Journal articles on the topic 'Dysfunctional eating attitudes'

This study aims to examine the differences in family environment, psychological distress, and disordered eating symptomatology between children classified by weight status with or without loss of control (LOC) eating and to test a model of the role of emotional regulation of LOC eating based on a dysfunctional family environment. A cross-sectional study was conducted among 239 families. The assessment measured family expressed emotion, family adaptability and cohesion, child levels of depression and anxiety, body esteem, and disordered eating attitudes. The assessment was carried out in primary care centers and primary schools. Child body mass index (BMI) was associated with higher expressed emotion, psychological distress, and disordered eating symptomatology. Children with obesity and LOC presented higher BMI, poorer body esteem, and more disordered eating attitudes than children without LOC. Children with overweight/obesity, both with or without LOC, exhibited higher psychological distress and emotional overinvolvement than normal-weight children. A partial mediation of depression or anxiety and disordered eating attitudes between expressed emotion and LOC was found. Findings support that children with overweight/obesity show more family and psychological distress. Body esteem issues and disordered eating attitudes could alert the presence of LOC in children with obesity. The function of LOC might be to cope with psychological distress that may appear in a dysfunctional family environment.

AbstractThe extent to which 113 adolescent Malay women studying in Australia expressed the desire to lose weight was examined, as was the degree to which this desire reflected a genuine need to lose weight. Comparisons between participants who expressed the desire to either lose weight, stay at their current weight, or gain weight were made using both attitudinal and behavioural components of body image. An in-depth analysis of those who wished to lose weight was also undertaken. There was evidence that negative body attitudes were in excess of what actual body weight might dictate. However, these negative attitudes were not found to be consistently predictive of dysfunctional eating behaviours. Results were interpreted with reference to the potential influence of Westernisation in countries in the South Pacific region, and in particular how attitudes and behaviours are influenced by this process.

Eating disorders (EDs), such as anorexia, bulimia, and bingeeating disorder, involve extreme emotions, attitudes, and behaviors surrounding weight, food, and body image, all of which can lead to destructive health consequences. While EDs have innumerable effects on affected individuals, less is known about the consequences for the offspring of childbearing women with past or current EDs. Children of mothers with EDs are at increased risk of various problems during gestation and childhood, including higher rates of miscarriage, cesarean-section deliveries, and stillbirth; greater likelihood of preterm delivery, small- or large-for-gestational-age, low or high birth weight, and growth disturbances; and lower likelihood of being breastfed. These children are also more likely to develop dysfunctional eating habits, behaviors, and attitudes throughout adolescence. Possible effects of maternal EDs on parenting include withholding food from children, using food to reward or punish, a preoccupation with weight interfering with the mother’s responsiveness to her child, failure to express positive attitudes toward eating, and higher tension during mealtimes. These risks are influenced by a variety of factors and the consequences for children are difficult to predict. Complicating matters, the foundations of an ED are established long before diagnosis. The familial setting provides a unique opportunity for integrated and concurrent primary and tertiary ED-prevention strategies for both child and mother. It is imperative for healthcare providers to consider the potential value of educational programs and support for mothers with EDs, as early intervention could interrupt the cycle of risk associated with eating disorders and their effects on the developing child.

Concern about body weight and shape is commonly allied with dysfunctional self-concepts and eating behaviour. When provided with group therapy structured around written handouts addressing these problems, women referred for weight control have improved in their self-esteem, assertiveness, attitudes to body size, control of emotional eating, self-efficacy about weight and susceptibility to cyclic dieting, improvements which were maintained to follow-up. The present study examined the effects of the handouts alone on 27 women who actively attempted to control their weight. Relative to a sample matched for initial scores on the target variables, reported incidences of emotional eating and vigour of dieting were significantly reduced over a period of one year in the sample who received the bibliotherapy. Also, perceived body size, weight assertiveness, self-efficacy about weight control and body mass index all moved in the predicted direction, relative to controls, but not to a statistically significant degree. Such bibliotherapy on eating and shape is recommended as an adjunct to group or individual psychotherapy or to initiate change in clients waiting for professional counsel.

Despite a dramatic increase in research on eating-related pathologies, gaps remain in our understanding of the factors responsible for the development and maintenance of dysfunctional attitudes and behaviour related to weight and eating among adolescents. A study was therefore conducted to compare eating and weight concerns among underweight, normal-weight and obese affluent adolescent girls in New Delhi. The sample comprised fifty underweight, fifty normal-weight and thirty obese girls, 16–18 years of age. Information was collected about their body image perception, weight concerns and eating attitudes by a well-structured questionnaire. Dietary intake was determined by 24 h recall and a food-frequency questionnaire. Body size was adjudged by measurements of weight, height, waist, hip and mid upper arm circumferences, and the BMI and waist : hip ratio were determined. Of the subjects, 99·2 % had a gynoid pattern of fat distribution. Concerns about excess weight were prevalent among the adolescent girls, even among those who were normal-weight and underweight. The level of satisfaction with body size decreased with increase in weight. Dieting behaviour was reported in a higher number of obese (76·6 %) compared with normal-weight (38 %) and underweight (14 %) girls. Of the obese girls, 43·3 % were found to be at a significantly (P=0·00109) greater risk of developing anorexia in the future. Characteristic dietary features of adolescence, such as missing meals, snacking and eating out, were observed. While the diets of most of the subjects were adequate in Ca, thiamin, riboflavin and vitamin C, they were found to be deficient in energy, protein, Fe, niacin, vitamin A and fibre. Thus, it is important to recognize that weight concerns and dissatisfaction with body size may pose a threat to a healthy nutritional state, and may develop into precursors of a later eating disturbance.

