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Objective The objective of this study was to systematically review the literature on the prevalence of eating disorders (EDs) during the DSM-5 era, and to report rates of point- and lifetime prevalence. Method A PubMed search was conducted targeting articles on the epidemiology of EDs, in particular, reported rates of prevalence. The review was performed in accordance with PRISMA guidelines, and was limited to DSM-5 based eating disorder diagnoses published between 2012 and 2017. Results A total of 19 studies fulfilled inclusion criteria and were included in the study. Discussion Following the transition to DSM-5, it is evident that the prevalence of eating disorder not otherwise specified (EDNOS)/other specified feeding and eating disorders (OSFED) has decreased as intended, and there is preliminary evidence suggesting that rates of anorexia nervosa (AN) and bulimia nervosa (BN) and binge eating disorder (BED) have increased. Further, we observed higher rates of BED prevalence among females compared to males, with rates increasing with age. A limitation to the study was the search date, and that none of the included studies investigated the “new” DSM-5 feeding disorders avoidant restrictive food intake disorder (ARFID), pica or rumination disorder warranting attention in future studies investigating the epidemiology of feeding and eating disorders.

Background: Individual differences in executive function may influence eating behavior, weight loss (WL), and WL maintenance in obesity treatment. Executive function, which designates top-down cognitive control processes, has been related to eating behaviors which may impact weight, and has been found to be predictive of WL in both behavioral WL programs and after bariatric surgery. Currently, we lack knowledge on the role of executive function in the period before bariatric surgery. If executive function impacts eating behavior and WL in the preoperative period, it may be a target for clinical attention in this stage. Objectives: We aimed to examine the relationship between objective performance-based measures of executive function, eating patterns, and WL in the preoperative period. Method: Baseline data in an ongoing observational longitudinal study of bariatric surgery patients were used. Eighty patients completed neuropsychological testing and self-report questionnaires 4 weeks prior to surgery. Results: We found that working memory predicted WL before surgery and inhibitory control predicted adherence to dietary recommendations. Conclusion: Our study indicates that executive function may play a role in short-term WL and dietary adherence prior to surgery, suggesting that executive function in the preoperative period deserves an extended research focus.

Background Studies into the disordered eating behaviour of chew and spit have alluded to several cohorts more likely to engage in the behaviour, one such group being bariatric surgery candidates and patients. Weight-loss surgery candidates have received little to no attention regarding engaging in chew and spit behaviour. Changes in pre- and post- surgery eating pathology related to chew and spit behaviour has yet to be explored and described in academic literature. Case presentation The current study reports on three cases of individual women, aged 30, 35, and 62 respectively, who indicated engagement in chew and spit. All three cases underwent bariatric surgery (two underwent gastric bypass, one underwent vertical sleeve gastrectomy). Eating pathology—including chew and spit behaviour, anxiety and depression, and adherence to the Norwegian nutritional guidelines were examined pre-operatively and post-operatively (one and two-year follow-up). At baseline (pre-surgery), two participants reported that they engaged in chew and spit, compared to one patient post-surgery. All three cases reported that they, to at least some extent, adhered to dietary guidelines post-surgery. Subjective bingeing frequency appeared to be relatively low for all three cases, further declining in frequency at one-year follow-up. At baseline, one participant reported clinically significant depression and anxiety, with no clinically significant depression or anxiety reported at follow-ups in participants that chew and spit. Conclusions The current study provides a starting point for the exploration of chew and spit as a pathological symptom of disordered eating in bariatric patients. It highlights the need to further explore chew and spit before and after weight-loss surgery.

