix (LaCwa) Mallik (Mal-ick), MA, RD, LDN. She is a dietitian and founder of The Food Therapist, a virtual private practice specializing in nutrition counseling and education for reproductive health. Rachelle supports clients who are trying to conceive, pregnant, postpartum, breastfeeding or managing conditions like PCOS and endometriosis with a weight-inclusive approach that focuses on nourishment rather than restriction.
Rachelle has been working in reproductive health for 18 years, starting as an IVF patient coordinator at the Weill Cornell Center for Reproductive Medicine, and is a mom to two young children. Rachelle is a member of the Academy of Nutrition and Dietetics, including the Women’s Health Dietetic Practice Group. She is also an active member of the Nutrition Special Interest Group of the American Society for Reproductive Medicine (ASRM). Rachelle serves as the reproductive nutrition content expert for the Nutrition Care Manual. [bio continues; see website for this podcast]
Research Publication Categories in This Newsletter
(i) New Book: Trauma-Informed Approaches to Eating Disorders (2nd ed.); (ii) Families and Eating Disorders; (iii) Social and Other Media, Part 1 (n = 3); (iv) Comorbity (n = 2); and (vii) June-July Treatment Interlude, Part 6 (n = 4)
CONGRATULATIONS to our own
Dr. Renee Rienecke (USA) and colleagues for publication of the Families and Eating Disorders Review article in #2.
Drs. Lynda Boothroyd (England), Tracey Thornborrow (England), and Elizabeth Evans (England), colleagues for publication of the Social Media review article in #3.
Ms. Karen Lucibello (Canada) and Dr. Catherine Sabiston (Canada) and colleagues for publication of the Social Media research article in #4.
Dr. Beth Bell (England) and colleagues for publication of the Social Media research article in #5.
Dr. Phillipa Hay (Australia) and colleagues, including our own Dr. Deborah Mitchison (Australia, #9), for publication of the Comorbidity research article in #6 and the Eating Disorders Treatment article in #9.
Dr. Timothy Brewerton (USA) and colleagues for publication of the Eating Disorders Treatment article in #10.
Drs. Janet Treasure (England; see also #1-ML NOTE 4 below) and Ulrike Schmidt (England) and colleagues — including distinguished scientist-practitioners Drs. Jon Arcelus (England) and Hubertus Himmerich (England) — and colleagues for publication of the Eating Disorders Treatment article in #11.
Corrigere Errorem
In regard to the previous Newsletter, NO. 53 on 6 August 2024, and the presentation of the following article in #5, I did congratulate our own Dr. Helga Dittmar AND managed to get her country location wrong. It is England, not the USA . . . . (sigh).
Hurst, M., Banerjee, R., & Dittmar, H. (2024). Applying objectification theory to adolescent girls’ gendered experiences of physical education in the United Kingdom. Psychology of Women Quarterly. Advance online publication. https://doi.org/10.1177/03616843241262692 [Full text available for download at: https://journals.sagepub.com/doi/pdf/10.1177/03616843241262692]
AND CONGRATULATIONS are also in order for the recent publication of a
New Book entitled
Trauma-Informed Approaches to Eating Disorders (2nd ed.)
Edited by Mr. Andrew Seubert, NCC, LMHC (USA) and our own Ms. Pam Virdi, MEd, RMN, CPN (England)
Springer (2025)
The Book: Seubert, A., & Virdi, P. (Eds.). (2025). Trauma-informed approaches to eating disorders (2nd ed.). Springer. [510 pages; paperback ISBN: 978-0-8261-4797-4]
From the publisher's website (bold in original):
The most comprehensive and practical book examining the relationship between trauma, dissociation, and eating disorders
This hands-on clinical guide delivers a trauma-informed phase model that promotes effective treatment for individuals with all forms of eating disorders. The second edition includes the addition of new chapters addressing the impact of a variety of contemporary issues—such as racism, LGBTQIA+ bias, COVID-19, and neurodiversity—on eating disorders as well as the treatment of eating disorders and trauma on children and teens. Case studies are also included throughout the text to illustrate these issues among all types of clients with eating disorders.
Selected Content:
ML NOTE 4: CONGRATULATIONS to Ms. Carolyn Costin (USA), Dr. Janet Treasure (see #11 below), Ms. Joslyn Smith (USA), and Drs. Madeline Altabe (USA), Norman Kim (USA), Marcella Raimondo (USA), and Amanda Bruening (USA) — all of whom authored or co-authored chapters in this book and are members of this Newsletter Group.
