Internet and smartphone application usage in eating disorders: A descriptive study in Singapore.

Eating disorders are associated with significant morbidity and mortality. The Internet is a popular medium for individuals with eating disorders to discuss and reinforce their affliction. However, the available literature on Internet usage and eating disorders is scarce, especially in the area of social media and smartphone application ("app") usage. This study looked at the Internet and smartphone app usage patterns of participants who presented with an eating disorder in Singapore, and whether it corresponded to severity of illness. Individuals who presented to the Eating Disorders clinic at the Singapore General Hospital completed a self-reported questionnaire on Internet and app usage. They also completed the EDE-Q, EAT-26 and CIA 3.0. 55 participants completed the study. 41.8% had anorexia nervosa, 34.5% had bulimia nervosa, and 9.1% were ED-NOS. 41.8% felt that apps helped to perpetuate their illness while 32.7% felt that the apps were helpful for recovery. Overall, any smartphone application usage was associated with younger age and greater eating disorder psychopathology and psychosocial impairment. While 30.9% had encountered eating disorder-related content on Facebook, only 12.7% visited Facebook groups related to eating disorders. For YouTube, "Cooking and Food" and "Beauty and Fashion" videos were among the top 3 types of videos that participants watched. In conclusion, Internet and smartphone app usage is significant, and they are associated with greater severity of illness. It is necessary to include interventions in this aspect as part of treatment of eating disorders.

Anorexia Nervosa And Eating Disorder Not Otherwise Specified (Nos) In Singapore: A Seven-Year Retrospective Study

Objective: Anorexia nervosa and eating disorder not otherwise specified (NOS), an eating disorder not fulfilling anorexia nervosa DSM-IV criteria are on a rising trend in Singapore. The aims of this paper were to study the clinical characteristics and features of patients with anorexia and eating disorder NOS in Singapore. Methods: A retrospective cohort analysis of 373 patients between 2003 and 2010 at a tertiary hospital was done. Inclusion criteria included inpatients and outpatients with the age range of 12 years old to 40 years old fulfilling the Diagnostic and Statistical Manual (DSM)-IV criteria for anorexia nervosa and patients with the diagnosis of eating disorder NOS. The subjects are analyzed based on the severity of the eating disorder and the presentation subtypes. Results: An analysis of the overall demographic data revealed the female to the male ratio to be 22.4:1. The Chinese formed the largest ethnic group in the study population with 242 (86.1%) patients, and the bulk of the patients (75.8%) patients were between 12 to 20 years old. Anorexia nervosarestricting subtype was the most common eating disorder (55.2%) and the most common body mass Index (BMI) was between BMI 14.6 – 16.5 (35.2%). Restriction technique (p = 0.01), binge/purge (p = 0.03) and exercise (p < 0.001) are statistically significant to cause transaminitis in patients. Conclusion: There were significant changes in the demographics compared to the study reviewing patients from 1994 and 2002. There was a significant increase in the Caucasian population with changes in the Singapore immigration policy. A detail history taken during first visit can reduce the morbidity and mortality of these patients.

Prevalence of abnormal liver function tests and comorbid psychiatric disorders among patients with anorexia nervosa and eating disorders not otherwise specified in the anorexia nervosa DSM-IV criteria.

INTRODUCTION: Anorexia nervosa (AN) and eating disorders not otherwise specified (EDNOS) are on the rise in Singapore. Abnormal liver function tests have been reported for up to 12.2% of patients with AN. These patients are also known to present with comorbid psychiatric disorders. This study aims to investigate the correlation between body mass index (BMI) and the severity of abnormal liver function tests, and between BMI and the presence of comorbid psychiatric disorders. METHODS: A retrospective cohort analysis of 373 patients diagnosed with AN or EDNOS at a tertiary hospital was performed. The clinical course of transaminitis and comorbid psychiatric disorders was correlated with the patient's BMI. RESULTS: Patients with a BMI of ≥ 16.6 kg/m(2) at their first consult had a significantly lower risk of having comorbid psychiatric disorders (χ(2) = 32.08, p < 0.001). These patients were five times less likely to have comorbid psychiatric disorders as compared to patients from the other BMI groups (odds ratio [OR] 0.21). On the other hand, patients with a BMI of < 14.6 kg/m(2) had a significantly higher risk of having transaminitis (χ(2) = 72.5, p < 0.001). They were 11.1 times more likely to develop transaminitis as compared to patients with a BMI of ≥ 14.6 kg/m(2) (OR 11.05). CONCLUSION: Severity of BMI can be used by clinicians as an indicator to assess for secondary psychiatric comorbidities and/or transaminitis during the first consultation. This could help reduce the morbidity and mortality rates in patients with AN or EDNOS.

