Changes in BMI-distribution from 1966–69 to 1995–97 in adolescents. The Young-HUNT study, Norway

Background The aim of this study was to explore changes in the BMI-distribution over time among Norwegian adolescents. Methods Height and weight were measured in standardised ways and BMI computed in 6774 adolescents 14–18 years who participated in the Young-HUNT study, the youth part of the Health-study of Nord-Trondelag County, Norway in 1995–97. The results were compared to data from 8378 adolescents, in the same age group and living in the same geographical region, collected by the National Health Screening Service in 1966–69. Results From 1966–69 to 1995–97 there was an increased dispersion and a two-sided change in the BMI-distribution. Mean BMI did not increase in girls aged 14–17, but increased significantly in 18 year old girls and in boys of all ages. In both sexes and all ages there was a significant increase in the upper percentiles, but also a trend towards a decrease in the lowest percentiles. Height and weight increased significantly in both sexes and all ages. Conclusion The increased dispersion of the BMI-distribution with a substantial increase in upper BMI-percentiles followed the same pattern seen in other European countries and the United States. The lack of increase in mean BMI among girls, and the decrease in the lowest percentiles has not been acknowledged in previous studies, and may call for attention

Eating- and weight problems in adolescents : The Young-HUNT study

Background Body shape and size have through centuries mediated important messages of both social status and health. A well-nourished body has been associated with status and wealth, while underweight has indicated poverty and poor health. The increasing welfare after the Second World War seemed to change the language of the body shape and size. The lean body became the ideal, and overweight and obesity became associated with lower social status and unhealthy lifestyle. Eating problems developed especially among adolescents in the western world in the same time-frame with substantial changes in diet and physical activity resulting in increased prevalence of overweight and obesity. Both eating problems and weight problems reduce quality of life, and may lead to several serious disorders in adulthood. To be able to prevent these health problems in adolescents it is important to follow the prevalence of eating problems as well as overweight and obesity, using repeated measures with the same methods and definitions. Little focus has been on sex differences in eating problems as this often has been treated as a female issue. There has also been little focus on sex differences in the prevalence of overweight and obesity. Aim With focus on sex differences, the aim of this study was first to assess the prevalence of eating problems in adolescents and the significance of different definitions used (Paper I). A second aim was to evaluate changes in the BMI-distribution and prevalence of overweight and obesity in the same geographical area during a period of 30 years (Paper II and III). The last aim was to evaluate the associations between weight problems (underweight, overweight and obesity) and psychological factors like anxiety, depression, self esteem, eating problems and personality, and to study the significance of these psychological factors on weight change during adolescence (Paper IV). Material and Methods Data from Young-HUNT 1 (the youth part of The Nord-Trøndelag Health Study1995-97) was used to assess the prevalence of eating problems and to study associations between weight problems and psychological factors including eating problems. Totally, 8090 adolescents (4018 boys and 4072 girls) aged 13-18 years completed the Young-HUNT questionnaire and had their height and weight measured in the clinical part of the study. To evaluate changes in the BMI-distribution and the prevalence of overweight and obesity, data from adolescents aged 14-18 years in Young-HUNT 1 (3307 boys and 3367 girls) was compared to data from 4372 boys and 4006 girls in the same age group, collected in the same geographical area by the National Health Screening Service in 1966-69. Among the participants in Young- HUNT 1, 1619 adolescents (747 boys and 872 girls) participated in Young- HUNT 2 four years later (2000-01), and had their height and weight measured. Data from Young- HUNT 1 was used to study the possible influence from psychological factors on weight change during adolescence (from Young-HUNT 1 to Young- HUNT 2). Results The prevalence of eating problems varied depending on the definitions used, with 47 % of the girls and 30% of the boys fulfilling at least one criterion for eating problem. The overlap between the different definitions was low indicating that the various definitions capture different eating features. The various definitions also gave different gender rations, but always with higher prevalence in girls compared to boys, and increasing with age in girls only. In 1995-97 17.2 % of adolescents in Nord-Trøndelag fulfilled the criteria for overweight or obesity, a 60 % increase from 1966-69 when the prevalence in the same age group was 10.7%. The extent of overweight and obesity had also increased, and the increase in both prevalence and extent was most prominent in boys. The change in the BMI-distribution during the same time period showed an increased dispersion and a two-sided change with a significant increase in the upper percentiles and a trend towards a decrease in the lowest percentiles, i.e the thinnest adolescents were thinner, while the most overweight were fatter. Mean BMI in girls did not increase in this period. Eating problems were associated with weight problems, and the two factors oral control (EAT-A) and food preoccupation (EAT-B) demonstrated an inverse association. Oral control was associated with underweight, while food preoccupation was associated with overweight and obesity. Low self-esteem was also associated with overweight and obesity. Oral control protected against unhealthy weight gain, but predicted unhealthy weight reduction. No psychological factors were found to predict healthy weight reduction. Conclusions Eating- and weight problems were common in the adolescent population, but varied with definition and in degree. Eating problems were more frequent in girls, but weight gain was more prominent in boys. Eating problems were associated with weight problems, and also with weight change. It is important to prevent these health problems in adolescents, and effective preventive strategies need to focus on sex differences and to bear in mind the associations between psychological factors and weight problems