Introduction Ketamine, an N-methyl-D-aspartate receptor antagonist, has demonstrated rapid antidepressant effects at sub-anesthetic doses, making it a promising candidate for treatment-resistant mood disorders, anxiety, post-traumatic stress disorder, suicidality, and recently, eating disorders (EDs). However, its effects are transient, and ketamine-assisted psychotherapy (KAP) has emerged as a method to extend therapeutic benefits by combining ketamine’s heightened neuroplasticity with psychotherapy. Emerging evidence suggests KAP can reduce ED psychopathology and alleviate comorbid symptoms of depression and anxiety, potentially improving patients’ engagement in psychotherapy and enhancing treatment outcomes. Case presentation This study presents a 5-month follow-up of a female patient in her late twenties who underwent a structured treatment protocol consisting of four KAP sessions delivered within an Acceptance and Commitment (ACT) framework, plus three ketamine booster treatments. At intake, the patient presented with a diagnosis of anorexia nervosa (AN) and comorbid depression, reporting persistent intrusive thoughts about food and body image, dissatisfaction with prior treatments, and only partial relief from antidepressants. The patient sought ketamine treatment to improve energy levels, emotional flexibility, and overall quality of life. Assessments, including medical evaluations and self-reported measures of eating disorder pathology, depression, anxiety, suicidal ideation, quality of life, psychological flexibility, and ketamine-related side effects, were conducted at five time points both before and after the intervention. The primary aim was to investigate potential changes in ED psychopathology and comorbid symptoms follwoing treatment. Conclusion To our knowledge, this is the first documented case of structured KAP for AN showing both rapid and sustained symptom remission five months post-treatment, as well as the first European study to comprehensively investigate outcomes associated with KAP in EDs. Changes observed across most assessments indicated a consistent pattern: marked symptom reduction from baseline through the fourth KAP session, followed by a temporary symptom increase during the therapy-free interval between the final KAP session and the first ketamine booster dose. Symptoms then declined during the booster phase, with stabilization or further improvement at five-month follow-up. Ketamine was well-tolerated, with no increase in side effects or emergence of new symptoms. While preliminary findings are promising, important knowledge gaps remain. These include ketamine’s applicability across ED subtypes, severity levels, and age groups, as well as optimal treatment and assessment protocols that support long-term therapeutic effects and prevent relapse.

Background This study aimed to evaluate the psychometric properties of the Eating Disorder Examination Questionnaire Short version (EDE-QS) in a community sample of adolescents and to establish an optimal clinical cut-off score for screening purposes. Method Clinical interview and self-report data were collected as part of a broader epidemiological study conducted across six upper secondary schools in Norway. The sample included 1,430 adolescents (744 females, 686 males) aged 16–19 years (M = 17.03, SD = 0.90). Data were collected between November 2020 and May 2021. Psychometric evaluation included confirmatory factor analysis (CFA), assessment of convergent validity, and receiver operating characteristic (ROC) analysis to determine the optimal clinical cut-off score in females. Results The EDE-QS demonstrated good structural validity and excellent internal consistency. Findings also supported its convergent and criterion validity. The measure appears particularly suitable for epidemiological and clinical research contexts, where brief yet valid screening tools are essential. ROC analysis using the Youden criterion identified a cut-off score of 20 as providing the optimal balance of sensitivity (0.64) and specificity (0.81). This cut-off was derived from female participants only. Conclusions The EDE-QS combines robust psychometric properties with brevity, making it especially appropriate for use in large-scale epidemiological and clinical studies, where minimizing participant burden is critical. A limitation of the current study is that the clinical cut-off was established based solely on diagnostic data from female participants. Further validation is needed to assess the utility of the EDE-QS as a screening tool in male and gender-diverse adolescents. Clinical trial number Not applicable.

Background Few studies have investigated how the plethora of contemporary social media (SM) platforms relate to, and influence eating disorder (ED) pathology, appearance ideals and pressure to conform to these ideals in youth. Methods In this study, 1558 girls (53%) and boys (47%), predominantly within the 16–19 age range, completed an online questionnaire assessing SM use and perceived influence on appearance, ED pathology, internalization of appearance ideals and perceived appearance pressure. Results Results showed that ED pathology was common, particularly in girls, and that internalization of body ideals was gender specific, a thin ideal being more prevalent in girls, and a muscular ideal being more common in boys. Results also showed a strong association between ED pathology and perceived pressure to conform to these appearance ideals. One fourth of the participants reported spending four hours or more on SM daily, and 80% of girls reported that SM, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media. Conclusion A clear pattern of associations between photo- and video specific SM platforms, ED pathology, internalization of body ideals and perceived pressure was found in this study. Adolescent girls appeared to be particularly at risk. The results illustrate an imperative need to keep addressing the potential risks of SM use in adolescents, and to continue monitoring the effect of SM on young people’s view of themselves, their appearance, and their eating habits. Future studies should attempt to identify aspects of SM use that may be particularly detrimental for girls and boys in their formative years, but also those that may enhance adolescents’ satisfaction and appreciation of their body and appearance. Trial registration: The study is registered in the Open Science Framework (Identifier: 10.17605/OSF.IO/5RB6P https://doi.org/10.17605/OSF.IO/5RB6P ). Plain English summary Social Media (SM) has become an increasingly influential part of people’s everyday life, and has transformed the patterns of communication, especially in teenagers. In this study, we investigated the relationship between eleven commonly used SM platforms in adolescents, eating disorder (ED) pathology, appearance ideals, and pressure to conform to these ideals. A little over 1500 adolescent girls and boys, predominantly within the 16-19 age range, participated in the study. Most girls who participated reported that SM use, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media. Future studies should attempt to identify aspects of SM use that are particularly harmful for girls and boys in their formative years, but also those who have the potential of strengthening the sense of self-worth and contribute to positive identity formation.

