Article

Incidence, prevalence and mortality of anorexia nervosa and other eating disorders.

Parnassia Psychiatric Institute, The Hague, The Netherlands.
Current Opinion in Psychiatry (Impact Factor: 3.55). 08/2006; 19(4):389-94. DOI: 10.1097/01.yco.0000228759.95237.78
Source: PubMed

ABSTRACT The purpose of this review is to evaluate the recent literature on the incidence and prevalence of and mortality associated with eating disorders.
General-practice studies show that the overall incidence rates of anorexia nervosa remained stable during the 1990s, compared with the 1980s. Some evidence suggests that the occurrence of bulimia nervosa is decreasing. Anorexia nervosa is a common disorder among young white females, but is extremely rare among black females. Recent studies confirm previous findings of the high mortality rate within the anorexia nervosa population.
The incidence of anorexia nervosa is around eight per 100,000 persons per year. An upward trend has been observed in the incidence of anorexia nervosa in the past century till the 1970s. The most substantial increase was among females aged 15-24 years, for whom a significant increase was observed from 1935 to 1999. The average prevalence rates for anorexia nervosa and bulimia nervosa among young females are 0.3 and 1%, respectively. Only a minority of people with eating disorders, especially with bulimia nervosa, are treated in mental healthcare.

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    ABSTRACT: Many athletes struggle with disordered eating or eating disorders (ED) as they attempt to conform to demands or competition regulations that might be ill-suited to their physique. In this situation, participation in sports may lead to an array of health concerns that may adversely affect the athlete’s short and long-term health at a variety of performance levels and sports. The peak onset of ED is adolescence, when most athletic participation and competition takes place and athletes begin to focus on a particularly sport. For athletes, the biological changes occurring during adolescence might affect not only attitudes toward weight and shape, but also performance. To prevent the medical and psychological consequences related to ED, early intervention and identification is important. Aims: The overall aim of this thesis was to examine the effect of a one-year school-based intervention program to prevent the development of new cases of ED and symptoms associated with ED among adolescent male and female elite athletes (Paper II). An educational program was developed for coaches and included as a separate part of the intervention program. In Paper III, we examine the effect of the education program on the coaches’ knowledge about nutrition, weight regulation, and ED. In Paper I, we investigate the prevalence of ED among adolescent elite athletes compared to non-athletic controls. Finally, we wanted to design and validate a brief screening questionnaire with the ability to discriminate between athletes with and without an ED (Paper IV). Methods: First-year students (athletes) and their coaches at all the Norwegian Elite Sport High Schools (n=16) and first-year students (controls) at two randomly selected regular high schools participated in the three school year project period (2008 to 2011). In phase I (pretest) of the study all the schools were included and the students were screened for symptoms associated with ED and ED. In phase II, the Elite Sport High Schools were stratified (by size) and randomized to the intervention (n=9) or control group (n=7). The intervention group received the intervention program. Data from the athletes and their coaches at phase I and II, and data from the controls at phase I are included in this thesis. Paper I: In this cross-sectional study we used a two-tiered approach: self-reported questionnaire (part I) and clinical interview (part II). The questionnaire, including the Eating Disorder Inventory 2 (EDI-2) and questions related to ED, was completed by 611 athletes (90%) and 355 controls (84%). Subjects reporting symptoms associated with ED were classified as “at risk” for ED. In part II, all at-risk athletes (n=153), a random sample not at risk for ED (n=153), and a random sample of 50% of the controls classified as at risk (n=91) and not at risk (n=88) were invited to the clinical interview (Eating Disorder Examination) to screen for ED. Paper II: The 611 athletes participating in Paper I formed the basis of this randomized controlled trial (RCT). After the pretest (Paper I) all athletes (and coaches, Paper III) from each school were randomized to the same treatment arm (intervention or control). A final sample of 465 (93.8%) athletes was followed during high school. The athletes completed the questionnaire screening at pretest (Paper I), pottest 1 (after the intervention) and posttest 2 (9-months after intervention). Clinical interviews were conducted after pretest and at posttest 2 (one-year after intervention). Paper III: In this part of the RCT 76 coaches (93.8%) employed at and working with the first-year students at the Elite Sport High Schools were followed during the project period. At pretest and posttest (9-months after intervention) the coaches completed a questionnaire including questions concerning nutrition, weight-regulation, and ED. Paper IV: We conducted this prospective cross-sectional study in three phases. Phase I consist of data from the screening at pretest among the female athletes (Paper I). Based on the questionnaire screening we extracted items with good predictive abilities for an ED-diagnosis to the Brief ED in Athletes Questionnaire (BEDA-Q) version 1 and version 2. Version 1 consisted of 7-items from the EDI-Body dissatisfaction, EDI-Drive for thinness, and questions regarding dieting. In version 2, two items from the EDI-Perfectionism subscale were added. In phase II, the external predictive validity of version 1 was tested involving 54 age-matched elite athletes from an external dataset. In phase III, the predictive ability of posttest assessments was determined among athletes with no ED at pretest (n=53, 100%). Main results: 1) No new cases of ED in athletes at the intervention schools one-year after the intervention program, while 13% of the females and one male at the control schools developed ED. 2) Coaches at the intervention schools had higher scores on total knowledge, weight-regulation and ED compared to coaches at the control schools after intervention. The intervention also showed positive effects on the coaches’ subjective evaluation of their ED knowledge. 3) Higher prevalence of ED in adolescent elite athletes than controls (although more controls than athletes reported symptoms associated with ED. 4) BEDA-Q version 2 showed higher discriminative accuracy than version 1 in distinguishing athletes with and without an ED, and higher diagnostic accuracy in predicting new cases of ED than version 1. Conclusions: A one-year school-based intervention program can prevent new cases of ED and symptoms associated with ED in adolescent female elite athletes. The intervention part targeting the coaches with strategies of identification, management and prevention of ED produced significant effect of at least 9-months. It is confirmed that the prevalence of ED is higher among adolescent elite athletes than controls and higher in female than male adolescent elite athletes. Finally, BEDA-Q containing 9-items reveal promising psychometric and predictive features to distinguish between adolescent female elite athletes with and without ED. Key words: athletes, coaches, eating disorders, prevalence, prevention, screening, instrument, intervention
    02/2015, Degree: PhD
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    ABSTRACT: Anorexia nervosa is a serious condition associated with high mortality. Incidence is highest for female adolescents, and prevalence data highlight a pressing unmet need for treatment. While there is evidence that adolescent-onset anorexia has relatively high rates of eventual recovery, the illness is often protracted, and even after recovery from the eating disorder there is an ongoing vulnerability to psychosocial problems in later life. Family therapy for anorexia in adolescence has evolved from a generic systemic treatment into an eating disorder-specific format (family therapy for anorexia nervosa), and this approach has been evidenced as an effective treatment. Individual treatments, including cognitive behavioral therapy, also have some evidence of effectiveness. Most adolescents can be effectively and safely managed as outpatients. Day-patient treatment holds promise as an alternative to inpatient treatment or as an intensive program following a brief medical admission. Evidence is emerging of advantages in detecting and treating adolescent anorexia nervosa in specialist community-based child and adolescent eating-disorder services accessible directly from primary care. Limitations and future directions for modern treatment are considered.
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