Validation of the exercise and eating disorders questionnaire

Objective Compulsive exercise is a well-known feature in eating disorders. The Exercise and Eating Disorder (EED) self-report questionnaire was developed to assess aspects of compulsive exercise not adequately captured by existing instruments. This study aimed to test psychometric properties and the factor structure of the EED among women with eating disorders and a control group. Method The study included 449 female participants, including 244 eating disorders patients and 205 healthy controls. The patient group consisted of 32.4% (n = 79) AN patients, 23.4% (n = 57) BN, 34.4% (n = 84) EDNOS and 9.8% (n = 24) with BED diagnosis. Results The analyses confirmed adequate psychometric properties of the EED, with a four-factor solution: (1) compulsive exercise, (2) positive and healthy exercise, (3) awareness of bodily signals, and (4) weight and shape exercise. The EED discriminated significantly (p < .001) between patients and controls on the global score, subscales, and individual items. Test-retest reliability was satisfactory (r = 0.86). Convergent validity was demonstrated by high correlations between the EED and the Eating Disorder Examination Questionnaire (EDE-Q; r = 0.79). Discussion The EED is the first clinically derived, self-report questionnaire to assess compulsive exercise among ED patients. The EED offers assessment that has broader clinical utility than existing instruments because it identifies treatment targets and treatment priorities. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:983–993)

Validation of the exercise and eating disorders questionnaire

Objective: Compulsive exercise is a well-known feature in eating disorders. The Exercise and Eating Disorder (EED) self-report questionnaire was developed to assess aspects of compulsive exercise not adequately captured by existing instruments. This study aimed to test psychometric properties and the factor structure of the EED among women with eating disorders and a control group. Method: The study included 449 female participants, including 244 eating disorders patients and 205 healthy controls. The patient group consisted of 32.4% (n = 79) AN patients, 23.4% (n = 57) BN, 34.4% (n = 84) EDNOS and 9.8% (n = 24) with BED diagnosis. Results: The analyses confirmed adequate psychometric properties of the EED, with a four-factor solution: (1) compulsive exercise, (2) positive and healthy exercise, (3) awareness of bodily signals, and (4) weight and shape exercise. The EED discriminated significantly (p < .001) between patients and controls on the global score, subscales, and individual items. Test-retest reliability was satisfactory (r = 0.86). Convergent validity was demonstrated by high correlations between the EED and the Eating Disorder Examination Questionnaire (EDE-Q; r = 0.79). Discussion: The EED is the first clinically derived, self-report questionnaire to assess compulsive exercise among ED patients. The EED offers assessment that has broader clinical utility than existing instruments because it identifies treatment targets and treatment priorities. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:983–993)

How to integrate physical activity and exercise approaches into inpatient treatment for eating disorders: fifteen years of clinical experience and research

Background The importance of physical activity and exercise among patients with eating disorders (EDs) is acknowledged among clinicians and researchers. The lack of clinical guidelines, the differing attitudes towards exercise approaches in treatment, and the lack of specialized competence all influence the management of ED symptoms in specialist ED treatment units. The purpose of the study was to examine 15 years of clinical experience with exercise approaches as an integrated part our inpatients treatment program. Methods From January 2003 to December 2017, 244 patients were admitted to a specialist ED unit in Norway. The treatment program at the ED unit is multidisciplinary. It is based on psychodynamic theory, and designed to enhance patients’ recovery and to enable them to adopt a lifestyle that is as healthy as possible. The authors describe the clinical management of patients with reference to practical examples and a case example. Recommendations and experience The treatment for exercise is not manualized, but adjusted to the specific symptoms and needs of individual ED patients. The treatment approaches to exercise are part of the body-oriented treatment at the Specialist eating disorder unit (Regionalt kompetansesenter for spiseforstyrrelser (RKSF)), and the therapy addresses the entire body and the relation between the body, emotions, and the patient’s social situation. It covers a chain of approaches from admission to discharge, from rest and relaxation to regular exercise groups. Conclusions Our experience and recommendations support earlier proposals for treatment approaches to exercise and exercise-related issues as a beneficial supplement to the treatment of ED inpatients. We have not experienced any adverse influences on patients’ recovery processes, such as their rate of weight gain. Our intention is that this paper will be a contribution to the field of ED, the integration of exercise approaches in the inpatient treatment of ED and development of clinical guidelines