Foreword by Michael P. Levine, PhD
SECTION I. OVERVIEW AND RECOGNIZING THE TERRITORY
SECTION II. TRAUMA TREATMENT IN EATING DISORDERS: A COMPLEX AFFAIR
Chapter 4. The Centrality of Presence and the Therapeutic Relationship in Eating Disorders, by Ms. Carolyn Costin (USA)
SECTION III. BRAIN, BODY, AND EATING DISORDERS
Chapter 5. The Neurobiology of Trauma and Eating Disorders, by Dr. Rayane Chami (England) and Dr. Janet Treasure (England)
SECTION IV. THE PHASE MODEL: PHASES I AND II
Chapter 7. Assessing “Trauma-Driven Eating Disorders”: A Road Map Through the Maze, by Ms. Pam Virdi (England) and Dr. Jackie Nicholls (England)
SECTION V. APPROACHES TO TRAUMA PROCESSING AND EATING DISORDERS: PHASE III
SECTION VI. PHASE IV: RELAPSE PREVENTION, REEVALUATION, AND INTEGRATION
Chapter 25. Recovery and Beyond: Dealing With Triggers and Setbacks, by Ms. Marnie Davis (USA) and Ms. Joslyn Smith (USA)
Chapter 26. Trauma-Informed Approaches to Body Image Disturbance: A Historical Review for a Holistic Future, by Dr. Madeline Altabe (USA)
SECTION VII. CONTEMPORARY ISSUES AND SPECIAL POPULATIONS
Chapter 29. Impact of Racism and Prejudice on Eating Disorders, by Dr. Rosa Lim (USA) and Dr. Norman Kim (USA)
Chapter 30. Impact of LGBTQIA+ Discrimination on Eating Disorders, by Ms. Scout Silverstein (USA), Mr. Emil Smith (USA), and Dr. Marcella Raimondo (USA)
Chapter 32. Eating Disorder Presence and Treatment in Teens and Children, by Dr. Amanda Bruening (USA), Dr. Laura Machlin (USA), and Dr. Abigail Matthews (USA)
Families and Eating Disorders
2. Renee Rienecke, R. D., Trotter, X., & Jenkins, P. E. (2024). A systematic review of eating disorders and family functioning. Clinical Psychological Review, 112. Advance online publication. https://doi.org/ 10.1016/j.cpr.2024.102462
Email address for correspondence: renee.rienecke@ercpathlight.com
ABSTRACT. The purpose of the current review was to address four questions: 1) Are there differences in family functioning or family environment among patients with different eating disorder (ED) diagnoses? 2) Are there differences in the perception of family functioning or family environment among different family members? 3) Is family functioning or family environment related to ED symptomatology? 4) Does family functioning or family environment change as a result of ED treatment? and 4a) If so, does this impact ED treatment outcome?
Although most studies found no differences among ED diagnostic groups, those that did generally found worse family functioning among those with binge/purge symptoms than among those with the restricting subtype of anorexia nervosa. Differences in perceptions of family functioning among family members were found, with patients generally reporting worse functioning than their parents. Worse family functioning was generally found to be related to worse ED symptoms.
The variety of treatment approaches and different assessments of outcome made it somewhat unclear whether family functioning consistently improves with ED treatment. More research is needed on family functioning and EDs, particularly in understudied groups such as males, and those with ED diagnoses other than anorexia nervosa or bulimia nervosa.
Social and Other Media
3. Andres, F. E., Boothroyd, L. G., Thornborrow, T., Chamorro, A. M., Dutra, N. B., Brar, M., Woodward, R., Malik, N., Sawhney, M., & Evans, E. H. (2024). Relationships between media influence, body image and sociocultural appearance ideals in Latin America: A systematic literature review. Body Image, 51. Advance online publication. https://doi.org/10.1016/j.bodyim.2024.101774
Full text available for download at: https://www.sciencedirect.com/science/article/pii/S1740144524000962
ABSTRACT. The rapidly growing body of research investigating media influence on body image in Latin America has not been previously comprehensively synthesised. We systematically reviewed studies of the relationships between media use/influence, body image, and sociocultural appearance ideals in Latin America (CRD42021254607). We searched PsycINFO/Medline, Pubmed, Web of Science, ERIC, Scopus, ProQuest Dissertations, SciElo, and LILACS for quantitative and qualitative peer-reviewed articles and doctoral theses in English, Spanish, and Portuguese. Research conducted in Latin America, published 1991–2023, measuring a) media use/influence, and b) body image or appearance ideals was included.
