SynopsisThe occurrence and course of eating disorder in a large representative population of 15-year-old London schoolgirls has been assessed using a two-stage survey methodology. Attempts to control weight were common and often transient. Dieting was in the great majority of girls found to be a benign practice without progression to more extreme concerns about food and weight. However, a small proportion of dieters did become cases and formed the majority of new cases found at follow-up. The relative risk of dieters becoming cases was eight times that of non-dieters. Many factors conventionally associated with eating disorder were associated more with attempting weight control than caseness. These included pre-morbid personality, pre-morbid obesity and family weight pathology. Other factors, including social class, career choice and psychosexual development, had no association either with attempting weight control or caseness.

SynopsisThe Eating Attitudes Test (EAT) and General Health Questionnaire (GHQ) have been validated in an unselected population of 15-year-old South London schoolgirls. Scores on the questionnaires were compared with the results of standard interview. The EAT was found to be an efficient screening instrument for abnormal eating attitudes and behaviour, whereas the GHQ was less satisfactory in its ability to screen for psychiatric morbidity in this age group than in adults. At the optimal cutting points, 6·9% of this population gave a positive response to the EAT and 19·3% gave a positive response to the GHQ. There was a statistically significant positive correlation between the two sets of scores

SynopsisOne thousand and ten unselected London state schoolgirls were screened by questionnaire to identify an ‘at risk’ cohort displaying abnormal eating attitudes and two control cohorts, one with probable general psychiatric morbidity, one without. Members of all cohorts were assessed at interview for the presence of eating disorder and for putative risk factors implicated in the development of anorexia nervosa. A prevalence rate of 0·99 % was detected for clinical eating disorder and 1·78 % for the partial syndrome of eating disorder. Factors specifically associated with abnormal eating attitudes were identified, in particular, current or past overweight, history of amenorrhoea and perceived stress in school and social life. Some commonly accepted risk factors for eating disorders were discovered to be associations with general psychiatric morbidity. These were perceived parental pressure to eat more, taking exercise to lose weight, perceived stress at home and reporting a family history of anxiety or depression. Other well reported putative risk factors for eating disorder, including social class, birth order, age at menarche, obsessional personality and weight related career choice were not associated specifically with abnormal eating attitudes in schoolgirls. These findings represent cross-sectional data at entry into a prospective epidemiological study.

Implementation of the guidelines led to an improvement in the nutritional management of this patient group. Implementation may be more likely if a dietitian is present at the combined head and neck clinic.