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CONTEXT: Eating disorders are severe conditions, but little is known about the prevalence or correlates of these disorders from population-based surveys of adolescents. OBJECTIVES: To examine the prevalence and correlates of eating disorders in a large, reprefentative sample of US adolescents. DESIGN: Cross-sectional survey of adolescents with face-to-face interviews using a modified version of the Composite International Diagnostic Interview. SETTING: Combined household and school adolescent samples. PARTICIPANTS: Nationally representative sample of 10,123 adolescents aged 13 to 18 years. MAIN OUTCOME MEASURES: Prevalence and correlates of eating disorders and subthreshold conditions. RESULTS: Lifetime prevalence estimates of anorexia nervosa, bulimia nervosa, and binge-eating disorder were 0.3%, 0.9%, and 1.6%, respectively. Important differences were observed between eating disorder subtypes concerning sociodemographic correlates, psychiatric comorbidity, role impairment, and suicidality. Although the majority of adolescents with an eating disorder sought some form of treatment, only a minority received treatment specifically for their eating or weight problems. Analyses of 2 related subthreshold conditions suggest that these conditions are often clinically significant. CONCLUSIONS: Eating disorders and subthreshold eating conditions are prevalent in the general adolescent population. Their impact is demonstrated by generally strong associations with other psychiatric disorders, role impairment, and suicidality. The unmet treatment needs in the adolescent population place these disorders as important public health concerns.

PURPOSE OF REVIEW: Eating disorders - anorexia nervosa, bulimia nervosa, and binge eating disorder - affect numerous Europeans. This narrative review summarizes European studies on their prevalence, incidence, comorbidity, course, consequences, and risk factors published in 2015 and the first half of 2016. RECENT FINDINGS: Anorexia nervosa is reported by <1-4%, bulimia nervosa <1-2%, binge eating disorder <1-4%, and subthreshold eating disorders by 2-3% of women in Europe. Of men, 0.3-0.7% report eating disorders. Incidences of anorexia appear stable, whereas bulimia may be declining. Although the numbers of individuals receiving treatment have increased, only about one-third is detected by healthcare. Over 70% of individuals with eating disorders report comorbid disorders: anxiety disorders (>50%), mood disorders (>40%), self-harm (>20%), and substance use (>10%) are common. The long-term course of anorexia nervosa is favorable for most, but a substantial minority of eating disorder patients experience longstanding symptoms and somatic problems. The risk of suicide is elevated. Parental psychiatric disorders, prenatal maternal stress, various family factors, childhood overweight, and body dissatisfaction in adolescence increase the risk of eating disorders. SUMMARY: Eating disorders are relatively common disorders that are often overlooked, although they are associated with high comorbidity and serious health consequences.

Introduction. Fairburn, This Book and How to Use It. Fairburn, Eating Disorders: The Transdiagnostic View and the Cognitive Behavioral Theory. Fairburn, Cooper, Shafran, Enhanced Cognitive Behavior Therapy for Eating Disorders (CBT-E): An Overview. Fairburn, Cooper, Waller, The Patients: Their Assessment, Preparation for Treatment and Medical Management. Fairburn, Cooper, Shafran, Bohn, Hawker, Murphy, Straebler, Enhanced Cognitive Behavior Therapy for Eating Disorders: The Core Protocol. Starting Well. Achieving Early Change. Taking Stock and Designing the Rest of Treatment. Shape Concern. Shape Checking. Feeling Fat and Mindsets. Dietary Restraint, Dietary Rules and Controlling Eating. Events, Moods and Eating. Underweight and Under-eating. Ending Well. Adaptations of CBT-E. Fairburn, Cooper, Shafran, Bohn, Hawker, Clinical Perfectionism, Core Low Self-esteem and Interpersonal Problems. Cooper, Stewart, CBT-E and the Younger Patient. Grave, Bohn, Hawker, Fairburn, Inpatient, Day Patient and Two Forms of Outpatient CBT-E. Fairburn, Cooper, Waller, 'Complex Cases' and Comorbidity. Postscript. Fairburn, Looking Forward. Appendices. Fairburn, Cooper, O'Connor, Appendix A: Eating Disorder Examination (16.0D). Fairburn, Beglin, Appendix B: Eating Disorder Examination Questionnaire (EDE-Q6.0). Bohn, Fairburn, Appendix C: Clinical Impairment Assessment Questionnaire (CIA 3.0).