Background Transdiagnostic Cognitive Remediation Therapy (TCRT) is a new adaptation of cognitive remediation therapy for eating disorders (EDs) developed to address common cognitive difficulties across ED diagnoses (i.e., cognitive flexibility, central coherence, and impulsivity). This is the first evaluation of this novel treatment. The aim of this study was to explore acceptability and patients’ experience of TCRT. Methods Thirteen patients diagnosed with restrictive or binge/purge subtypes of EDs and concurrent cognitive difficulties completed semi-structured qualitative interviews after receiving TCRT. Interview transcripts were analyzed using reflexive thematic analysis. Results The analysis resulted in four main themes: (1) Treatment fit (2), Treatment experience (3), Perceived outcomes, and (4) Future recommendations. Eleven of the thirteen patients evaluated the treatment positively, found the focus relevant and expressed how it contributed to new insights related to thinking style. Seven of the patients also described it as a starting point for making changes and using new strategies. Importantly, experiencing some challenges related to the cognitive difficulties addressed in the treatment seemed essential for engagement. Conclusion Offering TCRT as an adjunctive treatment for patients with EDs and concurrent cognitive difficulties can be a way to engage patients in treatment, build therapeutic alliances and provide important awareness and strategies to handle challenges related to thinking style. Trial registration This study is part of a larger randomized controlled trial, ClinicalTrials.gov Id: NCT03808467. Plain English summary Cognitive difficulties are thought to be one of several factors contributing to the development and maintenance of eating disorders (ED), but are rarely addressed in ED treatments. Cognitive remediation therapy (CRT) for EDs is a supplementary treatment originally developed for patients with anorexia nervosa (AN) that specifically targets cognitive difficulties. However, cognitive difficulties are found across ED diagnoses and not only in patients with AN. In this study, we have adapted CRT to address cognitive difficulties across ED diagnoses. The goal of this study was to explore patients’ experiences of this novel transdiagnostic CRT. We interviewed 13 individuals with various eating disorders after they had received the treatment. Eleven of the participants rated the treatment positively, expressed that it was engaging, offered something new and made them more aware of their thought processes. Seven participants also reported using new strategies to handle challenges related to cognitive difficulties. Importantly, one participant expressed that she did not experience cognitive difficulties and chose to drop out of the treatment, highlighting the importance of finding the treatment relevant to foster engagement.

Background Eating disorders (EDs) are a group of mental illnesses associated with significant psychological and physiological consequences. Overall, only about one-fifth of individuals with EDs receive treatment and treatment is effective for only about one-third for those who receive care. The development and implementation of effective prevention approaches for those at risk is therefore pivotal. The Body Project is the most effective ED prevention program for at-risk women according to several meta-analyses, but reach is limited since delivery, traditionally, has been in-person. Moreover, peer-led Body Project groups have been reported to produce stronger effects than clinician-led Body Project groups when delivered in-person. This has not yet been examined for virtually delivered Body Project groups. This study therefore seeks to investigate the effect of virtual Body Project groups delivered by peers versus clinicians on ED risk factors, ED symptoms, and prospective ED onset. Methods Young women with body image concerns aged 16–25 years (N = 441) will be included in the study and randomized to three conditions: (i) virtually delivered Body Project groups led by clinicians; (ii) virtually delivered Body Project groups led by peers; and (iii) psychoeducational control group. Participants will complete assessments at five timepoints over two years (pretest, posttest, 6-months, 1-year, and 2-years). Discussion Further research is needed to examine approaches to increase the potential for broad implementation of prevention of EDs. The virtual modality of the Body Project could markedly expand the reach for young women at risk. If findings confirm that peers can deliver virtual Body Project groups as effectively as clinicians, this will further enhance the implementation potential. Trial registration : The present study has been registered on clinicaltrials.gov (NCT05993728).