Abstract The аim is to study family influence on formation of eating and weight disorders. The concept of an “alimentary family” is defined as a family with dysfunctional, disharmonious relationships, which is a prerequisite for emergence and support of distorted patterns of eating behaviour, leading in the future to children’s eating and weight disorders. Methods: The research was carried out using the method of a thematic retrospective analysis (MTRA)-food, which is a variant of the narrative method, the questionnaire “Parental convictions and control tactics as for eating behaviour of their children during food taking”. The data was processed by the content analysis method; Fisher’s φ-criterion was used to compare differences between the groups. Results: The research has allowed us to clarify eating behavioural characteristics and to identify the “roots” of eating disorders. Various forms of forcing at eating, direct and indirect ways of making children to eat or blocking of eating are manifested in ignoring of children’s taste preferences, their desire and readiness to eat. Parents often use manipulative techniques influencing children’s eating behaviour (encouragement, inducement, reward promises, approval, recognition, warning, or switching attention), direct means of influence (coercion: prohibition, restriction, rejection, destructive criticism, intimidation, deprivation from various pleasures). There is the statistical confirmation that parents’ use of manipulative means and / or direct coercion towards their children during eating predetermines formation of pathological processes of corporeality, attitudes and psychological mechanisms stipulating eating disorders. Conclusions: The research results indicate necessity to develop psychotherapeutic programs for people with eating disorders, as well as programs to help parents improve family relationships and, accordingly, to apply correctional effects on their children.

The growing number of women, who are characterized by restrictive and bulimic behaviours towards their own body is observed especially in countries influenced by Westernalization. However, there is a lack of cross-cultural studies in this area. The main aim of the present study was to examine the psychological and socio-cultural risk factors for eating disorders in Polish and Japanese women. A cross-sectional research study was conducted among 18- to 29-year old Polish (n = 89) and Japanese (n = 97) women. The variables were measured using the Sociocultural Attitudes Towards Appearance Scale SATAQ-3, and the Eating Disorders Inventory EDI-3. The descriptive and comparative statistics, Spearman’s rho, and the stepwise regression analysis were used. The global internalization of socio-cultural standards of body image proved to be a significant predictor of Body Dissatisfaction among Polish and Japanese women. The main analysis showed a significant relation between the Drive for Thinness and Interoceptive Deficits in the group of Japanese women, as well as a correlation between Drive for Thinness and Asceticism in the group of Polish women. The obtained results could improve the prevention aimed the dysfunctional eating behaviours. However, the cultural nuances need to be considered in understanding the risk factors for eating disorders.

SynopsisPrevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18–64 was 1·0% and this was concentrated in young women: in women aged 18–44 lifetime prevalence was 2·6%, and 1·0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0·5%, for DSM-III it was 0·2%, and for Russell's Criteria bulimia nervosa 0·0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.

Self-esteem changes among adult women who had been practicing seido karate for at least six months and had acquired the perceived ability to physically self-defend were examined in this study. The research site was a feminist martial arts dojo for women in a midwestern state. Thirty women, aged 26-62, participated in strucured interviews. All of the women perceived improvements in self-esteem after participating in martial arts training for at least six months. These self-esteem changes were perceived to be related to improvement in physical self-perception. Recovery from psychosexual abuse, eating disorders, substance abuse, and growing up in dysfunctional families was another commonly perceived consequence of martial arts training, and most of the participants who had experienced such problems believed their martial arts practice was a valuable adjunct to traditional therapeutic approaches. Significantly, however, they viewed certain aspects of the feminist environment, particularly its gynocentricity, as essential to the self change process. A relationship between the martial arts experience, particularly gaining the ability to defend oneself physically, and other attitudes and behaviors related to self-perception is suggested.

Fears about sexual maturity and intimacy were among early explanations for the etiology of eating disorders and related concerns, and research with clinical samples revealed a relationship between eating disorders and atypical sexual experiences. In contrast, feminist scholars offer explanations for both eating disorders and sexual dysfunction that emphasize societal pressures. As an alternative approach to understanding these difficulties, the authors empirically explored the relationship between the cognitive and affective aspects of sexuality and disordered eating among a nonclinical sample of 167 university women. Participants completed the Eating Attitudes Test–Revised and the Garos Sexual Behavior Index–Research Version. Women who experienced greater psychic conflict about their sexual behavior, obsessiveness about sex, and discomfort with sexual stimulation also reported increased levels of disordered eating behavior. These results suggest a need to consider the potential disturbances in certain cognitive and affective aspects of sexual functioning when treating women with disordered eating.

Abstract Context: Prior authors have reported associations among increased risk of injury and factors of the female athlete triad, as defined before the 2007 American College of Sports Medicine position stand, in collegiate and adult club sport populations. Little is known about this relationship in an adolescent competitive sports population. Objective: To examine the relationship among disordered eating, menstrual dysfunction, and low bone mineral density (BMD) and musculoskeletal injury among girls in high school sports. Design: Prospective cohort study. Setting: The sample consisted of 163 female athletes competing in 8 interscholastic sports in southern California during the 2003–2004 school year. Each participant was followed throughout her respective sport season for occurrence of musculoskeletal injuries. Main Outcome Measure(s): Data collected included daily injury reports, the Eating Disorder Examination Questionnaire that assessed disordered eating attitudes and behaviors, a dual-energy x-ray absorptiometry scan that measured BMD and lean tissue mass, anthropometric measurements, and a questionnaire on menstrual history and demographic characteristics. Results: Sixty-one athletes (37.4%) incurred 90 musculoskeletal injuries. In our BMD z score model of ≤−1 SD, a history of oligomenorrhea/amenorrhea during the past year and low BMD (z score ≤−1 SD) were associated with the occurrence of musculoskeletal injury during the interscholastic sport season. In our BMD z score model of ≤−2 SDs, disordered eating (Eating Disorder Examination Questionnaire score ≥4.0), a history of oligomenorrhea/amenorrhea during the past year, and a low BMD (z score ≤−2 SDs) were associated with musculoskeletal injury occurrence. Conclusions: These findings indicate that disordered eating, oligomenorrhea/amenorrhea, and low BMD were associated with musculoskeletal injuries in these female high school athletes. Programs designed to identify and prevent disordered eating and menstrual dysfunction and to increase bone mass in athletes may help to reduce musculoskeletal injuries.

