Anxiety disorders predict fasting to control weight: A longitudinal large cohort study of adolescents

Lloyd, Eva; Haase, Anne M.; Zerwas, Stephanie; Micali, Nadia

doi:10.1002/erv.2714

Cited by 11 publications

(15 citation statements)

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“…Body mass index (BMI) was calculated based on self-reported height and weight (kg/m 2 ). In accordance with prior research on fasting and eating disorder behaviors [ 11 , 15 , 19 , 52 ], these demographic variables were adjusted for in the aim two analyses.…”

Section: Methodsmentioning

confidence: 99%

“…Despite the interest in their potential health benefits, fasting, caloric restriction, and dietary restraint behaviors are associated with psychopathology, including suicidal ideation and suicide attempts [11,12], non-suicidal selfinjury [13,14], and anxiety disorder and symptoms [15], as well as clinical and sub-clinical eating disorder symptoms. For example, the cyclical nature of fasting and as a period of unsustainably restricted eating may reduce cognitive control and promote binge eating behaviors [16,17], and among both college women and men, dietary restraint was shown to be a primary predictor of eating pathology [18].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

2021

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Background Fasting is an unhealthy behavior that has been frequently used as part of weight loss attempts. To date, little research has been conducted to determine the prevalence and substance use and mental health correlates of fasting among college students. Therefore, the aim of this study was to estimate the prevalence and associations between any (≥ 1 time) and regular (≥ 13 times) occurrences of fasting in the past 4 weeks and substance use and mental health correlates among a large sample of college students from 2016 to 2020. Methods Data from four academic survey years (2016–2020; N = 8255) of the national (USA) Healthy Minds Study were analyzed. Unadjusted prevalence of any and regular fasting by survey year and gender was estimated. Multiple logistic regression analyses were conducted to estimate the associations between any and regular fasting and the demographic (age, body mass index, race/ethnicity, sexual orientation, highest parental education), substance use (cigarette use, marijuana use, other illicit drug use, alcohol use), and mental health (depression, anxiety, eating disorder symptoms, suicidal ideation, non-suicidal self-injury) correlates. Results Any fasting in the past 4 weeks was common among both men (14.77%) and women (18.12%) and significantly increased from 2016 (10.30%) to 2020 (19.81%) only among men. Regular fasting significantly increased among both men and women from 2016 (men: 1.46%; women: 1.79%) to 2020 (men: 3.53%; women: 6.19%). Among men and women, both any and regular fasting in the past 4 weeks were associated with higher odds of all mental health symptoms, including a positive depression, anxiety, and eating disorder screen, suicidal ideation, and non-suicidal self-injury. Among women, but not men, any and regular fasting in the past 4 weeks were associated with higher odds of marijuana use and other illicit drug use (e.g., cocaine, ecstasy). Conclusions The results from this study underscore both the high and increasing prevalence of fasting among a national sample of college students, as well as the substance use and mental health symptoms associated with this behavior. Healthcare professionals both on and off campus should consider screening for fasting behaviors among college students and provide appropriate intervention when needed.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

2021

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“…Three strong predictors of missing data in ALSPAC, used in previous investigations probing associations between eating disorders and other psychiatric outcomes (e.g. [48,49]), were also included as covariates. This was to minimise the risk of non-random missingness, and subsequent bias in the estimate of association, particularly for analyses without imputed data.…”

Section: Data Sourcesmentioning

confidence: 99%

Understanding the nature of association between anxiety phenotypes and anorexia nervosa: a triangulation approach

et al. 2020

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Background Evidence from observational studies suggests an association between anxiety disorders and anorexia nervosa (AN), but causal inference is complicated by the potential for confounding in these studies. We triangulate evidence across a longitudinal study and a Mendelian randomization (MR) study, to evaluate whether there is support for anxiety disorder phenotypes exerting a causal effect on AN risk. Methods Study One assessed longitudinal associations of childhood worry and anxiety disorders with lifetime AN in the Avon Longitudinal Study of Parents and Children cohort. Study Two used two-sample MR to evaluate: causal effects of worry, and genetic liability to anxiety disorders, on AN risk; causal effects of genetic liability to AN on anxiety outcomes; and the causal influence of worry on anxiety disorder development. The independence of effects of worry, relative to depressed affect, on AN and anxiety disorder outcomes, was explored using multivariable MR. Analyses were completed using summary statistics from recent genome-wide association studies. Results Study One did not support an association between worry and subsequent AN, but there was strong evidence for anxiety disorders predicting increased risk of AN. Study Two outcomes supported worry causally increasing AN risk, but did not support a causal effect of anxiety disorders on AN development, or of AN on anxiety disorders/worry. Findings also indicated that worry causally influences anxiety disorder development. Multivariable analysis estimates suggested the influence of worry on both AN and anxiety disorders was independent of depressed affect. Conclusions Overall our results provide mixed evidence regarding the causal role of anxiety exposures in AN aetiology. The inconsistency between outcomes of Studies One and Two may be explained by limitations surrounding worry assessment in Study One, confounding of the anxiety disorder and AN association in observational research, and low power in MR analyses probing causal effects of genetic liability to anxiety disorders. The evidence for worry acting as a causal risk factor for anxiety disorders and AN supports targeting worry for prevention of both outcomes. Further research should clarify how a tendency to worry translates into AN risk, and whether anxiety disorder pathology exerts any causal effect on AN.