68 articles met inclusion criteria, and quality appraisal concluded that most were of medium/high quality. A narrative review found consistent quantitative relationships, stronger in women than men, between media use/internalisation of media ideals and both body dissatisfaction and thinner appearance ideals. In contrast, participants in qualitative studies acknowledged media influence on their body image, but perceived greater influence from family and peers.
Limitations included a predominance of cross-sectional research from Brazil and Mexico with adolescents and young adults. Additional longitudinal, experimental, and interventional work from elsewhere in Latin America is needed, recruiting more diverse samples and assessing more culturally salient appearance aspects (e.g., skin tone and hair texture).
4. Firasta, L., Vani, M. F., Lucibello, K. M., & Sabiston, C. M. (2024). Understanding social media appearance preoccupation: The role of body image emotions. Psychology of Popular Media. Advance online publication. https://doi.org/10.1037/ppm0000559
Email address for correspondence: catherine.sabiston@utoronto.ca
ABSTRACT. Social media appearance preoccupation, which is measured by appearance comparisons, online self-presentation, and appearance-related activity on social media, is a timely construct to understand given the range of psychosocial outcomes tied to social media use. An integration of theories of self-conscious emotions, self-presentation, and social media was used to inform this study exploring appearance shame and envy as correlates of social media appearance preoccupation.
Participants (N = 298; 65% women, Mage ± SD = 23.6 ± 3.6 years) completed an online self-report survey. Descriptive statistics and structural equation modeling were used to analyze the data. In the main model controlling for gender, age, body mass index, and time spent on social media, appearance envy and shame were associated with appearance comparisons on social media (R² = .54, p < .001). Appearance envy was also directly associated with online self-presentation (R² = .39, p < .001).
The emotions were not significant correlates of appearance-related activity on social media. These findings were generally consistent for women and men, with women reporting higher levels of shame, envy, appearance comparison, online self-presentation, and time on social media compared to men. Based on these findings, strategies to reduce or manage appearance-related emotions of shame and envy are needed to protect from social media appearance preoccupation. With these efforts in place, the detrimental effects of social media use may be curbed.
Impact Statement: This study suggests a strong relationship between appearance emotions of shame and envy and the way women and men present themselves online on social media platforms. Understanding that appearance shame and envy motivates individuals to self-present favorably online and can drive comparisons in the online space is crucial.
Based on the current findings, digital literacy strategies embedded within social media platforms and concomitantly presented across education and workplace settings is essential to help address excessive screen time and the negative impact on body image in an effort to promote more positive and healthy social media use in the digital age.
ML NOTE 5: The Calogero et al. (2021) study cited in the Abstract of the article described below in #5 is as follows. Drs. Rachel Calogero (Canada; Editor-in-Chief of Sex Roles), Tracy Tylka (USA; Editor-in-Chief of Body Image), and Jaclyn Siegel (USA) are members of this Newsletter Group.
Calogero, R. M., Tylka, T. L., Siegel, J. A., Pina, A., & Roberts, T.-A. (2021). Smile pretty and watch your back: Personal safety anxiety and vigilance in objectification theory. Journal of Personality and Social Psychology, 121(6), 1195–1222. https://doi.org/10.1037/pspi0000344 [Email address for correspondence: rcaloger@uwo.ca]
5. Dollimore, K., Hurst, M., Cassarly, J., & Bell, B. T. (2024). Cross-sectional and longitudinal relationships between young student women’s experiences of everyday sexual harassment on social media and self-objectification, body shame, and personal safety anxiety. Psychology of Popular Media. Advance online publication.https://doi.org/10.1037/ppm0000554
Full text available for download at: https://psycnet.apa.org/fulltext/2025-09086-001.html
ABSTRACT. Sexual harassment is highly prevalent in online settings, including social media, and has negative consequences for young women’s mental health. Understanding the psychological mechanisms underpinning these negative effects is important. Using an expanded objectification theory model as our theoretical framework (Calogero et al., 2021), we examine the relationship between sexual harassment on social media and young student women’s body shame and personal safety anxiety, cross-sectionally and longitudinally including by examining self-objectification as a mediator.
