Towards a science of eating disorders: Replacing myths with realities: The fourth Birgit Olsson lecture

Background: For too long we have been "stuck" in old perspectives that have hampered the advance of knowledge. In part, this is related to the challenges that people have in unlearning misinformation. Aim: To address the need for an upgrade in the eating disorders field. Method: To assist with replacing outdated and inaccurate ideas with new data, this lecture reviewed novel approaches to eating disorders that engage scientists and clinicians from diverse fields to approach questions about aetiology and treatment of eating disorders through new lenses. This forward-looking lecture outlined critical questions that need to be addressed to move the field forward and strategies for engaging scientists from different fields. Results: Leading-edge findings on genetics, intestinal microbiota, and neuroscience are reviewed. Conclusions: This review encourages the integration of new evidence-based knowledge to form the backbone of our understanding of and approach to eating disorders

Solving the Eating Disorders Puzzle Piece by Piece

Albeit slowly, we are beginning to piece together the complex biological puzzle of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). The article by Lutter et al. in this issue of Biological Psychiatry brings us one step closer to understanding these illnesses

Trends in female authorship in research papers on eating disorders: 20-year bibliometric study

Background There is a clear gender gap in scientific authorship. Although the proportions of female authors in medicine and psychiatry have increased over the past decades, women are still underrepresented. Aims To analyse authorship gender trends in eating disorder research. Method First and last author gender in research articles on eating disorders during the period 1997-2016 were assessed in eating disorder specialty journals, high-impact psychiatry journals and high-impact clinical psychology journals. Results The total number of papers on eating disorders increased substantially over the observation period, although a decrease was observed in high-impact psychiatry journals. Female authorship increased in both specialty journals and high-impact psychiatry journals. Authors were significantly less likely to be female in high-impact psychiatry and clinical psychology journals than in speciality journals. Conclusions Eating disorder research has been increasingly allocated to specialty journals over the past 20 years. A consistent gender gap between specialty and high-impact journals exists. Declaration of interest C.M.B is a grant recipient from Shire Pharmaceuticals, Inc. and has participated as a member of their scientific advisory board. These positions are unrelated to the content of this article

Specialist Supportive Clinical Management for anorexia nervosa: what it is (and what it is not)

Objective: Specialist Supportive Clinical Management (SSCM) is a psychotherapy comprising a clinical management focus addressing anorexia nervosa (AN) symptoms and a supportive therapy component. SSCM has been an active control therapy in randomised controlled trials for AN, but has proven to be an effective therapy in its own right. There has been speculation about how this relatively straightforward therapy works. Some of the commentaries and descriptors used for SSCM, however, do not reflect the content or principles of SSCM. This paper clarifies areas of misunderstanding by describing what SSCM is and what it is not, particularly in relation to commentary about its constituent characteristics. Conclusions: SSCM utilises well established clinical management for AN (with a sustained focus on normalised eating and weight restoration) coupled with supportive therapy principles and strategies. Common factors across both arms include core counselling skills and a positive therapeutic alliance to promote adherence and retention in treatment for AN. Compared to other comparator therapies to date, SSCM is a simpler therapy without unique or novel theoretically derived strategies. Comparable outcomes with more complex psychotherapies raise the question of whether the combined core components of SSCM may be sufficient for many people with AN

Eating Disorders and the Intestinal Microbiota: Mechanisms of Energy Homeostasis and Behavioral Influence

Purpose of Review: We reviewed and evaluated recently published scientific studies that explored the role of the intestinal microbiota in eating disorders. Recent Findings: Studies have demonstrated that the intestinal microbiota is a contributing factor to both host energy homeostasis and behavior—two traits commonly disrupted in patients with eating disorders. To date, intestinal microbiota research in eating disorders has focused solely on anorexia nervosa (AN). Initial studies have reported an atypical intestinal microbial composition in patients with AN compared to healthy controls. However, the impact of these AN-associated microbial communities on host metabolism and behavior remains unknown. Summary: The intriguing pattern of findings in patients with AN encourages further investigation of the intestinal microbiota in eating disorders. Elucidating the specific role(s) of these microbial communities may yield novel ideas for augmenting current clinical therapies to promote weight gain, decrease gastrointestinal distress, and even reduce psychological symptomatology