SynopsisAbnormalities in central serotonin function have been implicated in the pathogenesis of anorexia nervosa. It is difficult, however, to separate neuroendocrine abnormalities induced by weight loss and malnutrition from those related primarily to the disorder itself. To minimize these influences, this study assessed long-term weight restored anorexics. A correlation between persistent eating-related psychopathology, co-morbid illness and serotonin dysfunction was sought. Nine female weight-restored out-patients who had previously fulfilled DSM-III-R criteria for anorexia nervosa and nine healthy controls participated. Following baseline estimation, prolactin and cortisol responses to 30 mg p.o. ofD-fenfluramine were measured over a 5 h period. Eating related psychopathology was assessed using the Eating Disorders Inventory and Eating Attitudes Test. Depressive and obsessional symptoms were measured using the Beck Depressive and Maudsley Obsessive–Compulsive Inventories respectively. The Tridimensional Personality Questionnaire assessed impulsivity. The weight-restored anorexic group exhibited persistent eating-related psychopathology and significant co-morbid symptomatology. There was no difference between long-term weight restored anorexics and controls in their endocrine response toD-fenfluramine. Long-term weight-recovered anorexic subjects continued to exhibit behavioural and attitudinal disturbances characteristic of anorexia nervosa. The results suggest that abnormalities in 5HT activity do not contribute significantly to trait status in anorexia nervosa.

Background. The aim of the study was to establish the perceptions of lifestyles among middle-aged obese women. Methods. Data collection method was semi-structured face-to-face interview. Interview guide was based on short form 36 (SF-36), long form of IPAQ and previous research (Bukman et al., 2014). Results. All obese women of our study feel inferiority complex due to their physical appearance, feel dissatisfied with themselves trying to hide their appearance, discomfort, and disadvantages. They have a lot of health problems: joint pain, increased cholesterol level, increased blood pressure, heart beat rate, dyspnoea, as well as chronic diseases such as type 2 diabetes, thyroid gland dysfunction and sleep disorders. All the subjects both had poor eating habits and ate inadequate food. Some of the participants ate a lot before bedtime and skip breakfast. The physical activity is limited and reduced of all subjects. Conclusions. The relationship between excess weight and psychological well-being is complex, encompassing physical, social and psychological factors. All obese women of our study feel inferiority complex due to their physical appearance, dissatisfied with themselves. They complained of cardiovascular problems, sleep disorders and chronic diseases. The physical activity was limited and decreased. Also, such a great weight excess caused a discomfort in their daily life. Obese women in our study negatively view smoking effects, but they tolerate or even have positive attitudes to alcohol consumption, though they acknowledge that alcohol increases their weight. Malnutrition is most common problem of our respondents. They both had poor eating habits and ate inadequate food. Some of the participants ate a lot before bedtime and skip breakfast. A lot of participants reported about their negative attitude to their diet, but this attitude did not always act like a stimulus to change. Most of respondents could not find the time or motivation to engage in the adequate physical activity. They wanted to increase their physical activity, but found excuses not to do that – their excess of weight, lack of time, as well as laziness, passivity - the main causes of their inactivity or poor physical activity.

This study examined the prevalence of and relationship between the disorders of the female athlete triad in collegiate athletes participating in aesthetic, endurance, or team/anaerobic sports. Participants were 425 female collegiate athletes from 7 universities across the United States. Disordered eating, menstrual dysfunction, and musculoskeletal injuries were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), and the Eating Disorder Inventory Body Dissatisfaction Subscale (EDI-BD). The percentage of athletes reporting a clinical diagnosis of anorexia and bulimia nervosa was 3.3% and 2.3%, respectively; mean (±SD) EAT and EDI-BD scores were 10.6 ± 9.6 and 9.8 ± 7.6, respectively. The percentage of athletes with scores indicating “at-risk” behavior for an eating disorder were 15.2% using the EAT-26 and 32.4% using the EDI-BD. A similar percentage of athletes in aesthetic, endurance, and team/anaerobic sports reported a clinical diagnosis of anorexia or bulimia. However, athletes in aesthetic sports scored higher on the EAT-26 (13.5 ± 10.9) than athletes in endurance (10.0 ± 9.3) or team/anaerobic sports (9.9 ± 9.0, p < .02); and more athletes in aesthetic versus endurance or team/anaerobic sports scored above the EAT-26 cut-off score of 20 (p < .01). Menstrual irregularity was reported by 31% of the athletes not using oral contraceptives, and there were no group differences in the prevalence of self-reported menstrual irregularity. Muscle and bone injuries sustained during the collegiate career were reported by 65.9% and 34.3% of athletes, respectively, and more athletes in aesthetic versus endurance and team/anaerobic sports reported muscle (p = .005) and/or bone injuries (p < .001). Athletes “at risk” for eating disorders more frequently reported menstrual irregularity (p = .004) and sustained more bone injuries (p = .003) during their collegiate career. These data indicate that while the prevalence of clinical eating disorders is low in female collegiate athletes, many are “at risk” for an eating disorder, which places them at increased risk for menstrual irregularity and bone injuries.