Impact of female adult eating disorder inpatients' attitudes to compulsive exercise on outcome at discharge and follow-up

Background The link between compulsive exercise and eating disorders is well known, but research with clinical samples has been limited. The purpose of the study was to investigate changes in attitudes towards compulsive exercise and its impact on outcome at follow-up in female adult hospitalised patients with eating disorders. Methods The sample consisted of 78 patients: Diagnostic distribution: anorexia nervosa 59 % (n = 46), approximately 22 % (n = 16) in bulimia nervosa, and Eating Disorder not Otherwise Specified respectively. The average follow-up period was 26 months (SD =15 months). Compulsive exercise was measured by the Exercise and Eating Disorder (EED) questionnaire. Other measures were the Eating Disorder Inventory (EDI-2), Body Attitude Test (BAT), Symptom Checklist (SCL-90), Inventory of Interpersonal Problems (IIP 64), Beck Depression Inventory (BDI), and body mass index (BMI). Outcome measures were EDI-2 and BMI (patients with admission BMI ≤ 18.5). Paired sample t-tests and mixed model regression analysis were conducted to investigate changes in compulsive exercise and predictors of outcome respectively. Results All measures revealed significant improvements (p < .01 – p < .001) from admission to follow-up. EED scores significantly predicted changes in EDI-2 scores and BMI (p < .01 and p < .001 respectively). Other significant predictors were BAT, SCL-90, IIP-64, BMI (p < .01–.001) (EDI-2 as outcome measure), and BAT and BDI (p < .001) (BMI as outcome measure). Conclusions The results demonstrated significant improvements in attitudes towards compulsive exercise during treatment and follow-up. The change in compulsive exercise scores predicted the longer-term course of eating disorder symptoms and BMI

Changes in BMI-distribution from 1966–69 to 1995–97 in adolescents. The Young-HUNT study, Norway

Abstract Background The aim of this study was to explore changes in the BMI-distribution over time among Norwegian adolescents. Methods Height and weight were measured in standardised ways and BMI computed in 6774 adolescents 14–18 years who participated in the Young-HUNT study, the youth part of the Health-study of Nord-Trondelag County, Norway in 1995–97. The results were compared to data from 8378 adolescents, in the same age group and living in the same geographical region, collected by the National Health Screening Service in 1966–69. Results From 1966–69 to 1995–97 there was an increased dispersion and a two-sided change in the BMI-distribution. Mean BMI did not increase in girls aged 14–17, but increased significantly in 18 year old girls and in boys of all ages. In both sexes and all ages there was a significant increase in the upper percentiles, but also a trend towards a decrease in the lowest percentiles. Height and weight increased significantly in both sexes and all ages. Conclusion The increased dispersion of the BMI-distribution with a substantial increase in upper BMI-percentiles followed the same pattern seen in other European countries and the United States. The lack of increase in mean BMI among girls, and the decrease in the lowest percentiles has not been acknowledged in previous studies, and may call for attention.</p

Validation of the exercise and eating disorder questionnaire in males with and without eating disorders

Objective The need to consider gender when studying exercise in eating disorder (ED) has been underscored. The study aimed to test the psychometric properties and factor structure of the exercise and eating disorder (EED) questionnaire for males with and without ED, to highlight gender differences, and to explore issues relevant for a male version of the EED questionnaire. Method This cross sectional study included 258 male participants: 55 ED patients (inpatients and outpatients) and 203 student controls. The patient group consisted of 54.5% (n = 30) with AN, 18.2% (n = 10) with BN, 27.2% (n = 15) with unspecified ED. The ED sample was treated as transdiagnostic in all analyses. t Tests, chi‐square test, correlations analyses, and a principal component analysis were conducted. Results The analyses confirmed that the EED questionnaire had adequate psychometric properties, and a four‐factor solution: (a) compulsive exercise, (b) positive and healthy exercise, (c) awareness of bodily signals, and (d) weight and shape exercise. The questionnaire discriminated significantly (p < .01– < .001) between patients and controls on the global score, subscales, and 16 out of 18 individual items. Convergent validity was demonstrated by high correlations between the EED questionnaire and the eating disorder examination questionnaire (r = .65). Discussion The results indicated that the EED questionnaire is a valid and reliable tool for males. It is a clinically derived, self‐report questionnaire to assess compulsive exercise among ED patients, regarding attitudes and thoughts toward compulsive exercise and identification of treatment targets and prioritie