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Background Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders. Methods A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders. Results Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95% CI 2.00–6.89; I 2  = 81; p  ≤ 0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used. Discussion Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples.

Purpose Body weight dissatisfaction (BWD) and visual body perception are specific aspects that can influence the own body image, and that can concur with the development or the maintenance of specific psychopathological dimensions of different psychiatric disorders. The sexual orientation is a fundamental but understudied aspect in this field, and, for this reason, the purpose of this study is to improve knowledge about the relationships among BWD, visual body size-perception, and sexual orientation. Methods A total of 1033 individuals participated in an online survey. Physical comparison, depression, and self-esteem was evaluated, as well as sexual orientation and the presence of an eating disorder. A Figure Rating Scale was used to assess different valences of body weight, and mediation analyses were performed to investigated specific relationships between psychological aspects. Results Bisexual women and gay men reported significantly higher BWD than other groups ( p  < 0.001); instead, higher body misperception was present in gay men ( p  = 0.001). Physical appearance comparison mediated the effect of sexual orientation in both BWD and perceptual distortion. No difference emerged between women with a history of eating disorders and without, as regards the value of body weight attributed to attractiveness, health, and presence on social media. Conclusion This study contributes to understanding the relationship between sexual orientations and body image representation and evaluation. Physical appearance comparisons should be considered as critical psychological factors that can improve and affect well-being. The impact on subjects with high levels of eating concerns is also discussed. Level of evidence Level III: case–control analytic study.

Purpose “Making weight” behaviors are unhealthy weight control strategies intended to reduce weight in an effort to meet weight requirements. This study aimed to examine a brief measure of making weight and to investigate the relationship between making weight and weight, binge eating, and eating pathology later in life. Methods Participants were veterans [ N  = 120, mean age 61.7, mean body mass index (BMI) 38.0, 89.2% male, 74.2% Caucasian] who were overweight/obese and seeking weight management treatment. Participants completed the making weight inventory (MWI), a measure of making weight behaviors engaged in during military service, and validated measures of eating behavior. Analyses compared participants who engaged in at least one making weight behavior (MWI+) versus those who did not (MWI−). Results The MWI had good internal consistency. One-third of participants were MWI+ and two-thirds were MWI−. The most frequently reported behavior was excessive exercise, reported in one-quarter of the sample, followed by fasting/skipping meals, sauna/rubber suit, laxatives, diuretics, and vomiting. MWI+ participants were significantly more likely to be in a younger cohort of veterans, to be an ethnic/racial minority, and to engage in current maladaptive eating behaviors, including binge eating, vomiting, emotional eating, food addiction, and night eating, compared to the MWI− group. Groups did not differ on BMI. Conclusions One-third of veterans who were overweight/obese screened positive for engaging in making weight behaviors during military service. Findings provide evidence that efforts to “make weight” are related to binge eating and eating pathology later in life. Future research and clinical efforts should address how to best eliminate unhealthy weight control strategies in military service while also supporting healthy weight management efforts.

Background Internalized sociocultural standards of attractiveness are a risk factor repeatedly linked to eating disorders; however, many nonbinary individuals do not conform to these standards. Purpose This study investigated the body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. Methods Participants ( n  = 194) completed an online survey assessing body checking behaviors, body appreciation, gender congruence, and eating disorder pathology Results Body checking predicted eating disorder pathology, and body image significantly improved the model. Gender congruence did not additional variance in predicting eating pathology Conclusion Though gender congruence was not a significant predictor of eating pathology, content analysis revealed unique body behaviors specific to nonbinary individuals’ gender identity and gender expression. Clinical implications include expanding perceptions of eating disorder presentation when working with nonbinary individuals with androgynous appearance ideals. Level of evidence Level V, cross-sectional descriptive study.