Data from 207 student women aged 18–25 years (M = 21.06, SD = 1.89) from the United Kingdom were collected at two time points 10 weeks apart. Cross-sectional analyses at Time 1 and Time 2 showed that sexual harassment on social media was indirectly associated with body shame and physical safety anxiety via self-objectification, with additional direct paths to body shame (Time 1 and Time 2) and physical safety anxiety (Time 2 only). Over 10 weeks, sexual harassment on social media was not indirectly associated with body shame or physical safety anxiety, via self-objectification at Time 1 or Time 2.
These findings provide cross-sectional but not longitudinal support for an expanded objectification theory model in online contexts. Our findings have important methodological implications for research examining objectification processes over time that are discussed within.
Public Policy Relevance Statement: Sexual harassment on social media is a growing societal problem that disproportionately affects girls and women. Experiencing sexual harassment on social media was found to be associated with body shame and personal safety concerns among young student women. Interventions that seek to reduce sexual harassment on social media are needed.
Comorbidity
6. Appolinario, J. C., de Moraes, C. E. F., Sichieri, R., Hay, P., Faraone, S.V., & Mattos, P. (2024). Associations of Adult ADHD symptoms with binge eating spectrum conditions, psychiatric and somatic comorbidity, and healthcare utilization in a metropolitan Brazilian city. Brazilian Journal of Psychiatry. Advance online publication. https://doi.org/10.47626/1516-4446-2024-3728.
Prepublication proof available for download at: https://cdn.publisher.gn1.link/bjp.org.br/pdf/bjp3728.pdf
ABSTRACT. Objectives: To investigate the associations among symptoms of attention deficit hyperactivity disorder (ADHD) with binge eating spectrum conditions - BESC - [binge eating disorder (BED), bulimia nervosa (BN), and recurrent binge eating (RBE)], and psychiatric and somatic comorbidity and healthcare utilization in a representative sample of a Brazilian city.
Methods: A household survey with 2,297 adults and residents in Rio de Janeiro was conducted. The Adult Self-Rating Scale Screener was used to assess ADHD symptoms. BESC was assessed using the Questionnaire of Eating and Weight Patterns 5 and confirmed by telephone interview. Standardized questionnaires were used to assess psychiatric comorbidity. Close-ended questions investigated somatic comorbidity and healthcare utilization.
Results: ADHD symptoms were highly associated with BESC [BED, OR=13.2, 95%CI= 4.3-40.6; BN, OR=27.5, 95%CI= 5.9-128.7; RBE, OR=5.8, 95%CI= 2.9-11.4). However, with further adjustment for psychiatric comorbidity (depression, anxiety, alcohol use and impulsivity), the ORs were no longer significant. Healthcare resource utilization was significantly higher in participants with ADHD and BESC but lost significance after controlling for the psychiatric comorbidity.
Conclusion: ADHD was associated with an increased prevalence of BESC, and healthcare utilization. Nonetheless, there was an essential interplay among psychiatric comorbidity in the associations of ADHD and BESC.
7. Sharpe, S. L. (2024). A living experience proposal for the co-occurring diagnosis of avoidant/restrictive food intake disorder and other eating disorders. Journal of Eating Disorders, 12, 110. https://doi.org/10.1186/s40337-024-01073-1
Full text available for download at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01073-1#citeas
ABSTRACT. The eating and feeding disorder section of the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR) is organized by a diagnostic algorithm that limits the contemporaneous assignment of multiple eating disorder diagnoses. Avoidant/restrictive food intake disorder (ARFID) is a disturbance in food intake typically associated with lack of interest in food, food avoidance based on sensory characteristics, and/or fear of aversive consequences from eating. According to the DSM-5-TR, an ARFID diagnosis cannot be made when weight or shape disturbances are present, and ARFID cannot be co-diagnosed with other eating disorders characterized by these disturbances.
However, emerging evidence from both clinical and lived experience contexts suggests that the co-occurrence of ARFID with multiple other types of eating disorders may be problematically invisibilized by this trumping scheme. The diagnostic criteria for ARFID can contribute to inappropriate diagnosis or exclusion from diagnosis due to excessive ambiguity and disqualification based on body image disturbance and other eating disorder pathology, even if unrelated to the food restriction or avoidance. This harmfully limits the ability of diagnostic codes to accurately describe an individual’s eating disorder symptomatology, impacting access to specialized and appropriate eating disorder care.
