An 8-month longitudinal exploration of body image and disordered eating in the UK during the COVID-19 pandemic

Research suggests that the COVID-19 pandemic is negatively impacting mental health, with rates of eating disorder referrals in particular rising steeply during the pandemic. This study aimed to examine 8-month changes in body image and disordered eating during the COVID-19 pandemic, and explore whether any changes were moderated by gender, age, or eating disorder history. This study used a longitudinal survey design in which 587 adults living in the UK (85 % women; mean age = 32.87 years) completed assessments every two months over five timepoints from May/June 2020 to January/February 2021. Measures included body esteem, disordered eating, and psychological distress. Mixed effect models showed small but significant improvements in body esteem and disordered eating symptoms from May/June 2020 to January/February 2021. These improvements were independent of changes in psychological distress, and did not vary by gender, age or eating disorder history. Whilst poor body image and disordered eating may have been elevated in the early period of the pandemic, this study suggests improvements, rather than worsening, of these outcomes over time. This may reflect adaptation to this changing context

A consensus document on definition and diagnostic criteria for orthorexia nervosa

Purpose: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with “correct” eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. Methods: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A–Definition, Clinical Aspects, Duration; B–Consequences; C–Onset; D–Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. Results: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. Conclusions: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. Level of evidence_ Level V: opinions of expert committee

Conceptualising orthorexia nervosa: a multiperspective exploration of excessive health concerns and disordered eating in a culture of health preoccupation

Discussions around the construct of ‘Orthorexia Nervosa’ (ON) have challenged perceptions of healthy diets and lifestyles, as well as assumptions about core characteristics of eating disorder (ED) symptoms. As a potential new clinical picture, ON describes an obsessive preoccupation with healthy eating which leads to physical as well as psychosocial impairments. In its original definition, ON was described as a unique ED, which involves extreme beliefs about foods’ health-promoting and health-damaging properties, rather than weight loss motivations or body image concerns. However, ON is not officially recognized as a disorder and its specific components are still disputed. The present thesis aimed to explore the conceptualisation of ON in the context of research, clinical practice, and within the general population. Four studies were designed to investigate how current understanding of ON relate to disordered eating, specific dietary choices, and general sociocultural developments. First, a systematic review was conducted to evaluate the psychometric properties of all published ON assessment tools and to explore the variety of ON conceptualisations within current research. In total, ten ON assessment scales were identified and 68 unique studies were included in the narrative review, of which 40 studies were eligible for a reliability generalization analysis. By systematically evaluating available ON scales, conceptual inconsistencies were exposed, and limitations of published research findings were highlighted. Importantly, the most commonly used ON assessment tool (the ORTO-15) showed not only poor face validity, but also inconsistent and unsatisfactory psychometric properties across studies. In addition, culture-specific conceptualisations of ON were identified which challenge the generalizability of consequently preliminary findings. To explore individual conceptualisations of ON within specific contexts, the second research project combined a text-mining approach with a qualitative analysis to investigate comments posted on one of the most popular online discussion forums, Reddit. Two-hundred-forty-six comments that discussed ON were extracted from a publicly available data archive, and subsequently analysed using thematic analysis. As ON had been associated with both EDs as well as specific (restricted) diets and lifestyles, this study compared two different topical environments: ED-related versus diet-related subreddits. In both subreddit communities ON was linked to ED behaviours, food safety concerns, and moral superiority. Discrepancies between subreddit categories mostly involved ON’s conceptualisation as a (distinct) disorder. Shifting expressions of EDs as well as perceptions of problematic dietary norms were identified as complicating a clear definition of ON. Based on these findings, a third study was carried out to further investigate the perceived overlap between ON and ED symptoms from a clinical practice perspective. Interviews with ten mental health professionals working in the field of EDs were conducted to explore their professional experiences with the prevalence, development, and maintenance of excessive healthy eating motivations in ED populations. Overall, findings from this study suggest that sociocultural developments influence the expression of all ED presentations, with current health and wellness ideals further blurring the lines between conceptualisations of ON and other EDs. It was therefore concluded that ON-related ED presentations need to be contextualised within the framework of current societal messages around health, while ON’s unique characteristics as a disorder require further investigation. With all preceding studies highlighting difficulties regarding a clear conceptualisation of ON, especially in relation to its differentiation from other EDs, the final study aimed to explore how general health-promoting behaviours relate to disordered eating across time. A one-year longitudinal study was conducted to measure changes in disordered eating and health-related coping behaviours during the COVID-19 pandemic, a time of heightened health (risk) awareness. Both people with and without an ED were recruited. Using latent growth curve analysis, the relationship between disordered eating and health-related coping was investigated. Interestingly, individual levels of disordered eating and health-related coping were positively related at all measured timepoints. A past or present ED diagnosis significantly predicted higher levels of both disordered eating and health-related coping. While disordered eating levels slightly decreased throughout the specified timeframe, health-related coping behaviours displayed near stable values. This final study provided further evidence for the positive association between disordered eating and health-related behaviours. Especially during stressful experiences, specific health behaviours might constitute a means to control negative emotional states or to feel a sense of mastery, as has been reported for other ED behaviours. However, potential mechanisms underlying this relationship require further investigation. Across the four studies, health motivations and behaviours have been shown to be relevant for current ED manifestations. Based on the findings illustrated in the present thesis, ON is currently associated with a variety of clinical presentations, lifestyle habits, and societal demands, which complicates the progression of research in this field. Key findings of this thesis relate to the need for more culturally embedded research around ON and more differentiated public health policy work, integrating health promotion strategies and campaigns with ED-related policy work. Future research will need to utilize longitudinal and interdisciplinary approaches to further explore the unique developmental pathways of an ON symptomatology and related excessive health concerns. The clinical utility of an ON diagnosis will need to be explored by investigating its distinct aetiology and progression, as well as the need for unique treatment approaches and barriers to accessing support