Purpose Research concerning eating disorders among adolescent and young adult male athletes is limited compared with female counterparts, but increasing evidence indicates that they may be at unique risk for unhealthy exercise and eating behavior. The current study aimed to characterize unhealthy exercise and eating behavior according to competitive athlete status, as well as per sport type. Method Collegiate male athletes ( N  = 611), each affiliated with one of the 10 National College Athletics Association (NCAA) Division I schools in the United States, completed an online survey, reporting on eating and extreme weight control behaviors, and reasons for exercise. Results Competitive athletes endorsed increased driven exercise and exercising when sick. Baseball players, cyclists, and wrestlers emerged as the sports with the most players reporting elevated Eating Disorder Examination-Questionnaire scores in a clinical range, and basketball players reported the highest rates of binge eating. overall, baseball players, cyclists, rowers, and wrestlers appeared to demonstrate the greatest vulnerability for unhealthy eating and exercise behavior. Conclusion Findings revealed differences between competitive and non-competitive male athletes. Among competitive athletes, results identified unique risk for unhealthy eating and exercise behavior across a variety of sport categories and support continued examination of these attitudes and behaviors in a nuanced manner. Level II Evidence obtained from well-designed controlled trials without randomization.

Purpose Eating disorder (ED) awareness is low. We assessed if ED symptom recognition, perceived need for treatment, perceived distress, perceived acceptability, and perceived prevalence differed depending on the gender of the individual with the ED. Methods 276 community participants were randomly assigned to one of three gender conditions (female, male, and non-binary), read three vignettes describing three different individuals with ED symptoms [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)], and then answered a series of questions related to participants ED symptom recognition, perceived need for treatment, perceived distress associated with having ED symptoms, perceived acceptability (e.g., the extent to which it may not be too bad to have an ED), and perceived prevalence. Mixed ANOVAs and chi-square analyses were conducted to examine differences between groups. Results There were no significant main effects of gender condition across the outcome variables. There were main effects of ED type for problem recognition, perceived need for treatment, perceived level of distress, and perceived prevalence, with participants being more likely to recognize a problem in the AN and BN vignettes than the BED vignettes, refer for treatment and rate a higher perceived level of distress in then AN vignette than the BN and BED vignettes, and perceive a higher prevalence rate in the BN vignette than the AN vignette. There was a significant gender by condition interaction for perceived prevalence, with participants rating a higher prevalence of AN in women and non-binary individuals than men and a higher prevalence of BN in women than non-binary individuals and men. Conclusion These results highlight the importance of education on EDs and awareness that EDs can occur in any individual, regardless of their gender identification. Level of evidence Level I, experimental study with randomization.

Purpose Cisgender bisexual plus (including bisexual, pansexual, and polysexual) women and men experience unique health concerns including eating disorders. The purpose of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in cisgender bisexual plus women and men using the Eating Disorders Examination Questionnaire (EDE-Q). Methods Participants were cisgender bisexual plus women ( n  = 462) and men ( n  = 93) participants in The PRIDE Study, an existing study of sexual and gender minority people. Results Mean and standard deviation of EDE-Q scores among cisgender bisexual plus women and men, respectively, were: Global (1.75 ± 1.26, 1.56 ± 1.18), Restraint (1.34 ± 1.44, 1.42 ± 1.53), Eating Concern (0.96 ± 1.13, 0.63 ± 0.96), Weight Concern 2.27 ± 1.55, 1.89 ± 1.46), and Shape Concern 42 ± 1.62, 2.30 ± 1.57). Among cisgender bisexual plus women and men, respectively, 27.5% and 22.6% scored in the clinically significant range on the Global score. Bisexual plus women and men reported any occurrence (≥ 1/28 days) of dietary restraint (19.3%, 23.7%), objective binge episodes (11.1%, 10.8%), excessive exercise (4.5%, 5.4%), self-induced vomiting (1.7%, 0.0%), and laxative misuse (0.4%, 1.1%), respectively. A lower percentage of age-matched cisgender bisexual plus women (18–25 years) reported any occurrence of objective binge episodes, self-induced vomiting, laxative misuse, and excessive exercise than previously published in young women. Age-matched cisgender bisexual plus men (18–26 years) reported higher weight concern subscale scores than previously published in young men. Conclusions These norms should aid clinicians in applying and interpreting the EDE-Q scores of cisgender bisexual plus women and men. Level of evidence Level V: cross-sectional descriptive study

