Eating - PowerPoint Presentation

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Eating Disorders do not just disappear: implications of adolescent eating-disordered behaviour for body weight and mental health in young adulthood

Results of the mental health module (BELLA-study) of the nationwide German Health Interview and Examination survey for Children and Adolescents (KiGGs) ESCAP MADRID, 22/06/2015 Beate Herpertz-DahlmannSlide2

Disclosure ESCAP Madrid 2015Since

2012Vifor Pharma Research GrantGerman Research Society (DFG) Research GrantGerman Ministry for Education and Research GrantResearchEU FP 7 Research Grant

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BackgroundHigh

prevalence of eating disorders (DSM-IV) in female adolescents in Western countries (point prevalence) (Machado et al. 2007; Swanson et al. 2011)approx. 3 - 6% Increasing incidence in

adolescence

(UK,

primary

care, 15-19 y. )

(

Micali et al. 2013)Increase by 13% from 2000 to 2009)2/1000 girlsSecond most common new onset mental health disorder in adolescence after depression (UK) (Micali et al. 2013)11/1000 girls for comparison: Incidence of diabetes mellitus type 1 (UK) 0.4/1000 girls

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Aim of the BELLA- study

to investigate the stability of eating-disordered behaviour from adolescence

to

young adulthood

;

its

effect on the development of over- and underweight; its contribution to the development of mental disorders, e.g. depression; but also vice versa: association between adolescent psychopathology and later disordered eating and BMI (Herpertz-Dahlmann et al. 2009; 2015)Seite 4Slide5

BELLA-Study Method Mental health module of the nationwide German Health Interview and Examination survey for Children and

Adolescents (KiGGs) KiGGs: Population-based randomly chosen sample of 167 sampling units in cities and communities all over Germany; The final KiGGS study population included 17.641 children and adolescents between birth and the age of 17;BELLA-study: a randomly selected subsample of 2.863 families with children aged 7–17 years Computer-assisted interview with the children and adolescents and one of their parentsadditional questionnaires sent and returned by mail

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Populations of first and second wave of the mental health module (BELLA-study) of the German Health

Interview and Examination Survey for Children and Adolescents (KiGGS) 2003 – 2006 2863 baseline data (7-17 years) (48,5%♀, 51,5%♂) 1734 (60,6% )

assessed

(11-17

years) (48,7%

♀, 51,3%♂)

2009 – 2013 775 (44,7%) Follow-

up

2nd wave 771 sufficient data (45,5 %♀, 54,5 %♂) Dropouts: lower SESRelatively

more

males

Slightly

lower

SCOFF

scores

(Herpertz-Dahlmann

et al.,

ECAP 2015)

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Disordered EatingDefinition Note: symptoms do not fulfill classification criteria (DSM or ICD)Method of assessment SCOFF – screening questionnaire (conspicuous value: ≥ 2 ) 1) Do you make yourself sick because you feel uncomfortably full? (deliberate vomiting

) 2) Do you worry you have lost control over how much you eat ? (loss of control over eating) 3) Have you recently lost more than one stone in a three-month period ? (weight loss) 4) Do you believe yourself to be fat when others say you are thin (body image distortion) 5) Would you say that food dominates your life? (high impact of food on life) Body weight and height of probands measured in person at 1rst wave, at 6-year follow-up by telephone interview, self reported weight and height of the parents

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Disordered Eating and associated mental disorders Further

assessment instrumentsDepressionCES-DCThe Centre for Epidemiological Studies Depression scale for ChildrenAnxiety SCAREDScreen for Anxiety-Related Emotional Disorders questionnaire

Depression

(in young adults

)

PHQ

Patient

Health Questionnnaire, depression moduleSeite 8Slide9

Descriptive data on the BELLA- sample at baseline and follow-up

MeanSDMin.Max.Age (Baseline) (years)14.32.011.018.0Age (Follow-up) (years)21.02.217.127.0

BMI (Baseline) kg/m²

20.6

3.9

13.5

42.6

BMI (Follow-

up) kg/m²22.73.715.346.2Seite 9SES (Baseline)%Low18.1Medium49.2High32.7Slide10

RESULTSSlide11

Stability of ED behaviour and attitudes (n=771)SCOFF ≥ 2Baseline %SCOFF ≥ 2 follow-up %p =All participants19.3

13.80.002Females 26.017.60.002Males11.39.20.41Seite 11Note:

Decline more pronounced in females and in those with a higher BMI Slide12

Course of eating disordered behaviour Relationship between SCOFF/Baseline u. SCOFF/6-year-follow-up

Seite 12Highly significant relationship

between

eating

disordered

behaviour in adolescence and young adulthood ( p < 0.0001) (Poisson regression

model

after

adjusting

for

age

,

sex

,

and

baseline

BMI) Slide13

Association between eating-disordered behaviour (SCOFF-score) at baseline and BMI at follow-

upSeite 13Participants with

higher

SCOFF

scores

at

baseline

were highly likely to become overweight or obese in young

adulthood

OR.1.58

; p= 0.001

Controlled

for

baseline

and

parental BMI Slide14

Eating-disordered behaviour at baseline (SCOFF-Score) and depression at follow-upSeite 14

Individuals with

higher

SCOFF-

Scores

in

adolescence

have a higher risk for depressive symptoms in young adulthood (p=0.0006) Slide15

Association between symptom patterns (single SCOFF items) at baseline and later eating disordered behaviour % Partic.SCOFF Follow-upoverweight Follow-up

Low weight Follow-upDepression Follow-upPHQDeliberate vomiting4.50.060.050.020.003Loss of control over eating23.3< 0.00010.03

0.42

0.0006

Weight

loss

4.8

0.050.110.280.48Body image distortion19.3< 0.00010.020.400.31High impact of food on life 21.10.00040.220.070.25Seite 15Slide16

Association between depressive symptoms in adolescence and low body weight in early adulthood

Seite 16There is a significant relationship between

depressive

symptoms

In

adolescence

and very low body weight in early adulthood (< 3. Perzentile)

OR=1.13; p=0.02

1rst BMI-

Quartile

3rd BMI-

QuartileSlide17

Summary I: Eating Disorders do not just disappear…There is a decline in disordered eating behavior between adolescence and young adulthood; Disordered eating in adolescence is a significant predictor of disordered eating in young adulthood.Probands with more severe disordered eating have a higher probability to suffer from overweight and obesity in young adulthood (even after controlling for BMI at baseline and parental BMI) Disordered eating in adolescence is significantly associated with depression in young adulthood.

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Summary II: Eating Disorders do not just disappear… Higher depression scores in adolescence are significantly associated with very low

body weight (anorexia nervosa) in young adulthood. There is urgent need for early detection and interventions targeting disordered eating behaviour in adolescence.Seite

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Eating Disorders do not just disappear…..Thank you very much for your attention!For further

questions:bherpertz@ukaachen.de