Men Do Get It: Eating Disorders In Males From An Asian Perspective

To examine the clinical features of male patients with eating disorders in Singapore; and determine the differences in clinical features between the patients across the diagnostic categories. Methods: This is a database analysis of all male cases presenting to the Eating Disorders Clinic at Singapore General Hospital between 2003 and 2012. Results: 72 cases were identified; 36.1% were diagnosed with anorexia nervosa, 33.3% had bulimia nervosa and 30.5% had the diagnosis of eating disorder not otherwise specified. The mean presenting age was 19.9 years. 63.9% were heterosexual, while 15.3% were homosexual/bisexual. 61.1% had comorbid psychiatric diagnoses, with depression being the most common. 59.7% recorded premorbid obesity, while 66.7% reported excessive exercise. The patients in the various diagnostic categories had more similarities than differences. Conclusion: With more male cases over the years, it is important to further understand this condition, to better refine prevention, detection and treatment strategies.

Nutrition knowledge in young women with eating disorders in Australia and Singapore: a pilot study.

OBJECTIVE: The aim of the present study was to compare nutrition knowledge levels in young women with and without an eating disorder (ED) in two countries. METHOD: Women with a clinical ED (n = 55) and healthy control women (n = 99) in Australia and Singapore completed a Nutritional Knowledge Questionnaire, acculturation questionnaire and demographics survey. Nutrition knowledge was analysed in terms of clinical status, cultural group, acculturation, socioeconomic status and education level. results: Women with EDs had greater knowledge than controls, but the magnitude of the difference was small. Greater acculturation to Western culture was associated with greater knowledge. CONCLUSIONS: The difference in nutrition knowledge between women with and without EDs is unlikely to be of clinical importance. The findings may reflect today's ubiquitous availability of nutrition information.

The relationship between skinfold thickness and body mass index in North European Caucasian and East Asian women with anorexia nervosa: implications for diagnosis and management.

OBJECTIVE: To investigate the relationship between skinfold thickness and body mass index (BMI) in North European Caucasian and East Asian young women with and without anorexia nervosa (AN) in two countries. METHOD: Height, weight and skinfold thicknesses were assessed in 137 young women with and without AN, in Australia and Singapore. The relationship between BMI and the sum of triceps, biceps, subscapular and iliac crest skinfolds was analysed with clinical status, ethnicity, age and country of residence as covariates. RESULTS: For the same BMI, women with AN had significantly smaller sums of skinfolds than women without AN. East Asian women both with and without AN had significantly greater skinfold sums than their North European Caucasian counterparts after adjusting for BMI. CONCLUSION: Lower BMI goals may be appropriate when managing AN patients of East Asian ancestry and the weight for height diagnostic criterion should be reconsidered for this group.

Treatment emergent mania responding to valproate in a Chinese female adolescent population with eating disorders: a case series.

Eating disorders are commonly associated with depressive symptoms. In an adolescent and binge eating population fluoxetine is commonly used to treat co-morbid depression associated with eating disorders. In some patients this may precipitate treatment emergent mania (TEM). Risk factors in the adolescent population include being older, female, having a longer duration of illness, more previous mood episodes, a higher prevalence of subclinical hypothyroidism, early-onset anxiety and recent exposure to a mood-elevating agent. Diagnosis and management of these co-morbid conditions is challenging due to the overlapping symptomatology and the adverse effects of both conditions complicating pharmacological management. This is illustrated with three cases in a Chinese female adolescent population that experienced TEM while on fluoxetine and responded to valproate.