IntroductionGender is crucial in many aspects of life, including attitude towards body image perception. Although the well-known female preponderance, recent studies demonstrate an increasing Eating Disorders (EDs) incidence in males but scant literature attention.AimsThis study aims to highlight the growing phenomenon of EDs in males and shed light on sex-related clinical features and psychiatric comorbidities.MethodOut of 280 persons aged 18–74, consecutively referred to Bologna's outpatients EDs clinic, 267 were included in this retrospective observational study.ResultsThe men/women ratio was one to five. The most frequent EDs in males was Binge Eating Disorder, whereas in females Anorexia Nervosa and Bulimia Nervosa prevailed. Excessive exercising and fasting were the most common dysfunctional behaviors in men, while self-induced vomiting and laxative-diuretic abuse were more typical in women. Mood and Somatoform Disorders were more common in women, whereas Anxiety and Psychosis Disorders in males. Within personality disorders, borderline and histrionic prevailed in female, while narcissistic and anti-social in males.ConclusionsMale compared to female EDs, show differences in clinical presentation, symptoms and comorbidities. The increased proportion of affected men should alert general practitioners, clinicians and psychologists working in non-specialized settings to be more aware of the possibilities of encountering an ED in men and of the need of exploring the eating habits in all male patients. The finding of a more pronounced physical hyperactivity in men in order to achieve an ideal body shape which is muscular and athletic suggests the need of a deeper attention to sex-different symptoms and behaviors declination.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Purpose:Prevention of the female athlete triad is essential to protect female athletes’ health. The aim of this study was to investigate the knowledge, attitudes, and behaviors of regularly exercising adult women in Australia toward eating patterns, menstrual cycles, and bone health.Methods:A total of 191 female exercisers, age 18–40 yr, engaging in ≥2 hr/wk of strenuous activity, completed a survey. After 11 surveys were excluded (due to incomplete answers), the 180 participants were categorized into lean-build sports (n = 82; running/athletics, triathlon, swimming, cycling, dancing, rowing), non-lean-build sports (n = 94; basketball, netball, soccer, hockey, volleyball, tennis, trampoline, squash, Australian football), or gym/fitness activities (n = 4).Results:Mean (± SD) training volume was 9.0 ± 5.5 hr/wk, with participants competing from local up to international level. Only 10% of respondents could name the 3 components of the female athlete triad. Regardless of reported history of stress fracture, 45% of the respondents did not think that amenorrhea (absence of menses for ≥3 months) could affect bone health, and 22% of those involved in lean-build sports would do nothing if experiencing amenorrhea (vs. 3.2% in non-lean-build sports, p = .005). Lean-build sports, history of amenorrhea, and history of stress fracture were all significantly associated with not taking action in the presence of amenorrhea (all p < .005).Conclusions:Few active Australian women are aware of the detrimental effects of menstrual dysfunction on bone health. Education programs are needed to prevent the female athlete triad and ensure that appropriate actions are taken by athletes when experiencing amenorrhea.

The novel coronavirus disease 2019 (COVID-19) represents a massive global health crisis leading to different reactions in people. Those reactions may be adaptive or not depending on situational or psychological processes. Disordered eating attitudes and behaviors are likely to be exacerbated by the pandemic through multiple pathways as suggested by Rodgers et al. (2020). Among the psychological variables that may have increased dysfunctional eating attitudes and behaviors as a consequence of the social distancing and isolation, we looked at perfectionism. Perfectionism is a well-recognized risk and maintaining factor of eating-related symptoms and interact with stress increasing the probability of dysfunctional reactions (e.g., Wang and Li, 2017). The present study investigated the relationship between multidimensional perfectionism and eating behaviors by considering the mediating role of psychological distress. Data were collected from two countries (Italy and Spain) by means of an online survey. The samples included 465 (63.4% female) participants from Italy and 352 (68.5% female) from Spain. Participants completed the short form of the Hewitt and Flett Multidimensional Perfectionism Scale (Lombardo et al., 2021) to assess self-oriented, other-oriented and socially prescribed perfectionism, as well as the short form of Three Factors Eating Questionnaire (Karlsson et al., 2000) and the Italian version of Depression Anxiety and Stress Scale-21 (Bottesi et al., 2015), respectively used to assess restrictive, emotional and uncontrolled eating on one hand, and depression, anxiety and stress on the other. Multigroup analysis was performed to test the hypothesized model. Results showed that other-oriented and socially prescribed perfectionism were indirectly related to most of the dysfunctional eating aspects through the mediation of psychological distress, and the pattern obtained was consistent in both countries. These findings evidence that the psychological distress potentially related to the COVID-19 disease mediates the negative impact of interpersonal perfectionism and the tendency to eat in response to negative emotions.

Abstract Purpose: The etiology of functional hypothalamic amenorrhea (FHA) can involve both metabolic and psychogenic stressors. The role of metabolic stress has been described in exercising women who develop FHA secondary to chronic energy deficiency attributable to inadequate dietary intake in the face of exercise training. The potential for psychological factors to contribute to exercise-related FHA is unknown. Methods: In our cross-sectional comparison of exercising women ((n=61), exercise ≥2 hours/week, age 18-35 years, BMI 16-25 kg/m2, we tested whether psychological factors discriminated participants who were deemed eumenorrheic or had FHA as confirmed by physical examination, health history, metabolic and endocrine screening, menstrual calendars and daily urinary collection for reproductive hormone metabolites. Body composition, energy balance, and metabolic and endocrine parameters were assessed in addition to psychological factors (Dysfunctional Attitudes Scale, Brief-Resilient Coping, Daily Stress Inventory, Perceived Stress Scale (PSS), Profile of Mood States (POMS), Beck Depression Inventory) and eating behaviors (Eating Disorder Inventory-2, Three-Factor Eating Questionnaire). Results: Exercising women with FHA had a significantly lower BMI (20.2 vs 21.5 m/kg2, p&lt;0.05), less body fat (22.8 vs 25.8%, p&lt;0.05), and a lower fat mass (56.2 vs 58.3 kg, p&lt;0.05), compared to eumenorrheic women. Fasting total triiodothyronine (75.4 vs 89.8 ng/dL, p&lt;0.001), leptin (5.2 vs 9.0 ng/dL, p&lt;0.01), and the ratio of actual to predicted resting metabolic rate (0.84 vs 0.92, p&lt;0.01) were significantly lower in FHA women. FHA women demonstrated a greater drive for thinness (2.9 vs 2.1, p&lt;0.05), greater dietary cognitive restraint (11.3 vs 7.4, p&lt;0.001), and displayed more dysfunctional attitudes, i.e., need for social approval (39.1 vs 33.7, p&lt;0.05) compared to eumenorrheic women but there were no differences in perceived stress, depression, mood states, brief resilient coping, or daily stress (p &gt;0.05). Notably, FHA women displayed a significant positive correlation between need for social approval and indicators of stress (PSS: r=0.50), depression (Beck: r=0.59), and mood (POMS-depression/dejection: r=0.55), which was not apparent in eumenorrheic women. Additionally, EDI-drive for thinness was significantly positively correlated with many of the variables associated with stress (PSS: r=0.47), depression (Beck: r=0.51), dysfunctional attitudes (r=0.55), and mood disorders (POMS-depression-dejection: r= 0.37; tension/anxiety: r=0.44)(all p&lt;0.05). Conclusion: In exercising women, psychological factors do not overtly discriminate reproductive status; however, in women with FHA, there appears to be a higher need for social approval and restrictive eating behaviors may be related to underlying indicators of psychological stress and depression. US DoD PR054531