Therefore, revision of the DSM-5-TR criteria for ARFID and removal of limitations on the diagnosis of ARFID concurrent to other full-syndrome eating disorders stands to improve identification, diagnosis, and support of the full spectrum of ARFID presentations.
June - July 2024 Treatment Interlude, Part 6 of Many
8. Li, Z., Chubinidze, D., Croft, P., Webb, J., Sarpong, A., Zesch, E., & Tchanturia, K. (2024) “Don’t talk to me like Iam an illness”: Exploring patients’ needs using the communication passport in an eating disorder service. Neuropsychiatrie. Advance online publication. https://doi.org/10.1007/s40211-024-00501-7
Full text available for download at: https://link.springer.com/article/10.1007/s40211-024-00501-7#citeas
SUMMARY. Purpose: Social challenges are common in patients with eating disorders (ED). The presence of autistic characteristics often exacerbates social difficulties within this group, potentially affecting treatment outcomes. This study investigates the communication preferences, challenges, dislikes, and support needs of patients with ED, both with and without autistic traits, using acommunication passport in anational inpatient ED service. Methods: An explorative qualitative analysis of 38 completed communication passports was conducted to investigate patients’ communication preferences, sensory needs, struggles and dislikes, and areas of support required, paying particular attention to the distinct needs of patients with high levels of autistic traits.
Results: The communication passport provided valuable insights into patients’ communication preferences, sensory sensitivities, challenges, and support needed. Patients also used the passports to share information about their strengths, personal identity, and life beyond the hospital. Conclusion: The communication passport fosters adeeper understanding of patients’ needs and may support clinicians in care planning and communication strategies tailored to each patient’s needs. Regular evaluation and updates are warranted to ensure its usability and accessibility by the wider care team.
9. Day, S., Houlihan, C., Mitchison, D., Conti, J., Gill, K., Mannan, H., McMahon, K., Ramjan, L., Rankin, R., Tannous, W. K., Utpala, R., & Phillipa Hay, P. (2024). Pilot study outcomes and recommendations from developing an Australian residential treatment for eating disorders. Adolescents, 4, 324–334. https://doi.org/10.3390/adolescents4030023
Full text available for download at: https://www.mdpi.com/2673-7051/4/3/23
ABSTRACT. Individuals with eating disorders often face difficulty accessing sufficiently intensive, recovery-focused treatment. Residential treatment may fill a gap in the spectrum of care, offering 24-h support in a more home-like environment than a hospital and using a holistic approach including individual and group psychological therapy, meal support, and lived experience staff. As residential treatment has not previously been examined in Australia, the current study aimed to document the development, treatment components, and structure of this first Australian residential service for eating disorders and provide a pilot of its treatment outcomes.
Preliminary outcomes are included from a sample of 19 individuals from the first six months of admissions, including eating disorder symptoms, eating disorder-related impairment, anxiety, and depression. Significant pre- to post-treatment improvement was found in total eating disorder psychopathology, dietary restraint, eating concerns, body mass index, eating disorder-related impairment, and depression, but not from pre-treatment to a six-month follow-up. Pilot outcomes were positive at end-of-treatment but require further clinical evaluation to examine follow-up effects. Clinical insights are discussed from the establishment of this new treatment service, including recommendations for clinicians involved in the current roll-out of residential programs across Australia.
10. Dennis, K., Barrera, S., Bishop, N., Nguyen, C., & Brewerton, T. D. (2024). Food addiction screening, diagnosis and treatment: A protocol for residential treatment of eating disorders, substance use disorders and trauma-related psychiatric comorbidity. Nutrients, 16, 2019. https://doi.org/10.3390/nu16132019
Full text available for download at: https://www.mdpi.com/2072-6643/16/13/2019
ABSTRACT. Food addiction, or ultra-processed food addiction (UPFA), has emerged as a reliable and validated clinical entity that is especially common in individuals seeking treatment for eating disorders (EDs), substance use disorders (SUDs) and co-occurring psychiatric disorders (including mood, anxiety and trauma-related disorders). The clinical science of UPFA has relied on the development and proven reliability of the Yale Food Addiction Scale (YFAS), or subsequent versions, e.g., the modified YFAS 2.0 (mYFAS2.0), as well as neurobiological advances in understanding hedonic eating.
