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Objective: Although exercise is generally considered healthy, many individuals engage in maladaptive exercise (e.g., compulsive in nature). Several definitions of maladaptive exercise exist, leading to multiple, varied assessment tools; assuming homogeneity across these assessments contributes to low consensus in etiological models. Method: We used a Jaccard Index to quantify content overlap among 15 commonly‐used self‐report instruments measuring maladaptive exercise, with 31 features identified across 224 items. Results: The most common features were exercise to control weight/shape and to avoid negative affect (both included in 9/15 instruments), or compensate for calories consumed (8/15 instruments). Overlap among instruments was low (.206) and no features were common across all instruments. Conclusions: Findings generally support theoretical models of exercise in eating pathology. However, instruments most commonly used to assess maladaptive exercise measure heterogenous content. Careful consideration should be taken when comparing findings derived from differing instruments, when synthesizing literature on maladaptive exercise, and when selecting instruments to measure specific maladaptive exercise features. Public Significance: Many, varied, tools exist for the assessment of maladaptive exercise (e.g., compulsive or compensatory) in the context of eating disorders. Assuming homogeneity across tools contributes to low consensus in the field. We used a Jaccard Index to quantify content overlap among 15 self‐report instruments measuring maladaptive exercise. The most commonly used instruments measure heterogenous content. Careful consideration should be taken when synthesizing literature and selecting instruments to use in research. [ABSTRACT FROM AUTHOR]

Background: Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors among youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise‐related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior. Method: Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of 'No Exercise for Weight Loss', 'Exercise for Weight Loss', and 'Maladaptive Exercise' over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified predictors of these behaviors. Results: Endorsement of exercise for weight loss and maladaptive exercise increased over time in both males and females. Those in the 'Exercise for Weight Loss' category were more likely than those in the 'No Exercise for Weight Loss Category' to transition to 'Maladaptive Exercise' over time. Body mass index (Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across sex. Conclusions: Results support re‐framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high‐risk individuals. [ABSTRACT FROM AUTHOR]

Objective: There is increasing consensus that open science practices improve the transparency and quality of clinical science. However, several barriers impede the implementation of these practices at the individual, institutional, and field levels; understanding and addressing these barriers is critical to promoting targeted efforts in increasing effective uptake of open science. Methods: Within this research forum, we drew from publicly available online information sources to identify initial characterizations of researchers engaged in several types of open science practices in the field of eating disorders. We use these observations to discuss potential barriers and recommendations for next steps in the promotion of these practices. Results: Data from online open science repositories suggest that individuals using these publishing approaches with pre‐prints and articles with eating‐disorder‐relevant content are predominantly non‐male gender identifying, early to mid‐career stage, and are more likely to be European‐, United States‐, or Canada‐based. Discussion: We outline recommendations for tangible ways that the eating disorder field can support broad, increased uptake of open science practices, including supporting initiatives to increase knowledge and correct misconceptions; and prioritizing the development and accessibility of open science resources. Public Significance Statement: The use of open science practices has the potential to increase the transparency and quality of clinical science. This Forum uses publicly sourced online data to characterize researchers engaged in open science practices in the field of eating disorders. These observations provide an important framework from which to discuss potential barriers to open science and recommendations for next steps in the promotion of these practices. [ABSTRACT FROM AUTHOR]

Objective: Driven exercise (DEx) is a serious and common feature of eating disorders (EDs), but current understanding of factors that give rise to and maintain DEx is limited. DEx may be reinforced through its effects on the threat reduction and reward systems. The current protocol is designed to evaluate acute psychobiological response to exercise among female participants (age 16‐22) with and without EDs. Method: Twenty medically‐stable participants with restrictive‐spectrum EDs and 20 healthy control (HC) participants will complete study screening and three task visits which will include two 30‐minute bouts of aerobic exercise. Results: We aim to validate and demonstrate feasibility of two tasks capturing exercise response in this sample. Further, we will estimate the degree to which a bout of exercise impacts state body image, affect, and circulating concentrations of biological markers among participants, and we will examine whether the impact of exercise on psychological outcomes may differ across ED and HC groups. Discussion: Completion of this project will contribute to the conceptualization of DEx and how individuals' acute biological and affective responses to exercise contribute to risk for and maintenance of DEx. [ABSTRACT FROM AUTHOR]