Purpose This study examined how eating disorder symptoms, assessed by the Eating Pathology Symptoms Inventory (EPSI), vary across chronological age in a large national (USA) sample of transgender and gender-diverse (TGD) adults. Method Participants were 2098 TGD adults—including transgender men ( n  = 599), transgender women ( n  = 293), and gender-diverse individuals ( n  = 1,206, including nonbinary and those who identified with “another gender identity”)—enrolled in The PRIDE Study. A multivariate general linear model tested the effects of chronological age, gender group (with gender-diverse as the reference), and their interaction on the eight EPSI scales. Results Multivariate analyses showed significant main effects of age ( V  = .045, p < .001) and gender group ( V  = .098, p < .001), but no significant age-by-group interaction. Older age was associated with greater Cognitive Restraint ( β  = .22, p < .001), Negative Attitudes toward Obesity ( β  = .22, p < .001), and Excessive Exercise ( β  = .12, p = .001). Compared to gender-diverse individuals, transgender men exhibited higher Muscle Building, Cognitive Restraint, and Excessive Exercise scores, whereas transgender women reported higher Binge Eating, Purging, Cognitive Restraint, and Negative Attitudes toward Obesity, but lower Muscle Building. A single significant interaction indicated that transgender women showed stronger age-related differences in Purging. Conclusions These findings contribute to growing evidence that disordered eating symptoms may not simply resolve with age among TGD individuals and necessitate lifespan-sensitive approaches to eating disorder care. These patterns likely capture a mix of aging processes and cohort-specific exposures to weight-normative and cis-normative ideals. Level of evidence Level V: based on descriptive studies.

Purpose To examine the prevalence of disordered eating (DE) in elite male and female soccer players and the influence of perfectionism. Methods Using a cross-sectional design, elite male ( n  = 137) and female ( n  = 70) soccer players and non-athlete controls ( n  = 179) completed the clinical perfectionism questionnaire (CPQ-12) and the eating attitudes test (EAT-26) to assess perfectionism and DE risk, respectively. Results Male soccer players had higher EAT-26 scores than controls (10.4 ± 9.9 vs. 6.8 ± 6.7; P  = 0.001), but there were no differences in the prevalence of clinical levels of DE (EAT-26 score ≥ 20) (15 vs. 5%, respectively; X 2  = 0.079) The proportion of females with DE risk was higher in controls [EAT-26: 13.9 ± 11.6 (25% of population)] than female players [EAT-26: 10.0 ± 9.0% (11% of population)] ( X 2  = 0.001). With linear regression, perfectionism explained 20% of the variation in DE risk in males ( P  = 0.001); in females, athletic status (player vs. control) and perfectionism were significant predictors of DE risk, explaining 21% of the variation ( P  = 0.001). Male reserve team players had higher EAT-26 (+ 3.5) and perfectionism (+ 2.7) scores than first-team players ( P  < 0.05). There were no differences in the prevalence of DE risk between the male and female soccer players ( X 2  = 0.595). Conclusions The prevalence of DE risk was not different in elite male and female soccer players; in fact, the prevalence was greatest in non-athlete female controls. Perfectionism is a significant predictor of DE risk in males and females. Level of evidence III, case–control study.

Purpose To report on the mortality of DSM-IV eating disorders and predictors of premature death in males compared to females after inpatient treatment. Methods Crude mortality rate (CMR) and standardized mortality ratio (SMR) were computed for a large sample of males aged at treatment 16–61 years [ N  = 66 anorexia nervosa (AN), 52 bulimia nervosa (BN), 70 eating disorder not otherwise specified (ED-NOS)] and females aged 14–65 years ( N  = 2066 AN, 1880 BN, 1350 ED-NOS). In addition, a survival analysis and Cox regression analyses for identifying predictors of death were computed. Results CMRs for males and females, respectively, were 15% and 5% in AN, 8% and 3% in BN, and 4% and 3% in ED-NOS. Compared to the general population, mortality was elevated in males with AN (SMR = 4.93) and in all female diagnostic groups (AN, BN, ED-NOS). No significant sex differences for SMR emerged in any diagnostic group. Compared to females with AN or BN, males with AN or BN showed a shorter survival time after onset (survival analysis). Being male, and having AN, increased the risk of premature death. Conclusion Mortality in inpatients with eating disorder is high, especially in AN. Males appear to have about the same outcome in terms of mortality as females with AN, BN, and ED-NOS. However, long-term survival was shorter in males with AN or BN compared to females. The need for intensive treatment in both males and females with an eating disorder remains an important issue. Level of evidence Level III, case–control analytic study.