Abstract Background Physical activity (PA) is an integral part of healthcare for the general population and individuals with psychiatric disorders. However, PA is significantly more complex for and related to both healthy (e.g., reduced anxiety and depressive symptoms) and unhealthy outcomes (e.g., intrusive, repetitive thoughts that lead to abnormally high levels of PA) among women with an eating disorder (ED). Consequently, many healthcare professionals recommend abstinence from PA during ED treatment. Despite this, women may remain engaged in PA during ED treatment or resume PA shortly thereafter. Little has been done to understand women’s PA behaviors and attitudes and to explore how they integrate PA into their lives during and after ED treatment. Thus, this study sought to explore PA behaviors and attitudes among women with an ED. Methods Nine women who self-reported receiving an ED diagnosis participated in semi-structured interviews, which were transcribed and analysed thematically. Results Six interrelated themes were constructed to represent participants’ PA experiences: PA as a lifestyle, PA can be beneficial, How I feel when I can’t do PA, Being cautious about PA, Reactions to healthcare professionals’ practice of recommending abstinence from PA during ED treatment, and PA programming thoughts. Conclusions Overcoming dysfunctional PA behaviors (e.g., engaging in abnormally high levels of PA) and attitudes (e.g., associating PA with caloric expenditure) can be a long and complicated journey for women with an ED. Nevertheless, women with an ED want PA to be integrated into their ED treatment protocol for two key reasons, namely to accrue the benefits associated with PA and to learn how to engage in PA in adaptive and healthy ways.

Abstract Background and Aims Approaches promoting eating guided by internal cues, such as intuitive eating (IE), have emerged as an alternative to decrease the impact of external cues on eating behavior while simultaneously avoiding the risk for dysfunctional eating. IE helps to connect with internal cues (i.e. hunger and satiety) and feelings rather than relying on external strategies to regulate what, how much and when to eat. In obese women, IE-based approaches have shown to enhance motivation and adherence to lifestyle changes, hence improving metabolic and psychological parameters, quality of life and diet quality. However, studies evaluating IE in chronic kidney disease (CKD) patients are scarce. Thus, we aimed to evaluate the impact of a behavioral multi-session group intervention on IE scores of overweight non-dialysis-dependent (NDD) CKD women. Method This is a prospective non-controlled clinical trial of a behavioral multi-session group intervention for dietary management. It was conducted with overweight women with chronic kidney disease (CKD). Each group comprised 5-8 participants in fifteen weekly or biweekly sessions lasting about 90 minutes. Most of IE principles were discussed throughout the meetings. IE scale 2 (IES2) translated and adapted to Brazilian population and composed of 23 questions with 5-point Likert response scale ranging from 1=“strongly disagree” to 5=“strongly agree” and four-factor model (Unconditional Permission to Eat, Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Body-Food Choice Congruence) was applied before and after the intervention. The higher the score, the higher the intuitive eating attitudes. Results Of the 33 patients that initiated the study, 23 patients [age=62.0 (58.0-68.0) years; schooling= 9.0 (7.0-12.0) years of study; BMI=32.6 (30.2-39.3); eGFR=28.0 (22.0-31.0) ml/min/1.73m²] completed the intervention. Figure 1 shows the results regarding IES2. Conclusion The intervention approaching IE principles was effective to improve IE attitudes in the studied patients. With exception for “body-food choice congruence”, all IE subscales improved after intervention. These results are promising and may contribute to a paradigm change in the strategies aiming to enhance motivation and adherence to dietary recommendations in CKD population.

Abstract Objective To assess whether ballet dancers have higher eating psychopathology mean scores than the general population. Methods Meta-analysis of cross-sectional observational studies comparing the scores of one or more of the validated eating psychopathological scales between ballet dancers and any control groups. Results Twelve studies were included in the metanalysis. Ballet dancers had a significantly higher EAT score (12 studies retrieved, SMD 0.82 [95% CI 0.44–1.19], p < 0.00001, I2 = 84)]; subgroup analysis suggested a possible role of control subjects’ choice in explaining heterogeneity. Scores on the EDI subscales of Drive for Thinness, Bulimia, and Body dissatisfaction were available from four studies; Drive for Thinness was higher in ballet dancers (SMD 0.62 [0.01, 1.22]), as well as the Bulimia scale (SMD 0.38 [0.02, 0.73], p = 0.04) and the Body Dissatisfaction scale (SMD 0.34 [0.15, 0.53]). Data on Perfectionism, Interpersonal problems, Ineffectiveness, and Maturity fears, were available from three studies. Higher scores in Perfectionism (SMD 0.68 [0.24, 1.12] p = 0.02), Interpersonal problems (SMD 0.24 [0.02, 0.47], in Inefficacy, (SMD 2.18 [1.31, 3.06]) were found for ballet dancers; on the other hand, Maturity fears scores were not significantly different between ballet dancers and controls (IV-MD = 0.15 [− 0.07, 0.36]). Seven studies reported tests not performed elsewhere. Discussion Ballet dancers show a higher level of restriction and drive for thinness than controls, and they may be, therefore, at higher risk for the development of eating disorders. Available studies do not allow the discrimination of dysfunctional eating attitudes and behaviors from adaptive responses. Level of evidence Level I (evidence obtained from systematic reviews and meta-analyses).