Anxiety and eating disorders (EDs) often co‐occur, prompting calls to explore anxiety‐related maintenance processes in ED samples. Safety behaviors, which function to prevent a feared outcome from occurring or to reduce anxiety associated with a feared stimulus, are observed across anxiety disorders and, along with overt avoidance behaviors, are an important target in treatment. Data suggest that individuals with EDs also engage in safety behaviors. However, no existing assessments provide a comprehensive measure of eating‐disorder‐specific overt avoidance and safety behaviors. The goal of this Stage 1 Registered Report is to develop a comprehensive self‐report measure of ED‐specific safety behaviors. In Study 1, we will recruit 50 women with EDs to complete the scale and provide feedback on the response scale. Feedback from these participants will be used to refine the measure. In Study 2, we will evaluate the psychometric properties of the measure in a large sample of women with EDs (n dependent on the size of measurement) and a community sample without current or a history of ED symptoms. We will explore the measure factor structure, known‐groups validity by comparing scores from women with EDs to healthy controls, internal consistency, and convergent and divergent validity with other psychological instruments. [ABSTRACT FROM AUTHOR]

Objective: The Criterion B binge‐eating symptoms represent five symptoms associated with binge eating. Any three out of five symptoms can be used to meet Criterion B. However, Criterion B symptoms may not be interchangeable in terms of how binge‐eating severity is associated with each symptom. Item response theory (IRT) can test how endorsing each symptom relates to the overall level (i.e., severity) of binge‐eating measured by Criterion B. We used IRT to identify (a) how each Criterion B symptom corresponded with binge‐eating severity in a transdiagnostic binge‐eating sample and (b) how well each symptom differentiated individuals with differing levels of severity. Method: Participants (N = 219) were adults (80.8% female) with a current ED that included objective binge‐eating episodes assessed via semi‐structured interview. A two‐parameter logistic IRT model evaluated how endorsement of each Criterion B symptom corresponded with the level of latent binge‐eating severity. Results: "Eating large amounts when not hungry" and "eating alone" reflected the highest binge‐eating severity. "Eating alone" was the best discriminator across different binge‐eating severity levels, whereas "uncomfortably full" was the poorest discriminator across binge‐eating severity levels. Discussion: Criterion B symptoms were not interchangeable in terms of what level of binge‐eating severity corresponded with symptom endorsement. "Eating large amounts when not hungry" or "eating alone" may signify elevated binge‐eating severity, whereas "uncomfortably full" and "feeling disgusted/depressed/guilty" were not necessarily indicative of elevated severity. Results suggested that Criterion B may need to be revised to eliminate symptoms that are redundant with other binge‐eating diagnostic criteria. [ABSTRACT FROM AUTHOR]

Objective: Cross‐sectional associations between eating disorders (EDs) and deficits in neuropsychological functioning have been well documented; however, limited research has examined whether neuropsychological functioning is prospectively associated with EDs. The current study investigated prospective associations between neuropsychological functioning in childhood (ages 8 and 10) and ED behaviours and disorders in adolescence (at ages 14, 16, and 18 years) in a population‐based sample. Method: Participants (N = 4,803) were children enrolled in the Avon Longitudinal Study of Parents and Children, a population‐based, prospective study of women and their children. Regression methods tested associations between facets of neuropsychological functioning (attention, working memory, and inhibition) and eating disorder symptoms and diagnoses. Results: Better scores on working memory tasks in childhood were associated with decreased risk of fasting but increased risk of excessive exercise during adolescence. Better inhibitory control was associated with decreased risk for disordered eating at age 14, and attentional difficulties were associated with increased risk for binge eating disorder during adolescence among boys but not girls. Conclusions: Neuropsychological functioning may enhance risk for disordered eating behaviours in specific ways. Overall, effect sizes were small, and results did not support global associations between neuropsychological differences and ED risk in this sample. [ABSTRACT FROM AUTHOR]