The development of the Dutch Eating Behaviour Questionnaire (DEBQ) with scales for restrained, emotional, and external eating is described. Factor analyses have shown that all items on restrained and external eating each have high loadings on one factor, but items on emotional eating have two dimensions, one dealing with eating in response to diffuse emotions, and the other with eating in response to clearly labelled emotions. The pattern of corrected item-total correlation coefficients and of the factors was very similar for various subsamples, which indicates a high degree of stability of dimensions on the eating behavior scales. The norms and Cronbach's alpha coefficients of the scales and also the Pearson's correlation coefficients to assess interrelationships between scales indicate that the scales have a high internal consistency and factorial validity. However, their external validity has yet to be investigated.

The first years of life mark a time of rapid development and dietary change, as children transition from an exclusive milk diet to a modified adult diet. During these early years, children's learning about food and eating plays a central role in shaping subsequent food choices, diet quality, and weight status. Parents play a powerful role in children's eating behavior, providing both genes and environment for children. For example, they influence children's developing preferences and eating behaviors by making some foods available rather than others, and by acting as models of eating behavior. In addition, parents use feeding practices, which have evolved over thousands of years, to promote patterns of food intake necessary for children's growth and health. However in current eating environments, characterized by too much inexpensive palatable, energy dense food, these traditional feeding practices can promote overeating and weight gain. To meet the challenge of promoting healthy weight in children in the current eating environment, parents need guidance regarding alternatives to traditional feeding practices.

It was hypothesized that individual differences in eating behavior based on the distinction between obese and normal subjects could be demonstrated within a population of normal subjects classified as to the extent of restraint chronically exercised with respect to eating. Restrained subjects resembled the obese behaviorally, and unrestrained subjects resembled normals. This demonstration was effected in the context of a test .of the psychosomatic hypothesis of obesity. The results indicated that although some individuals may eat more when anxious, there is little empirical support for the notion that eating serves to reduce anxiety. An explanation for this apparent inconsistency was offered. The role of anxiety as a possible causal agent in obesity has recently been subjected to experimental analysis. Schachter, Goldman, and Gordon (1968) hypothesized that although anxiety would decrease eating in normal-weight subjects by inhibiting gastric contractions and releasing sugar into the bloodstream, it would have little if any effect on the obese, who do not eat on the basis of internal physiological state. These predictions were confirmed, with normal-weight subjects eating substantially less (34%) when anxious and the obese eating nonsignificantly more (15%). Schachter et al. (1968) concluded that the psychosomatic hypothesis of obesity —that the obese in effect confuse hunger with negative affect (Bruch, 1961) and thus overeat in response to aversive emotional states (Kaplan & Kaplan, 1957)— had failed to find confirmation. Obese subjects did not eat more when anxious and did not exhibit significant anxiety reduction as a consequence of eating.

Eating disorders are relatively rare among the general population. This review discusses the literature on the incidence, prevalence and mortality rates of eating disorders. We searched online Medline/Pubmed, Embase and PsycINFO databases for articles published in English using several keyterms relating to eating disorders and epidemiology. Anorexia nervosa is relatively common among young women. While the overall incidence rate remained stable over the past decades, there has been an increase in the high risk-group of 15-19 year old girls. It is unclear whether this reflects earlier detection of anorexia nervosa cases or an earlier age at onset. The occurrence of bulimia nervosa might have decreased since the early nineties of the last century. All eating disorders have an elevated mortality risk; anorexia nervosa the most striking. Compared with the other eating disorders, binge eating disorder is more common among males and older individuals.

▪ Abstract The study of food and eating has a long history in anthropology, beginning in the nineteenth century with Garrick Mallery and William Robertson Smith. This review notes landmark studies prior to the 1980s, sketching the history of the subfield. We concentrate primarily, however, on works published after 1984. We contend that the study of food and eating is important both for its own sake since food is utterly essential to human existence (and often insufficiently available) and because the subfield has proved valuable for debating and advancing anthropological theory and research methods. Food studies have illuminated broad societal processes such as political-economic value-creation, symbolic value-creation, and the social construction of memory. Such studies have also proved an important arena for debating the relative merits of cultural and historical materialism vs. structuralist or symbolic explanations for human behavior, and for refining our understanding of variation in informants' responses to ethnographic questions. Seven subsections examine classic food ethnographies: single commodities and substances; food and social change; food insecurity; eating and ritual; eating and identities; and instructional materials. The richest, most extensive anthropological work among these subtopics has focused on food insecurity, eating and ritual, and eating and identities. For topics whose anthropological coverage has not been extensive (e.g., book-length studies of single commodities, or works on the industrialization of food systems), useful publications from sister disciplines—primarily sociology and history—are discussed.

