A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States.

OBJECTIVE: Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS: We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS: Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION: We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE: Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.

OBJETIVO: Los trastornos de la conducta alimentaria (TCA) alguna vez se conceptualizaron como enfermedades que afectaban principalmente a las mujeres blancas, adineradas, un concepto erróneo que informó la investigación y la práctica clínica durante muchos años. Abundante evidencia ahora desacredita este estereotipo, pero no está claro si los tratamientos prevalecientes "basados en la evidencia" se han evaluado en muestras representativas de la diversidad de individuos afectados por los TCA. Nuestro objetivo fue evaluar el informe, la inclusión y el análisis de las variables sociodemográficas en los ensayos controlados aleatorios (ECA) del tratamiento psicoterapéutico para TCA en los Estados Unidos hasta 2020. MÉTODOS: Se realizó una revisión sistemática de los ECA de tratamiento psicoterapéutico de los TCA en los Estados Unidos y se examinó el informe y la inclusión de la identidad de género, la edad, la raza/etnia, la orientación sexual y el estado socioeconómico (ESE) de los participantes inscritos, así como los métodos de reclutamiento, los análisis de poder y la discusión de las limitaciones y la generalización. RESULTADOS: La búsqueda arrojó 58 estudios que cumplieron los criterios de inclusión que datan de 1985. Los informes a veces eran incompletos, ausentes o centrados en el grupo mayoritario racial / de género. Ningún estudio informó participantes con diversidad de género, y los hombres y las personas de color estuvieron subrepresentados en general, con diferencias observadas entre los diagnósticos. Una minoría de los artículos consideró variables sociodemográficas en los análisis o reconoció limitaciones relacionadas con las características de la muestra. Se lograron algunos avances a lo largo de las décadas, con estudios que proporcionan cada vez más datos raciales y étnicos completos, y más hombres incluidos con el tiempo. Aunque la diversidad racial y étnica mejoró un poco, el progreso pareció estancarse en la última década. DISCUSIÓN: Resumimos los hallazgos, consideramos el contexto y los desafíos para los investigadores de ECA, y ofrecemos sugerencias para investigadores, editores de revistas y revisores sobre cómo mejorar la representación, el informe y las prácticas analíticas.

The tension between ethics and rigor when using Amazon MTurk for eating disorder research: Response to commentaries on Burnette et al. (2021).

We respond to commentaries on our 2021 paper "Concerns and recommendations for using Amazon MTurk for eating disorder research." The commentators raised many thoughtful and nuanced points regarding data validity and ethical means of online data collection. We echo concerns about the ethics of recruiting via platforms such as MTurk, and highlight tensions between recommendations for ethical data collection and ensuring data integrity. Especially, we highlight the consistent finding that MTurk workers display elevated (often remarkably so) rates of psychopathology, and argue such findings merit further scrutiny to ensure both data are valid and workers not exploited.

Concerns and recommendations for using Amazon MTurk for eating disorder research.

OBJECTIVE: Our original aim was to validate and norm common eating disorder (ED) symptom measures in a large, representative community sample of transgender adults in the United States. We recruited via Amazon Mechanical Turk (MTurk), a popular online recruitment and data collection platform both within and outside of the ED field. We present an overview of our experience using MTurk. METHOD: Recruitment began in Spring 2020; our original target N was 2,250 transgender adults stratified evenly across the United States. Measures included a demographics questionnaire, the Eating Disorder Examination-Questionnaire, and the Eating Attitudes Test-26. Consistent with current literature recommendations, we implemented a comprehensive set of attention and validity measures to reduce and identify bot responding, data farming, and participant misrepresentation. RESULTS: Recommended validity and attention checks failed to identify the majority of likely invalid responses. Our collection of two similar ED measures, thorough weight history assessment, and gender identity experiences allowed us to examine response concordance and identify impossible and improbable responses, which revealed glaring discrepancies and invalid data. Furthermore, qualitative data (e.g., emails received from MTurk workers) raised concerns about economic conditions facing MTurk workers that could compel misrepresentation. DISCUSSION: Our results strongly suggest most of our data were invalid, and call into question results of recently published MTurk studies. We assert that caution and rigor must be applied when using MTurk as a recruitment tool for ED research, and offer several suggestions for ED researchers to mitigate and identify invalid data.

Barriers to access, implementation, and utilization of parenting interventions: Considerations for research and clinical applications.

In February 2019, the American Psychological Association approved a resolution on physical discipline of children by parents that recognized its negative impact on children; called for increased use of more effective, alternate forms of discipline; and highlighted the need for greater access to behavioral parenting intervention for underserved groups. Despite a wealth of empirical evidence supporting these statements and similar resolutions by other influential organizations (e.g., American Academy of Pediatrics, American Professional Society on the Abuse of Children), many challenges exist in providing empirically supported parent training interventions to individuals in need. The current article reviews many barriers to access and implementation of best practices for parents of children and adolescents, including structural barriers to accessing care and factors that interfere with effective delivery of interventions. The review also provides suggestions for clinicians, researchers, and public policy advocates to begin making progress toward reducing and removing these barriers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Eating Disorders in Male Athletes.

CONTEXT: Eating disorders (EDs) in male athletes are potentially debilitating disorders with significant medical, psychological, and athletic performance consequences. EVIDENCE ACQUISITION: Searches were performed across PubMed, EBSCOhost, and PSYCinfo from 1990 to 2019. Keywords searched were eating disorder, male, athlete, anorexia nervosa, bulimia nervosa, muscularity, muscle dysmorphia, and sports. Search results included articles written in the English language and encompassed reviews, empirical studies, and theoretical articles. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: EDs among male athletes may lead to serious negative outcomes, including increased susceptibility to injury, inconsistent performance, problematic recovery, muscle deficiencies, impairment of optimal athletic functioning, and medical, social, and emotional problems. Male athletes with EDs may be more difficult to identify and diagnose for a variety of reasons related to differential presentation of symptoms, secretiveness or shame around behaviors, and sex-related stigma. CONCLUSION: Professionals working closely with athletes are uniquely positioned to identify and screen those who may require further evaluation and treatment.