A same-but-different dichotomy has recently been encapsulated within the US Food and Drug Administration’s ill-defined concept of “substantial equivalence” (USFDA, FDA). By invoking this concept the genetically modified organism (GMO) industry has escaped the rigors of safety testing that might otherwise apply. The curious concept of “substantial equivalence” grants a presumption of safety to GMO food. This presumption has yet to be earned, and has been used to constrain labelling of both GMO and non-GMO food. It is an idea that well serves corporatism. It enables the claim of difference to secure patent protection, while upholding the contrary claim of sameness to avoid labelling and safety scrutiny. It offers the best of both worlds for corporate food entrepreneurs, and delivers the worst of both worlds to consumers. The term “substantial equivalence” has established its currency within the GMO discourse. As the opportunities for patenting food technologies expand, the GMO recruitment of this concept will likely be a dress rehearsal for the developing debates on the labelling and testing of other techno-foods – including nano-foods and clone-foods. “Substantial Equivalence” “Are the Seven Commandments the same as they used to be, Benjamin?” asks Clover in George Orwell’s “Animal Farm”. By way of response, Benjamin “read out to her what was written on the wall. There was nothing there now except a single Commandment. It ran: ALL ANIMALS ARE EQUAL BUT SOME ANIMALS ARE MORE EQUAL THAN OTHERS”. After this reductionist revelation, further novel and curious events at Manor Farm, “did not seem strange” (Orwell, ch. X). Equality is a concept at the very core of mathematics, but beyond the domain of logic, equality becomes a hotly contested notion – and the domain of food is no exception. A novel food has a regulatory advantage if it can claim to be the same as an established food – a food that has proven its worth over centuries, perhaps even millennia – and thus does not trigger new, perhaps costly and onerous, testing, compliance, and even new and burdensome regulations. On the other hand, such a novel food has an intellectual property (IP) advantage only in terms of its difference. And thus there is an entrenched dissonance for newly technologised foods, between claiming sameness, and claiming difference. The same/different dilemma is erased, so some would have it, by appeal to the curious new dualist doctrine of “substantial equivalence” whereby sameness and difference are claimed simultaneously, thereby creating a win/win for corporatism, and a loss/loss for consumerism. This ground has been pioneered, and to some extent conquered, by the GMO industry. The conquest has ramifications for other cryptic food technologies, that is technologies that are invisible to the consumer and that are not evident to the consumer other than via labelling. Cryptic technologies pertaining to food include GMOs, pesticides, hormone treatments, irradiation and, most recently, manufactured nano-particles introduced into the food production and delivery stream. Genetic modification of plants was reported as early as 1984 by Horsch et al. The case of Diamond v. Chakrabarty resulted in a US Supreme Court decision that upheld the prior decision of the US Court of Customs and Patent Appeal that “the fact that micro-organisms are alive is without legal significance for purposes of the patent law”, and ruled that the “respondent’s micro-organism plainly qualifies as patentable subject matter”. This was a majority decision of nine judges, with four judges dissenting (Burger). It was this Chakrabarty judgement that has seriously opened the Pandora’s box of GMOs because patenting rights makes GMOs an attractive corporate proposition by offering potentially unique monopoly rights over food. The rear guard action against GMOs has most often focussed on health repercussions (Smith, Genetic), food security issues, and also the potential for corporate malfeasance to hide behind a cloak of secrecy citing commercial confidentiality (Smith, Seeds). Others have tilted at the foundational plank on which the economics of the GMO industry sits: “I suggest that the main concern is that we do not want a single molecule of anything we eat to contribute to, or be patented and owned by, a reckless, ruthless chemical organisation” (Grist 22). The GMO industry exhibits bipolar behaviour, invoking the concept of “substantial difference” to claim patent rights by way of “novelty”, and then claiming “substantial equivalence” when dealing with other regulatory authorities including food, drug and pesticide agencies; a case of “having their cake and eating it too” (Engdahl 8). This is a clever slight-of-rhetoric, laying claim to the best of both worlds for corporations, and the worst of both worlds for consumers. Corporations achieve patent protection and no concomitant specific regulatory oversight; while consumers pay the cost of patent monopolization, and are not necessarily apprised, by way of labelling or otherwise, that they are purchasing and eating GMOs, and thereby financing the GMO industry. The lemma of “substantial equivalence” does not bear close scrutiny. It is a fuzzy concept that lacks a tight testable definition. It is exactly this fuzziness that allows lots of wriggle room to keep GMOs out of rigorous testing regimes. Millstone et al. argue that “substantial equivalence is a pseudo-scientific concept because it is a commercial and political judgement masquerading as if it is scientific. It is moreover, inherently anti-scientific because it was created primarily to provide an excuse for not requiring biochemical or toxicological tests. It therefore serves to discourage and inhibit informative scientific research” (526). “Substantial equivalence” grants GMOs the benefit of the doubt regarding safety, and thereby leaves unexamined the ramifications for human consumer health, for farm labourer and food-processor health, for the welfare of farm animals fed a diet of GMO grain, and for the well-being of the ecosystem, both in general and in its particularities. “Substantial equivalence” was introduced into the food discourse by an Organisation for Economic Co-operation and Development (OECD) report: “safety evaluation of foods derived by modern biotechnology: concepts and principles”. It is from this document that the ongoing mantra of assumed safety of GMOs derives: “modern biotechnology … does not inherently lead to foods that are less safe … . Therefore evaluation of foods and food components obtained from organisms developed by the application of the newer techniques does not necessitate a fundamental change in established principles, nor does it require a different standard of safety” (OECD, “Safety” 10). This was at the time, and remains, an act of faith, a pro-corporatist and a post-cautionary approach. The OECD motto reveals where their priorities lean: “for a better world economy” (OECD, “Better”). The term “substantial equivalence” was preceded