Despite its emergence as a valid and reliable clinical entity with important clinical implications, the best treatment approaches remain elusive. To address this gap, we have developed and described a standardized assessment and treatment protocol for patients being treated in a residential program serving patients with psychiatric multi-morbidity.
Patients who meet mYFAS2.0 criteria are offered one of three possible approaches: (1) treatment as usual (TAU), using standard ED treatment dietary approaches; (2) harm reduction (HR), offering support in decreasing consumption of all UPFs or particular identified UPFs; and (3) abstinence-based (AB), offering support in abstaining completely from UPFs or particular UPFs. Changes in mYFAS2.0 scores and other clinical measures of common psychiatric comorbidities are compared between admission and discharge.
11. İnce, B., Phillips, M., Dalton, B., Irish, M., Webb, H., Mercado Beivide, D., McCombie, C. Zenasni, Z., Shearer, J., Potts, L., Peachey, G., Au, K., Kern, N., Clark-Stone, S., Connan, F., Johnston, A. L., Lazarova, S., Zadeh, E., Tomlin, S., Battisti, F., . . . Treasure, J., & Schmidt, U. (in press). Stepping into day treatment approach versus inpatient treatment for adults with anorexia nervosa: the DAISIES RCT. Health Technology Assessment.
Email address for correspondence: ulrike.schmidt@kcl.ac.uk
ABSTRACT. Background: A substantial proportion of anorexia nervosa (AN) patients require intensive treatments, commonly inpatient (IP) or day patient treatment (DPT). The relative merits of these treatments for adults with AN are unknown. Therefore, a trial investigating the clinical effectiveness, and cost-effectiveness of IP treatment-as-usual (TAU) versus a stepped-care DP approach in adults with AN (DAISIES) was commissioned. This trial terminated prematurely due to poor recruitment, mainly resulting from COVID-19’s impact on service provision.
Objective(s): We describe the rationale, methods, and available outcomes of the DAISIES trial. Reasons behind the trial’s failure and implications for future research are investigated. Design: A two-arm multi-centre open-label parallel group non-inferiority randomised controlled trial, evaluating the effectiveness, acceptability and cost-effectiveness of two intensive treatments for adults with severe AN. Setting: Specialist eating disorder (ED) services in the UK with IP and/or DPT facilities. Participants: Adults (age 17+) with severe AN (body mass index [BMI] < 16 kg/m2) requiring intensive treatment and (optionally) their carers. Intended sample size: 386.
Interventions: IP-TAU and a stepped care DPT approach (with the option of initial IP treatment for medical stabilisation). Main outcome measures: The primary outcome was BMI at 12 months post-randomisation. Qualitative interviews conducted during the trial included semi-structured interviews to investigate patients’, families’, and clinicians’ views on treatments.
Results: During the 16-month recruitment period (November 2020 to March 2022), 53 patients were approached. Of these, 15 were enrolled and randomly allocated to the IP-TAU (n=7) or DPT (n=8) treatment arms. All participants were female with a mean (SD) age of 24.8 (9.1) years and a mean (SD) BMI of 14.4 (1.6) kg/m2. Patients’ BMIs had increased similarly in both groups at 12-months. Participants perceived the stepped-care DPT approach to be more acceptable than IP-TAU. Qualitative interviews with patients, carers, and clinicians suggested valued (e.g., multidisciplinary provision of care) and disliked (e.g., perceived overfocus on weight gain) aspects of treatment. Investigation of the reasons behind the trial’s failure revealed strong treatment preferences amongst patients as the most common reason for non-participation, alongside the impact of COVID-19 on service provision.
Limitations: The main trial questions could not be answered due to low participant numbers.
Conclusions: No conclusions can be drawn concerning the clinical and cost-effectiveness of IP-TAU and stepped-care DPT. The DPT approach was perceived more positively by patients and carers. Service-related (e.g., reduced clinician time for research), patient-related (e.g., treatment preferences) and wider systemic factors (e.g., reduced service capacity and patient throughput nationally during COVID-19) seem to have contributed to the failure of the DAISIES trial.
Future work: Despite the trial’s failure, the need to investigate the effectiveness and experience of intensive treatments of adult AN remains. Alternative trial designs incorporating patient preferences, and investigating community-based intensive treatment options have potential to improve acceptability and recruitment.