Stress is widely thought to lead to overeating. Studies of stress-induced eating have tested two models. One has tested whether stress increases eating in all exposed organisms and has been tested primarily with animals and physical stressors. The other has tested individual differences in vulnerability to stress-induced eating and has tested only human subjects and psychological stressors. The most consistent set of findings shows that "restrained" eating predicts vulnerability among women; we conclude that for the stressors studied to date, the individual-difference model has received stronger support. Because the question motivating much of this research is whether stress-induced eating causes obesity, future research should assess the effect of stress on weight-change more directly.

The development of the Emotional Eating Scale (EES) is described. The factor solution replicated the scale's construction, revealing Anger/Frustration, Anxiety, and Depression subscales. All three subscales correlated highly with measures of binge eating, providing evidence of construct validity. None of the EES subscales correlated significantly with general measures of psychopathology. With few exceptions, changes in EES subscales correlated with treatment-related changes in binge eating. In support of the measure's discriminant efficiency, when compared with obese binge eaters, subscale scores of a sample of anxiety-disordered patients were significantly lower. Lack of correlation between a measure of cognitive restraint and EES subscales suggests that emotional eating may precipitate binge episodes among the obese independent of the level of restraint. The 25-item scale is presented in an Appendix (Arnow, B., Kenardy, J., & Agras, W.S.: International Journal of Eating Disorders, 17, 00-00, 1995). © 1995 by John Wiley & Sons, Inc.

CONTEXT: Morbidity and mortality rates in patients with eating disorders are thought to be high, but exact rates remain to be clarified. OBJECTIVE: To systematically compile and analyze the mortality rates in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). DATA SOURCES: A systematic literature search, appraisal, and meta-analysis were conducted of the MEDLINE/PubMed, PsycINFO, and Embase databases and 4 full-text collections (ie, ScienceDirect, Ingenta Select, Ovid, and Wiley-Blackwell Interscience). STUDY SELECTION: English-language, peer-reviewed articles published between January 1, 1966, and September 30, 2010, that reported mortality rates in patients with eating disorders. DATA EXTRACTION: Primary data were extracted as raw numbers or confidence intervals and corrected for years of observation and sample size (ie, person-years of observation). Weighted proportion meta-analysis was used to adjust for study size using the DerSimonian-Laird model to allow for heterogeneity inclusion in the analysis. DATA SYNTHESIS: From 143 potentially relevant articles, we found 36 quantitative studies with sufficient data for extraction. The studies reported outcomes of AN during 166 642 person-years, BN during 32 798 person-years, and EDNOS during 22 644 person-years. The weighted mortality rates (ie, deaths per 1000 person-years) were 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. The standardized mortality ratios were 5.86 for AN, 1.93 for BN, and 1.92 for EDNOS. One in 5 individuals with AN who died had committed suicide. CONCLUSIONS: Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN. The mortality rates for BN and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with AN. Further research is needed to identify predictors of mortality in patients with BN and EDNOS.

OBJECTIVE: Meta-analyses of behavior change (BC) interventions typically find large heterogeneity in effectiveness and small effects. This study aimed to assess the effectiveness of active BC interventions designed to promote physical activity and healthy eating and investigate whether theoretically specified BC techniques improve outcome. DESIGN: Interventions, evaluated in experimental or quasi-experimental studies, using behavioral and/or cognitive techniques to increase physical activity and healthy eating in adults, were systematically reviewed. Intervention content was reliably classified into 26 BC techniques and the effects of individual techniques, and of a theoretically derived combination of self-regulation techniques, were assessed using meta-regression. MAIN OUTCOME MEASURES: Valid outcomes of physical activity and healthy eating. RESULTS: The 122 evaluations (N = 44,747) produced an overall pooled effect size of 0.31 (95% confidence interval = 0.26 to 0.36, I(2) = 69%). The technique, "self-monitoring," explained the greatest amount of among-study heterogeneity (13%). Interventions that combined self-monitoring with at least one other technique derived from control theory were significantly more effective than the other interventions (0.42 vs. 0.26). CONCLUSION: Classifying interventions according to component techniques and theoretically derived technique combinations and conducting meta-regression enabled identification of effective components of interventions designed to increase physical activity and healthy eating.

Obesity has increased dramatically over the past two decades and currently about 50% of US adults and 25% of US children are overweight. The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity. This chapter reviews what is known about environmental influences on physical activity and eating behaviors. Recent trends in food supply, eating out, physical activity, and inactivity are reviewed, as are the effects of advertising, promotion, and pricing on eating and physical activity. Public health interventions, opportunities, and potential strategies to combat the obesity epidemic by promoting an environment that supports healthy eating and physical activity are discussed.