Understanding perceived characteristics and causes of orthorexia nervosa in online communities—A Reddit analysis

The present study analysed individual experiences of orthorexia nervosa (ON), a term commonly associated with obsessive health behaviors. With no universal definition available in research or practice, this study aimed to analyse six months of publicly available Reddit data to identify common characteristics and perceived causes of ON as reported in eating disorder- (ED) and diet-related subreddits. A Python code was used to extract comments from a publicly available Reddit data archive. To explore themes for each category of subreddit, a text-mining approach was combined with thematic analysis within a social constructionist framework. In both subreddit categories, the manifestation of ON was conceptualized in the context of shifting ED expressions and associated with the perception of food as a threat as well as the pursuit of superiority. In ED-subreddits, commenters discussed ON as a safety mechanism for health anxieties, the role of the body as visualising ON, and ON’s role within a proactive selfcare culture. Diet-related subreddit themes encompassed the conceptualization of ON as health perfectionism, ON’s underlying mental health concerns, and ON pathology as the result of problematic norms. The analysis of 246 online comments revealed a wide scope of ON conceptualizations and highlighted the need for a coherent diagnostic model of ON, which takes into account sociocultural as well as individual factors

Associations between the use of fitness and diet tracking technology and disordered eating behaviour. A systematic review

The practice of tracking one’s food intake and physical activity through the use of a wearable device or a smartphone application has become increasingly popular. There are concerns use of this technology may be associated with disordered eating behaviours. Particularly for vulnerable groups such as young adults and individuals with a pre-existing eating psychopathology. This study aims to systematically review the current literature investigating this association. This review aims to investigate the following research questions: 1. Is there an association between the use of fitness and diet tracking technology and disordered eating? 2. Are there vulnerable groups who are at a greater risk of negative outcomes of this technology use? Studies will be included in the review if they meet set eligibility criteria. Studies must (1) include a measure of fitness and/or diet tracking used in the context of self-monitoring; (2) include a measure of disordered eating symptomatology; (3) contain quantitative research, and (4) be written in English. The following electronic databases will be searched: PsycInfo, MEDLINE/PubMed, CINAHL Plus (Cumulative Index to Nursing and Allied Health Literature), Scopus, EMBASE, ASSIA (Applied Social Science Index and Abstracts), Cochrane Library, Sociological Abstracts and ERIC, ProQuest Dissertation and Theses Global, Sports Medicine & Educational Health, and SportDiscus. Quality of the studies will be assessed using the NIH Quality Assessment Tool. Preliminary searches were run with databases being examined from January 2005 (this is when fitness and diet tracking technology came into use) to September 2021 as part of a Masters project. The searches will now be updated and run from January 2005 to the current date (February 2023) to ensure continuity

Severe pneumonia during primary infection with an atypical strain of Toxoplasma gondii in an immunocompetent young man.

International audienceWe report a case of severe acute primary pulmonary toxoplasmosis in an immunocompetent young man living in Nice (Southern France). The Toxoplasma DNA extracted from the broncho-alveolar lavage fluid allowed a genetic characterization of the responsible strain which displayed an atypical genotype of Toxoplasma gondii. This unusual genetic composition of the parasite may have influenced, among other factors, the severity of the disease

PRE-PRINT Associations between the use of fitness and diet tracking technology and disordered eating behaviour: A systematic review.

Abstract Background: The past 15 years have seen exponential growth in the fitness and well-being device industry aiming to improve health and fitness. However, concerns are emerging regarding the possible negative effects of fitness and diet trackers (FDT1) and whether they may increase disordered eating behaviours. The current review is the first to systematically examine the relationship between FDT use and disordered eating in both general and clinical populations. Methods: The following databases were searched: EMBASE, Medline/PubMed, PsychInfo, CINAHL Plus, ERIC, SportDiscus, ASSIA, Social Science Premium, Sociological Abstracts, Sports Medicine and Educational Health, SCOPUS, Cochrane Library, and ProQuest Dissertation and Theses Global. A date limit was set to 2005 onwards when FDT were first introduced. Studies were eligible if they were quantitative, written in English, and included both a measure of disordered eating behaviours and FDT use. A narrative synthesis was used and separated results by disordered eating outcomes. Results: 17 studies were included in the final review with heterogeneous results. Cross-sectional studies revealed reasonably consistent evidence of an association between disordered eating and FDT use, specifically regarding global disordered eating, dietary restraint, excessive exercise, and disordered muscle-orientated behaviour. However, this association was not consistently replicated as in experimental research. Conclusion: The results of the current review reveal that while FDT use is a correlate of disordered eating, it is currently not possible to conclude if FDT increase disordered eating or the direction of this relationship. Future research is needed to determine the nature of this relationship and the possible mechanisms. Given this, caution should be exercised by those promoting use of these devices and using them in research