Estimation of meal portions in bulimia nervosa compared to anorexia nervosa and healthy controls

Abstract

Purpose Bulimia nervosa (BN) and anorexia nervosa (AN) are potentially life-threatening eating disorders (ED) that primarily affect young people, mostly women. The central common pathology is linked to the relationship with food and with abnormalities in food intake. A previous study indicated that individuals with AN tend to overestimate food portion sizes compared to healthy controls (HC), but no study has investigated these patterns in BN, which was the objective of this study. Methods Women with BN (27), AN (28), and HC (27) were asked to rate different meal portion sizes in two conditions: as if they were supposed to eat them (intent-to-eat condition) or in general (general condition). BN results were compared to HC and AN using mixed model analyses. Results BN showed larger estimations compared to HC, while smaller estimations compared to AN. These differences were found mostly for intermediate portion sizes. No difference for conditions (intent-to-eat; general) was found between groups. Conclusion When estimating food portion sizes, individuals with BN seem to fall intermediately between HC and AN. ED symptoms in BN were most strongly associated with higher portion estimation. This might therefore reflect one aspect of the cognitive distortions typically seen also in AN. A therapeutic option could include the frequent visual exposure to increasing portions of food, what may serve to recalibrate visual perceptions of what a “normal-sized” portion of food looks like. Level of evidence Level II: Evidence obtained from well-designed controlled trials without randomization.

Serving size estimates using digital food photographs among Japanese adults: a critical analysis

“…Additionally, it is suggested to include questions related to eating disorders, notably anorexia and bulimia, and hunger levels in future iterations of the survey. This is because individuals with certain eating disorders may have distorted perceptions of serving size portions, and their responses to the questionnaire may be influenced by their current level of hunger ( 6 ) .…”