by the 1992 USFDA concept of “substantial similarity” (Levidow, Murphy and Carr) and was adopted from a prior usage by the US Food and Drug Agency (USFDA) where it was used pertaining to medical devices (Miller). Even GMO proponents accept that “Substantial equivalence is not intended to be a scientific formulation; it is a conceptual tool for food producers and government regulators” (Miller 1043). And there’s the rub – there is no scientific definition of “substantial equivalence”, no scientific test of proof of concept, and nor is there likely to be, since this is a ‘spinmeister’ term. And yet this is the cornerstone on which rests the presumption of safety of GMOs. Absence of evidence is taken to be evidence of absence. History suggests that this is a fraught presumption. By way of contrast, the patenting of GMOs depends on the antithesis of assumed ‘sameness’. Patenting rests on proven, scrutinised, challengeable and robust tests of difference and novelty. Lightfoot et al. report that transgenic plants exhibit “unexpected changes [that] challenge the usual assumptions of GMO equivalence and suggest genomic, proteomic and metanomic characterization of transgenics is advisable” (1). GMO Milk and Contested Labelling Pesticide company Monsanto markets the genetically engineered hormone rBST (recombinant Bovine Somatotropin; also known as: rbST; rBGH, recombinant Bovine Growth Hormone; and the brand name Prosilac) to dairy farmers who inject it into their cows to increase milk production. This product is not approved for use in many jurisdictions, including Europe, Australia, New Zealand, Canada and Japan. Even Monsanto accepts that rBST leads to mastitis (inflammation and pus in the udder) and other “cow health problems”, however, it maintains that “these problems did not occur at rates that would prohibit the use of Prosilac” (Monsanto). A European Union study identified an extensive list of health concerns of rBST use (European Commission). The US Dairy Export Council however entertain no doubt. In their background document they ask “is milk from cows treated with rBST safe?” and answer “Absolutely” (USDEC). Meanwhile, Monsanto’s website raises and answers the question: “Is the milk from cows treated with rbST any different from milk from untreated cows? No” (Monsanto). Injecting cows with genetically modified hormones to boost their milk production remains a contested practice, banned in many countries. It is the claimed equivalence that has kept consumers of US dairy products in the dark, shielded rBST dairy farmers from having to declare that their milk production is GMO-enhanced, and has inhibited non-GMO producers from declaring their milk as non-GMO, non rBST, or not hormone enhanced. This is a battle that has simmered, and sometimes raged, for a decade in the US. Finally there is a modest victory for consumers: the Pennsylvania Department of Agriculture (PDA) requires all labels used on milk products to be approved in advance by the department. The standard issued in October 2007 (PDA, “Standards”) signalled to producers that any milk labels claiming rBST-free status would be rejected. This advice was rescinded in January 2008 with new, specific, department-approved textual constructions allowed, and ensuring that any “no rBST” style claim was paired with a PDA-prescribed disclaimer (PDA, “Revised Standards”). However, parsimonious labelling is prohibited: No labeling may contain references such as ‘No Hormones’, ‘Hormone Free’, ‘Free of Hormones’, ‘No BST’, ‘Free of BST’, ‘BST Free’,’No added BST’, or any statement which indicates, implies or could be construed to mean that no natural bovine somatotropin (BST) or synthetic bovine somatotropin (rBST) are contained in or added to the product. (PDA, “Revised Standards” 3) Difference claims are prohibited: In no instance shall any label state or imply that milk from cows not treated with recombinant bovine somatotropin (rBST, rbST, RBST or rbst) differs in composition from milk or products made with milk from treated cows, or that rBST is not contained in or added to the product. If a product is represented as, or intended to be represented to consumers as, containing or produced from milk from cows not treated with rBST any labeling information must convey only a difference in farming practices or dairy herd management methods. (PDA, “Revised Standards” 3) The PDA-approved labelling text for non-GMO dairy farmers is specified as follows: ‘From cows not treated with rBST. No significant difference has been shown between milk derived from rBST-treated and non-rBST-treated cows’ or a substantial equivalent. Hereinafter, the first sentence shall be referred to as the ‘Claim’, and the second sentence shall be referred to as the ‘Disclaimer’. (PDA, “Revised Standards” 4) It is onto the non-GMO dairy farmer alone, that the costs of compliance fall. These costs include label preparation and approval, proving non-usage of GMOs, and of creating and maintaining an audit trail. In nearby Ohio a similar consumer versus corporatist pantomime is playing out. This time with the Ohio Department of Agriculture (ODA) calling the shots, and again serving the GMO industry. The ODA prescribed text allowed to non-GMO dairy farmers is “from cows not supplemented with rbST” and this is to be conjoined with the mandatory disclaimer “no significant difference has been shown between milk derived from rbST-supplemented and non-rbST supplemented cows” (Curet). These are “emergency rules”: they apply for 90 days, and are proposed as permanent. Once again, the onus is on the non-GMO dairy farmers to document and prove their claims. GMO dairy farmers face no such governmental requirements, including no disclosure requirement, and thus an asymmetric regulatory impost is placed on the non-GMO farmer which opens up new opportunities for administrative demands and technocratic harassment. Levidow et al. argue, somewhat Eurocentrically, that from its 1990s adoption “as the basis for a harmonized science-based approach to risk assessment” (26) the concept of “substantial equivalence” has “been recast in at least three ways” (58). It is true that the GMO debate has evolved differently in the US and Europe, and with other jurisdictions usually adopting intermediate positions, yet the concept persists. Levidow et al. nominate their three recastings as: firstly an “implicit redefinition” by the appending of “extra phrases in official documents”; secondly, “it has been reinterpreted, as risk assessment processes have … required more evidence of safety than before, especially in Europe”; and thirdly, “it has been demoted in the European Union regulatory procedures so that it can no longer be used to justify the claim that a risk assessment is unnecessary” (58). Romeis et al. have proposed a decision tree approach to GMO risks based on cascading tiers of risk assessment. However what remains is that the defects of the concept of “substantial equivalence” persist. Schauzu identified that: such