Objective: Clinically, anorexia nervosa (AN) presents with altered body composition. We quantified these alterations and evaluated their relationships with metabolites and hormones in patients with AN longitudinally. Method: In accordance with PRISMA guidelines, we conducted 94 meta‐analyses on 62 samples published during 1996–2019, comparing up to 2,319 pretreatment, posttreatment, and weight‐recovered female patients with AN with up to 1,879 controls. Primary outcomes were fat mass, fat‐free mass, body fat percentage, and their regional distribution. Secondary outcomes were bone mineral density, metabolites, and hormones. Meta‐regressions examined relationships among those measures and moderators. Results: Pretreatment female patients with AN evidenced 50% lower fat mass (mean difference [MD]: −8.80 kg, 95% CI: −9.81, −7.79, Q = 1.01 × 10−63) and 4.98 kg (95% CI: −5.85, −4.12, Q = 1.99 × 10−28) lower fat‐free mass, with fat mass preferentially stored in the trunk region during early weight restoration (4.2%, 95% CI: −2.1, −6.2, Q = 2.30 × 10−4). While the majority of traits returned to levels seen in healthy controls after weight restoration, fat‐free mass (MD: −1.27 kg, 95% CI: −1.79, −0.75, Q = 5.49 × 10−6) and bone mineral density (MD: −0.10 kg, 95% CI: −0.18, −0.03, Q = 0.01) remained significantly altered. Discussion: Body composition is markedly altered in AN, warranting research into these phenotypes as clinical risk or relapse predictors. Notably, the long‐term altered levels of fat‐free mass and bone mineral density suggest that these parameters should be investigated as potential AN trait markers. ResumenObjetivo: Clínicamente, la anorexia nervosa (AN) se presenta con alteraciones en la composición corporal. Cuantificamos estas alteraciones y evaluamos longitudinalmente su relación con metabolitos y hormonas en pacientes con AN. Método: De acuerdo con las pautas PRISMA, realizamos 94 meta‐análisis en 62 muestras publicadas entre 1996–2019, comparando hasta 2,319 pacientes mujeres en pre‐tratamiento, post‐tratamiento, y recuperadas en base al peso con hasta 1,879 controles. Las principales medidas fueron masa grasa, masa libre de grasa, porcentaje de grasa corporal y su distribución regional. Las medidas secundarias fueron densidad mineral ósea, metabolitos y hormonas. Las meta‐regresiones examinaron las relaciones entre esas medidas y moderadores. Resultados: Las pacientes femeninas con AN pre‐tratamiento mostraron un 50% menos de masa grasa (MD: −8.80 kg, CI 95%: −9.81, −7.79, Q = 1.01 × 10–63) y 4.98 kg (CI 95%: −5.85, −4.12, Q = 1.99 × 10–28) menos de masa libre de grasa, con masa grasa preferentemente almacenada en la región del tronco durante la recuperación temprana del peso (4.2%, CI 95%: −2.1, −6.2, Q = 2.30 × 10–4). Aunque la mayoría de los rasgos regresaron a los niveles vistos en los controles sanos después de la restauración del peso, la masa libre de grasa (MD: −1.27 kg, CI 95%: −1.79, −0.75, Q = 5.49 × 10–6) y la densidad mineral ósea (MD: −0.10 kg, CI 95%: −0.18, −0.03, Q = 0.01) permanecieron significativamente alteradas. Discusión: La composición corporal es marcadamente alterada en la AN, lo que garantiza la investigación en estos fenotipos como predictores de riesgo clínico o de recaída. Notablemente, la alteración a largo plazo de los niveles de masa libre de grasa y densidad mineral ósea sugieren que estos parámetros debe ser investigados como potenciales rasgos indicadores de AN. [ABSTRACT FROM AUTHOR]

Background: Cross‐sectional associations between anxiety disorders and eating disorders (EDs) have been well documented; however, limited research has examined whether symptoms of anxiety disorders are prospectively associated with EDs. Identifying these longitudinal associations can aid in discerning relationships among eating and anxiety disorders and point toward a mechanistic understanding of developmental psychopathology. This study investigated the prospective associations between parent‐reported anxiety in mid‐childhood (age 10) and child‐reported ED behaviors and disorders in adolescence (at ages 14 and 16 years) in a population‐based sample. Methods: Participants were individuals enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population‐based, prospective study of women and their children; 7,767 children whose parents provided data at age 10 were included in current analyses. An exploratory factor analysis identified latent anxiety factors at age 10, followed by a path analysis that evaluated associations between these factors and eating disorder symptoms and cognitions at age 14. Results: Parent‐reported anxiety symptoms at age 10 yielded 5 factors: obsessive‐compulsive disorder (OCD) symptoms related to symmetry and checking (Factor 1); OCD symptoms associated with aversion to dirt and germs (Factor 2); physical anxiety symptoms (Factor 3); worries (Factor 4); and social phobia symptoms (Factor 5). Factors 3 and 4 showed the most consistent, positive associations with a range of ED symptoms at age 14. Factor 3 predicted diagnosis of bulimia nervosa by age 16 (OR = 1.11, p = .007), whereas Factor 4 predicted diagnoses of anorexia nervosa (OR = 1.10, p = .01) and disordered eating by age 16 (OR = 1.08, p = .001). Conclusions: Results indicate that symptoms of generalized anxiety in middle childhood may predict adolescent‐onset ED symptoms and ED diagnoses. [ABSTRACT FROM AUTHOR]