OBJECTIVE: To review the literature on the incidence and prevalence of eating disorders. METHODS: We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found. Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases. RESULTS: An average prevalence rate for anorexia nervosa of 0.3% was found for young females. The prevalence rates for bulimia nervosa were 1% and 0.1% for young women and young men, respectively. The estimated prevalence of binge eating disorder is at least 1%. The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year. The incidence of anorexia nervosa increased over the past century, until the 1970s. DISCUSSION: Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care.

Relevant factors involved in the creation of some children's food preferences and eating behaviours have been examined in order to highlight the topic and give paediatricians practical instruments to understand the background behind eating behaviour and to manage children's nutrition for preventive purposes. Electronic databases were searched to locate and appraise relevant studies. We carried out a search to identify papers published in English on factors that influence children's feeding behaviours. The family system that surrounds a child's domestic life will have an active role in establishing and promoting behaviours that will persist throughout his or her life. Early-life experiences with various tastes and flavours have a role in promoting healthy eating in future life. The nature of a narrative review makes it difficult to integrate complex interactions when large sets of studies are involved. In the current analysis, parental food habits and feeding strategies are the most dominant determinants of a child's eating behaviour and food choices. Parents should expose their offspring to a range of good food choices while acting as positive role models. Prevention programmes should be addressed to them, taking into account socioeconomic aspects and education.

Anorexia nervosa and bulimia nervosa have emerged as the predominant eating disorders. We review the recent research evidence pertaining to the development of these disorders, including sociocultural factors (e.g., media and peer influences), family factors (e.g., enmeshment and criticism), negative affect, low self-esteem, and body dissatisfaction. Also reviewed are cognitive and biological aspects of eating disorders. Some contributory factors appear to be necessary for the appearance of eating disorders, but none is sufficient. Eating disorders may represent a way of coping with problems of identity and personal control.

Part 1 The context for treatment: anorexia nervosa - historical perspective on treatment, Silverman the history of bulimia nervosa, Russell diagnostic issues, Walsh and Garner assessment, Crowther and Sherwood sequencing and integration of treatments, Garner and Needleman. Part 2 Cognitive-behavioural and educational approaches: cognitive-behavioural therapy for bulimia nervosa, Wilson et al cognitive-behavioural therapy for anorexia nervosa, Garner et al psychoeducational principles in treatment, Garner nutritional counselling and supervised exercise, Beumont et al cognitive-behavioural body image therapy, Rosen. Part 3 Psychodynamic, feminist and family approaches: eating disorders - a self- psychological perspective, Goodsitt consultation and therapeutic engagement in severe anorexia nervosa, Strober anorexia nervosa as flight from growth, Crisp interpersonal psychotherapy for bulimia nervosa, Fairburn the aetiology and treatment of body image disturbance, Kearney-Cooke and Striegel-Moore family therapy for anorexia nervosa, Dare and Eisler. Part 4 Hospital and drug treatments: in-patient treatment of anorexia nervosa, Andersen et al partial hospitalization, Kaplan and Olmsted behavioural treatment to promote weight gain in anorexia nervosa, Touyz and Beumont drug therapies, Garfinkel and Walsh. Part 5 Special topics in treatment: managing medical complications, Mitchell et al sexual abuse and other forms of trauma, Fallon and Wonderlich management of substance abuse and dependence, Mitchell et al management of patients with comorbid medical conditions, Powers treatment of patients with personality disorders, Dennis and Sansone addressing treatment refusal in anorexia nervosa, Goldner et al group psychotherapy, Polivy and Federoff prepubertal eating disorders, Lask and Bryant-Waugh adapting treatment for patients with binge-eating disorder, Marcus self-help and guided self-help for binge-eating problems, Fairburn and Carter.

Food and eating environments likely contribute to the increasing epidemic of obesity and chronic diseases, over and above individual factors such as knowledge, skills, and motivation. Environmental and policy interventions may be among the most effective strategies for creating population-wide improvements in eating. This review describes an ecological framework for conceptualizing the many food environments and conditions that influence food choices, with an emphasis on current knowledge regarding the home, child care, school, work site, retail store, and restaurant settings. Important issues of disparities in food access for low-income and minority groups and macrolevel issues are also reviewed. The status of measurement and evaluation of nutrition environments and the need for action to improve health are highlighted.

This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.