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“…It has been hypothesized that emotional avoidance might increase negative affect and the use of maladaptive coping strategies, such as disordered eating behaviors . Although such maladaptive behaviors typically begin during adolescence, emotion regulation difficulties emerge throughout childhood and are associated with later psychopathology, including obsessive-compulsive disorder, depression, and anxiety, common comorbidities of and proposed risk factors for anorexia nervosa …”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] Although such maladaptive behaviors typically begin during adolescence, emotion regulation difficulties emerge throughout childhood 13 and are associated with later psychopathology, including obsessive-compulsive disorder, depression, and anxiety, 14,15 common comorbidities 16,17 of and proposed risk factors for anorexia nervosa. 18,19 Existing studies of emotion regulation and anorexia nervosa have predominantly used case-control designs within clinical populations. 7 These studies have limitations.…”

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confidence: 99%

Association of Emotion Regulation Trajectories in Childhood With Anorexia Nervosa and Atypical Anorexia Nervosa in Early Adolescence

et al. 2021

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IMPORTANCE People with anorexia nervosa often experience difficulties regulating their emotions. There is no longitudinal evidence as to whether these differences are already present in childhood or when they begin to emerge.OBJECTIVE To investigate the association between emotion regulation trajectories from 3 to 7 years of age and symptoms of anorexia nervosa and atypical anorexia nervosa in adolescence. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included all children with complete exposure data in the Millennium Cohort Study, a UK general population birth cohort. Data were acquired from June 2001 to March 2016 and analyzed from June to November 2020.EXPOSURES Mothers reported on their children's emotion regulation skills at 3, 5, and 7 years of age using the Children's Social Behavior Questionnaire. Multilevel models were used to derive early childhood emotion regulation scores (ie, predicted intercept) and within-child changes in emotion regulation scores from 3 to 7 years of age (ie, predicted slope). MAIN OUTCOME AND MEASURESSymptoms consistent with a DSM-5 diagnosis of anorexia nervosa or atypical anorexia nervosa at 14 years of age, defined using a range of questions relative to body image, weight perception, and dieting behaviors (hereinafter referred to as broad anorexia nervosa). Univariable and multivariable logistic regression models tested the association between exposures and outcome. Regression models were adjusted for child and family sociodemographic and socioeconomic characteristics and mental health difficulties, prenatal and perinatal factors, child's cognitive development, and maternal attachment.RESULTS A total of 15 896 participants (85.7% of total sample; 51.0% boys; 84.5% White individuals) had complete data on the exposure and were included in the main analyses. Among those with complete exposure and outcome data (9912 of the analytical sample [62.4%]), 97 participants (1.0%; 86 [88.7%] girls and 85 [87.6%] White individuals) had symptoms consistent with a diagnosis of broad anorexia nervosa at 14 years of age. No evidence suggested that children with lower emotion regulation ability at 3 years of age had greater odds of later reporting symptoms of broad anorexia nervosa (odds ratio [OR], 1.21; 95% CI, 0.91-1.63). However, children whose emotion regulation skills did not improve over childhood and who had greater problems regulating emotions at 7 years of age had higher odds of having broad anorexia nervosa at 14 years of age (OR, 1.45; 95% CI,.CONCLUSIONS AND RELEVANCE These findings suggest that difficulties in developing age-appropriate emotion regulation skills in childhood are associated with experiencing broad anorexia nervosa in adolescence. Interventions to support the development of emotion regulation skills across childhood may help reduce the incidence of anorexia nervosa.

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Anxiety disorders predict fasting to control weight: A longitudinal large cohort study of adolescents

Cited by 11 publications

References 74 publications

Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

Understanding the nature of association between anxiety phenotypes and anorexia nervosa: a triangulation approach

Association of Emotion Regulation Trajectories in Childhood With Anorexia Nervosa and Atypical Anorexia Nervosa in Early Adolescence

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