Objective: Evidence suggests that eating disorders (EDs) may be under‐detected in males. Commonly used measures of EDs such as the Eating Disorder Examination‐Questionnaire (EDE‐Q) were initially developed within female samples, raising concern regarding the extent to which these instruments may be appropriate for detecting EDs in males. The current study used receiver operating characteristic curve analysis to (a) examine the accuracy of the EDE‐Q global score in correctly classifying males with and without clinically significant ED pathology, and (b) establish the optimal EDE‐Q global clinical cutoff for males. Method: Participants were a clinical sample of 245 male ED patients and a control sample of 205 male undergraduates. Results: Eating Disorder Examination‐Questionnaire global scores demonstrated moderate‐high accuracy in predicting ED status (area under the curve = 0.85, 95% CI: 0.82–0.89). The optimal cutoff of 1.68 yielded a sensitivity of 0.77 and specificity of 0.77. Discussion Overall, results provide preliminary support for the discriminant validity of EDE‐Q scores among males. However, concerns remain regarding the measure's ability to comprehensively assess domains of disordered eating most relevant to males. Therefore, careful attention to the possibility for measurement bias and continued evaluation of the scale in males is encouraged. [ABSTRACT FROM AUTHOR]

Objective In 2015, the Academy for Eating Disorders collaborated with international patient, advocacy, and parent organizations to craft the 'Nine Truths About Eating Disorders'. This document has been translated into over 30 languages and has been distributed globally to replace outdated and erroneous stereotypes about eating disorders with factual information. In this paper, we review the state of the science supporting the 'Nine Truths'. Methods The literature supporting each of the 'Nine Truths' was reviewed, summarized and richly annotated. Results Most of the 'Nine Truths' arise from well-established foundations in the scientific literature. Additional evidence is required to further substantiate some of the assertions in the document. Future investigations are needed in all areas to deepen our understanding of eating disorders, their causes and their treatments. Conclusions The 'Nine Truths About Eating Disorders' is a guiding document to accelerate global dissemination of accurate and evidence-informed information about eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Initial trials evaluating exposure-based interventions for eating disorders (EDs) in the 1980s demonstrated mixed results. Since that time, innovations in exposure therapy for anxiety disorders have yielded insights that can be used to refine and expand the approach to effectively target ED behaviors. This article provides a brief summary of relevant advances in exposure therapy for anxiety and outlines how these advances may be adapted and evaluated for use with ED samples. More specifically, we propose shifting to an inhibitory learning framework, considering treatment targets other than fear, and increasing variability in exposure techniques represent three important areas for future study. Overall, this article aims to provide professionals in the field with a framework for how to incorporate cutting-edge advances in exposure therapy into rigorous intervention research for EDs. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to compare weight loss through a traditional behavioral treatment (BT) approach that integrated skills for managing the obesogenic food environment (BT + E) with an approach that integrated environmental and acceptance-based skills (BT + EA). Moderators were examined as an exploratory aim.Methods: Adults (N = 283) were randomly assigned to treatment condition and provided with 26 group-based sessions over the course of 12 months. Weight was measured in the clinic at months 0, 6, and 12.Results: Change in weight over time did not significantly differ by condition. However, race significantly moderated the effect of condition on weight loss (P = 0.04), such that African-American participants lost less weight than non-Hispanic white participants in the BT (6.2% vs. 11.5%) and BT + E conditions (6.6% vs. 12.2%), but weight loss in these two groups was similar in the BT + EA condition (9.4% vs. 11.5%). Among African Americans, rates of achieving a clinically significant weight loss (i.e., > 5%) at 12 months were higher in BT + EA (80%) than BT (57%) or BT + E (48%) (P = 0.04).Conclusions: This innovative behavioral approach shows promise for treatment of African Americans, which is notable given the lack of progress to date addressing racial disparities in obesity intervention efficacy. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the association between pretreatment and during-treatment weight change, as well as differences in self-regulation between those who gain weight, remain weight stable, and lose weight pretreatment.Methods: Data from the first 6 months of a behavioral weight loss study were used. Participants (n = 283) were weighed at two assessment points (screening visit and baseline) prior to the start of treatment and at every treatment session. Participants were divided into those who gained weight, remained weight stable, or lost weight between the screening visit and the first treatment session.Results: Pretreatment weight change was not significantly associated with during-treatment change. Weight change from the screening visit to month 6 was significantly different by category, with losses of 11% and 7% for those who lost and gained weight pretreatment, respectively. Weight change from first treatment session to month 6 was not different by category. Poorer self-regulation was associated with pretreatment weight gain and better self-regulation with pretreatment weight loss.Conclusions: Pretreatment weight change may not relate to success during behavioral weight loss treatment. Researchers should carefully consider when the "baseline" assessment takes place to reduce bias introduced by pretreatment weight change. Poorer self-regulation may place individuals at risk for weight gain prior to treatment. [ABSTRACT FROM AUTHOR]