Cross-cultural differences in the macronutrient intakes of women with anorexia nervosa in Australia and Singapore.

AIM: To compare the macronutrient intakes of women with and without anorexia nervosa (AN) across cultures. METHOD: Participants were women with AN (n = 39) and without AN (n = 89) of North European and East Asian backgrounds recruited in Australia and Singapore. Energy and the percentage energy contributed by protein (%protein), fat (%fat) and carbohydrate (%CHO) were assessed from participant's diet histories and analysed in terms of cultural group, acculturation, socio-economic status (SES) and education level. RESULTS: AN status was associated with lower energy and higher %CHO. Greater %protein was associated with greater acculturation to Western culture and lower SES, but not AN. Greater %fat was associated with lower SES and lower acculturation in women with AN, but with higher acculturation in controls. Greater %CHO was also associated with higher SES. CONCLUSION: The findings may represent Western diets' higher protein and fat contents, 'Western' knowledge of weight-loss diets, and affordability of low fat foods.

Body image disturbance in young North European and East Asian women with and without eating disorders in Australia and in Singapore.

OBJECTIVE: To investigate body image disturbance in young women with and without an eating disorder (ED) across two different ethnic groups in Australia and Singapore. METHOD: The relationship of body image disturbance to cultural orientation and socio-cultural factors was analysed in 154 women with and without an ED. Participants were from the following backgrounds: North European Australian, East Asian Australian, Singaporean Chinese (SC) and North European expatriates in Singapore. RESULTS: Irrespective of cultural group, women with an ED had similar body dissatisfaction. Among those without an ED, SC women reported greater body dissatisfaction than all other cultural groups. Finally, within each cultural group, ED participants reported significantly higher body dissatisfaction than their non-ED counterparts with the exception of SC women where there was no difference. DISCUSSION: Socio-cultural factors other than body image may play more important roles in SC women's ED psychopathology.

Restraint and eating concern in North European and East Asian women with and without eating disorders in Australia and Singapore.

OBJECTIVE: To investigate eating disorder psychopathology, restraint and eating concern in young women with and without an eating disorder from two different ethnic groups in Australia and Singapore. METHOD: The relationship of Eating Disorder Examination Questionnaire Global, Restraint and Eating Concern scores to cultural orientation and sociocultural factors was analysed in 154 women with and without an eating disorder. Participants were from the following backgrounds: North European Australian, East Asian Australian, Singaporean Chinese and North European expatriates in Singapore. RESULTS: Women with eating disorders had similar psychopathology across the cultural groups. Among controls, Singaporean Chinese reported significantly greater overall eating disorder psychopathology than other cultural groups and greater restraint than North European Australians/expatriates. Eating concern was not associated with cultural group overall or acculturation to Western culture. Dissatisfaction with family functioning, socioeconomic status and education level were not significantly associated with any of the eating disorder measures. CONCLUSION: In eating disorder psychopathology, the specific symptom of eating concern may transcend cultural influences.

Pattern of birth in early-onset anorexia nervosa: an equatorial study.

OBJECTIVE: Patients with anorexia nervosa (AN) born in the northern and southern hemispheres are more likely to be born during spring months than at any other time of the year. It has been hypothesized that environmental temperature at the time of conception may have a significant role in this pattern of findings. The current study aims to investigate the pattern of birth of early-onset AN patients in an equatorial region (Singapore), where there is little difference in environmental temperature throughout the year. METHOD: Dates of birth were collected for 102 patients who were born in Singapore and diagnosed with early-onset AN. The patterns of birth were analyzed using chi-square analysis. RESULTS: There was no difference across the year in the birth patterns of patients with early-onset AN in Singapore, nor were there any differences between patients with restrictive and binge/purge AN. DISCUSSION: This lack of seasonal variation in the equator adds support to the "temperature at conception" hypothesis.