Background Negative body image and disordered eating are common among adolescents and young adults. The Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised (SATAQ-4R) captures the internalization of societal appearance ideals and perceived pressures from others but has not been validated in a Norwegian adolescent population. Methods The current study explored the factor structure of SATAQ-4R in a sample of adolescent Norwegian males and females ( n  = 1558, mean age 17.04 ± 0.95) using confirmatory factor analysis (CFA) for a 6- and 7-factor structure in females, and a 7-factor structure in males. Correlations between subscales, internal consistency and reliability, and comparisons with convergent measures (disordered eating, body mass index, negative influence of social media) were explored. Results The CFA supported a 7-factor structure of the SATAQ-4R for both males and females. Internal consistency and reliability were acceptable. SATAQ-4R subscales largely correlated with disordered eating and additional convergent measures. Conclusions Results confirm the structure and reliability of the SATAQ-4R in a Norwegian adolescent population. The subscales showed good convergent validity, and high scores on internalization and societal pressures were related to higher levels of disordered eating and negative social media influence. The Norwegian version of the SATAQ-4R thus demonstrates good psychometric properties in adolescent males and females, and is well suited to capture internalization and sociocultural pressures that particularly affect adolescents. Results highlight the need to continue working towards reducing adverse internalization and improving body image among adolescents. Plain English summary Appearance pressures and internalization of appearance ideals are empirically supported risk factors for body dissatisfaction and disordered eating. Having validated tools to measure these risk factors is essential, particularly for young people, as adolescence itself presents an increased risk for the development of eating disorders. The SATAQ-4R is a self-report questionnaire designed to measure the internalization of western beauty standards, and pressure to conform to these. Although the measure has been used in Norwegian research, it hasn’t been validated yet. This study aimed to test how well the SATAQ-4R works with Norwegian teenagers. The results showed that it effectively captures the internalization of societal expectations and pressures that particularly affect adolescents.

Background Pathological eating and addictive processes are linked to obesity. Food addiction (FA) involves hedonic eating of highly palatable foods, accompanied by addictive symptoms like craving, loss-of-control (LOC) eating, and withdrawal. The main objectives of this study were to assess FA prevalence and symptoms in bariatric surgery candidates, and its relationship with depression, dysregulated eating, and 1- year postoperative weight loss (WL). Methods Data from 69 bariatric surgery patients (74% female, 26% male, ) were analysed. Self-report measures including Yale Food Addiction Scale (YFAS) 2.0, Eating Disorder Examination-Questionnaire (EDE-Q), Repetitive Eating Questionnaire [Rep(eat)-Q] and Hospital Anxiety and Depression Scale (HADS) were administered pre-surgery and at 1-year follow-up. Results The mean preoperative YFAS symptom score was 2.2. (SD = 2.59). 16% of the sample met YFAS diagnostic criteria for FA. Top reported FA criteria were “substance taken in larger amount than intended” (33%), “persisted desire or repeated unsuccessful attempts to quit” (29%), and “use in physically hazardous situations” (23%). The YFAS symptom scores correlated significantly with the frequency of LOC binge eating, depression and repetitive eating scores, but showed no correlation with age or BMI. Preoperative YFAS symptom scores did not significantly predict % WL at 1-year follow-up. Conclusions Our findings align with previous research, indicating that preoperative FA symptoms is unrelated to preoperative BMI and total %WL, but linked to eating pathology, such as LOC binge eating and grazing, as well as depression in bariatric surgery candidates. Plain English Summary Pathological eating and addictive behaviors are linked to obesity. This study looked at food addiction (FA) in people preparing for bariatric surgery and how it relates to depression, eating habits, and weight loss a year after surgery. Researchers studied 69 patients using surveys to measure FA, eating behaviors, and mental health before surgery and one year later. Key findings include: • 16% of participants met the criteria for FA before surgery. • Common FA symptoms were eating more than intended, trying and failing to cut down on eating, and eating in dangerous situations. • FA symptoms were linked to binge eating, depression, and repetitive eating but not to age or BMI. • Pre-surgery FA symptoms did not predict weight loss a year after surgery. In conclusion, FA symptoms before surgery are associated with problematic eating behaviors and depression but do not influence the amount of weight lost after surgery. Highlights The prevalence of a food addiction diagnosis in the bariatric candidate sample was 16%. Preoperative food addiction symptoms were significantly associated with preoperative grazing, binge eating, and depression. Preoperative food addiction symptoms did not predict 1- year postoperative weight loss.