Bridging the gap: Short structural variants in the genetics of anorexia nervosa

Anorexia nervosa (AN) is a devastating disorder with evidence of underexplored heritability. Twin and family studies estimate heritability (h2) to be 57%–64%, and genome-wide association studies (GWAS) reveal significant genetic correlations with psychiatric and anthropometric traits and a total of nine genome-wide significant loci. Whether significantly associated single nucleotide polymorphisms identified by GWAS are causal or tag true causal variants, remains to be elucidated. We propose a novel method for bridging this knowledge gap by fine-mapping short structural variants (SSVs) in and around GWAS-identified loci. SSV fine-mapping of loci associated with complex disorders such as schizophrenia, amyotrophic lateral sclerosis, and Alzheimer's disease has uncovered genetic risk markers, phenotypic variability between patients, new pathological mechanisms, and potential therapeutic targets. We analyze previous investigations' methods and propose utilizing an evaluation algorithm to prioritize 10 SSVs for each of the top two AN GWAS-identified loci followed by Sanger sequencing and fragment analysis via capillary electrophoresis to characterize these SSVs for case/control association studies. Success of previous SSV analyses in complex disorders and effective utilization of similar methodologies supports our proposed method. Furthermore, the structural and spatial properties of the 10 SSVs identified for each of the top two AN GWAS-associated loci, cell adhesion molecule 1 (CADM1) and NCK interacting protein with SH3 domain (NCKIPSD), are similar to previous studies. We propose SSV fine-mapping of AN-associated loci will identify causal genetic architecture. Deepening understandings of AN may lead to novel therapeutic targets and subsequently increase quality-of-life for individuals living with the illness

Genetics of Eating Disorders: What the Clinician Needs to Know

Anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) are heritable conditions that are influenced by both genetic and environmental factors. Recent genome-wide association studies (GWAS) of AN have identified specific genetic loci implicated in AN, and genetic correlations have implicated both psychiatric and metabolic factors in its origin. No GWAS have been performed for BN or BED. Genetic counseling is an important tool and can aid families and patients in understanding risk for these illnesses

In response

IN RESPONSE: Dr. Wilfley and colleagues highlight several critical gaps in the evidence base on effective treatments for patients with BED, including information about treatment durability, generalizability, and tradeoffs between benefits and harms. They recommend longer-term outcome studies to address such shortcomings, including comparative effectiveness studies, and express concern about the adverse effects of some pharmacologic agents. In many respects, their observations echo our conclusions about treatment efficacy and harms as presented in our article and comparative effectiveness. Nonetheless, we note some important caveats for readers to consider

Factors associated with self-identification of an eating disorder history among Latinas meeting criteria for past or current eating disorders

Objective: This paper compared Latinas who self-identified as having had an eating disorder (ED) with those who did not (despite both groups meeting criteria for an ED history) on ED pathology and mental health stigma. Method: Seventy-seven Latinas completed an online survey. Results: All 77 participants met criteria for lifetime EDs, and 92% met current criteria for an ED; however, 47% did not report having an ED history vs. 53% did report an ED history. There was no difference on binge eating frequency. Those who endorsed an ED history engaged in more compensatory behaviors, had higher EAT-26 scores, and were less fearful of stigmatization due to seeking mental health treatment. Those reporting an ED history were more likely to have met criteria for anorexia nervosa or bulimia nervosa, generally more recognizable EDs than binge eating disorder and other specified feeding or eating disorders, than those who did not report an ED history. Discussion: Latinas with certain patterns of eating pathology and those with less fear of being stigmatized due to seeking mental health treatment were more likely to endorse an ED history, which has implications for treatment seeking

Weight suppression and weight elevation are associated with eating disorder symptomatology in women age 50 and older: Results of the gender and body image study

Objective: Weight suppression (WS), the difference between highest past non-pregnancy weight and current weight, predicts negative outcomes in eating disorders, but the impact of WS and related weight constructs are understudied in nonclinical, midlife populations. We examined WS (current weight < highest weight) and weight elevation (WE), the opposite of WS (current weight > lowest weight) and their associations with eating psychopathology in women aged 50+. Method: Participants were a community-based sample (N = 1,776, M age = 59) who completed demographic and eating psychopathology questions via online survey. WS, WE, and WS × WE were tested as predictors of outcome variables; BMI and medical conditions that affect weight were controlled for. Results: Individuals that were higher on WS and WE were most likely to engage in current weight loss attempts, dieting in the past 5 years, and extreme lifetime restriction. Individuals with higher WS were more likely to experience binge eating, greater frequency of weight checking, overvaluation of shape and weight, and lifetime fasting. Individuals with higher WE were more likely to report negative life impacts of eating and dieting. Higher WS and WE each predicted higher levels of skipping meals over the lifetime. Discussion: This novel study investigated WS in midlife women and introduced a new conceptualization of weight change (WE) that may be more relevant for aging populations given that women tend to gain weight with age. The findings implicate the utility of investigating both WS and WE as factors associated with eating psychopathology in midlife women