decisions are a matter of “opinion”; that there is “no clear definition of the term ‘substantial’”; that because genetic modification “is aimed at introducing new traits into organisms, the result will always be a different combination of genes and proteins”; and that “there is no general checklist that could be followed by those who are responsible for allowing a product to be placed on the market” (2). Benchmark for Further Food Novelties? The discourse, contestation, and debate about “substantial equivalence” have largely focussed on the introduction of GMOs into food production processes. GM can best be regarded as the test case, and proof of concept, for establishing “substantial equivalence” as a benchmark for evaluating new and forthcoming food technologies. This is of concern, because the concept of “substantial equivalence” is scientific hokum, and yet its persistence, even entrenchment, within regulatory agencies may be a harbinger of forthcoming same-but-different debates for nanotechnology and other future bioengineering. The appeal of “substantial equivalence” has been a brake on the creation of GMO-specific regulations and on rigorous GMO testing. The food nanotechnology industry can be expected to look to the precedent of the GMO debate to head off specific nano-regulations and nano-testing. As cloning becomes economically viable, then this may be another wave of food innovation that muddies the regulatory waters with the confused – and ultimately self-contradictory – concept of “substantial equivalence”. Nanotechnology engineers particles in the size range 1 to 100 nanometres – a nanometre is one billionth of a metre. This is interesting for manufacturers because at this size chemicals behave differently, or as the Australian Office of Nanotechnology expresses it, “new functionalities are obtained” (AON). Globally, government expenditure on nanotechnology research reached US$4.6 billion in 2006 (Roco 3.12). While there are now many patents (ETC Group; Roco), regulation specific to nanoparticles is lacking (Bowman and Hodge; Miller and Senjen). The USFDA advises that nano-manufacturers “must show a reasonable assurance of safety … or substantial equivalence” (FDA). A recent inventory of nano-products already on the market identified 580 products. Of these 11.4% were categorised as “Food and Beverage” (WWICS). This is at a time when public confidence in regulatory bodies is declining (HRA). In an Australian consumer survey on nanotechnology, 65% of respondents indicated they were concerned about “unknown and long term side effects”, and 71% agreed that it is important “to know if products are made with nanotechnology” (MARS 22). Cloned animals are currently more expensive to produce than traditional animal progeny. In the course of 678 pages, the USFDA Animal Cloning: A Draft Risk Assessment has not a single mention of “substantial equivalence”. However the Federation of Animal Science Societies (FASS) in its single page “Statement in Support of USFDA’s Risk Assessment Conclusion That Food from Cloned Animals Is Safe for Human Consumption” states that “FASS endorses the use of this comparative evaluation process as the foundation of establishing substantial equivalence of any food being evaluated. It must be emphasized that it is the food product itself that should be the focus of the evaluation rather than the technology used to generate cloned animals” (FASS 1). Contrary to the FASS derogation of the importance of process in food production, for consumers both the process and provenance of production is an important and integral aspect of a food product’s value and identity. Some consumers will legitimately insist that their Kalamata olives are from Greece, or their balsamic vinegar is from Modena. It was the British public’s growing awareness that their sugar was being produced by slave labour that enabled the boycotting of the product, and ultimately the outlawing of slavery (Hochschild). When consumers boycott Nestle, because of past or present marketing practices, or boycott produce of USA because of, for example, US foreign policy or animal welfare concerns, they are distinguishing the food based on the narrative of the food, the production process and/or production context which are a part of the identity of the food. Consumers attribute value to food based on production process and provenance information (Paull). Products produced by slave labour, by child labour, by political prisoners, by means of torture, theft, immoral, unethical or unsustainable practices are different from their alternatives. The process of production is a part of the identity of a product and consumers are increasingly interested in food narrative. It requires vigilance to ensure that these narratives are delivered with the product to the consumer, and are neither lost nor suppressed. Throughout the GM debate, the organic sector has successfully skirted the “substantial equivalence” debate by excluding GMOs from the certified organic food production process. This GMO-exclusion from the organic food stream is the one reprieve available to consumers worldwide who are keen to avoid GMOs in their diet. The organic industry carries the expectation of providing food produced without artificial pesticides and fertilizers, and by extension, without GMOs. Most recently, the Soil Association, the leading organic certifier in the UK, claims to be the first organisation in the world to exclude manufactured nonoparticles from their products (Soil Association). There has been the call that engineered nanoparticles be excluded from organic standards worldwide, given that there is no mandatory safety testing and no compulsory labelling in place (Paull and Lyons). The twisted rhetoric of oxymorons does not make the ideal foundation for policy. Setting food policy on the shifting sands of “substantial equivalence” seems foolhardy when we consider the potentially profound ramifications of globally mass marketing a dysfunctional food. If there is a 2×2 matrix of terms – “substantial equivalence”, substantial difference, insubstantial equivalence, insubstantial difference – while only one corner of this matrix is engaged for food policy, and while the elements remain matters of opinion rather than being testable by science, or by some other regime, then the public is the dupe, and potentially the victim. “Substantial equivalence” has served the GMO corporates well and the public poorly, and this asymmetry is slated to escalate if nano-food and clone-food are also folded into the “substantial equivalence” paradigm. Only in Orwellian Newspeak is war peace, or is same different. It is time to jettison the pseudo-scientific doctrine of “substantial equivalence”, as a convenient oxymoron, and embrace full disclosure of provenance, process and difference, so that consumers are not collateral in a continuing asymmetric knowledge war. References Australian Office of Nanotechnology (AON). 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