A Study of Eating Disorders and Their Effects on Adult Mental Health

Introduction

Eating disorders are complex psychiatric conditions involving consistent maladaptive patterns of eating that negatively impact physical and mental health. Anorexia nervosa, bulimia nervosa, and binge eating disorder subcategories, extend beyond eating and are intimately related to emotional control and cognitive and psychosocial self-evaluation posing a significant challenge to public health. Disordered eating stems from a complex interplay of biological, psychological, and sociocultural factors that shape individuals including genetic and neurobiological factors, insecurity, a drive for perfection, poor coping mechanisms, dissatisfaction with one's body, and the social pressure to conform. These factors also include social influences including the media and social constructs of body image to cope with or conceal diminished satisfaction with one's body giving rise to disordered eating. Eating disorders are comorbid with mental health conditions, including but not limited to, depression, anxiety, obsessive-compulsive disorder, and attention-deficit hyperactivity disorder (ADHD). This comorbidity suggests a bidirectional effect of mental stress that contributes to the onset of disordered eating patterns and the effect of disordered eating on emotional stress and mental health. Stressors in the environment and difficult life situations exacerbate the relationships between disordered eating and mental health patterns. For instance, studies done during the COVID-19 pandemic have shown that increased levels of stress, anxiety, and depression have been correlated with increased disordered eating. Most of the research focuses on the behavior of adolescents or young adults; however, adults are also vulnerable to the negative longer-term psychological effects of unhealthy eating behaviors. This is particularly true when these behaviors are chronic. The co-occurrence of eating and psychiatric disorders is associated with poor outcomes, including low remission rates and an increased risk of death, particularly when the eating disorder is anorexia nervosa. The evidence stresses the necessity of initiating prompt, holistic treatment that incorporates multidisciplinary teams to address both the psychological and the nutritional aspects of the problem. Recognizing the relationship between disordered eating and mental health is key to understanding and improving the psychological effects that disordered eating has on individuals.

Methods

Participants for this study were young adults aged 18-30 years, and included individuals of all genders and religions to allow for diversity within the sample population. A total of 100 participants from Babasaheb Bhimrao Ambedkar University (BBAU), Lucknow were included, with representation from different academic and social backgrounds, eating and dietary patterns, and from different mental health statuses, including eating disorders and depression. Participant selection was based on a set of inclusion criteria, which required individuals to voluntarily participate in the study after providing informed consent and those who were able to read, comprehend, and respond to the questionnaire in English or Hindi. Participants also had to meet the required criteria of not having a diagnosed mental health condition other than depression. Participants also were required to not be undergoing any type of psychiatric treatment, nor be taking any type of supplementation within the previous three months due to the potential of these factors to affect psychological and emotional responses and related behaviors to eating. Individuals were also excluded from the study if they had a chronic health condition that was associated with a change of lifestyle and eating patterns. Participants tended to have altered dietary and mental health requirements if they were substance dependent (i.e. alcohol or drugs), and were pregnant or lactating. To meet eligibility requirements, only individuals who were able to comprehensively communicate their responses to all questions and who met inclusion criteria were selected for the study. This was done to ensure that the data collected was reliable and valid.

Collection

Baseline data was derived from a pre-tested survey with a section of general demographic and medical history data on diabetes, hypertension, cardiovascular disorders, thyroid disorders, and obesity. Standardized methods were used to determine anthropometric data and Biochemical data was collected by laboratory methods. During the physical examination, clinical signs of the conditions were assessed. Data on the type of diet, meal frequency, and the consumption of food prepared outside the home was collected using a food frequency questionnaire.

Tools

The Depression Anxiety Stress Scale-10 (DASS-10) measures symptoms of depression, anxiety and stress. It was developed as a self-report screening DASS-10 was designed to survey these symptoms more efficiently. It contains 10 selected items from the longer DASS-42 and DASS-21 and their adaptations. A 4-point Likert scale was used by participants to indicate how much the statement in the screening tool applied to them in the past week. The scoring ranged from 0 (did not apply at all) to 3 (applied most of the time). The total score was interpreted to range from no symptoms (0) to extreme symptoms of depression, anxiety and/or stress (30). While an overall score of distress can be interpreted, depression, anxiety and stress can be interpreted in a more limited sense with some of the scoring methods.

Result

To understand the personal characteristics of the study subjects. The demographic data for respondents indicated that 65% were in the age range 22-26 years, 24% were in the 18-22 years age range, and 11% were in the 26-30 years age range. There were more females (56%) than males (44%) in the study. The religion data of the respondents showed that the majority (93%) were Hindus, followed by Muslims (5%) and Christians (2%). The education data showed that 71% had a post-graduate degree, 19% had a graduate degree, and 10% were PhD scholars. Of those surveyed, 45% were living in PG accommodations, 34% in hostels, 13% at home, and 8% in other accommodations.

The majority (83%) of the study subjects were from the middle class, followed by 13% lower and 4% upper class.

Nutritional Status of Participants

The health profile of respondents indicated a distribution of height as follows: 150-160 cm (50%), 160-170 cm (35%), 170-180 cm (13%), and 180-190 cm (2%). The distribution of weight showed" that the majority (40%) weighed 50-60 kg, followed by 28% weighing 40-50 kg, 19% weighing 60-70 kg, 11% weighing 70-80 kg, and 1% weighing 80-90 kg and 90-100 kg. The majority (78%) of respondents were in the normal BMI range, followed by overweight (14%) and underweight (8%) respondents. The distribution of blood pressure showed normal levels in 77% of respondents, elevated blood pressure in 5% of respondents, and 18% of respondents did not know their blood pressure status.

Dietary Pattern and Eating Disorders

The dietary pattern showed that 45% of respondents consumed fruits and vegetables daily, 42% consumed them weekly, and 13% did so occasionally. 57% reported whole grain consumption daily, 23% weekly, and 19% did so occasionally. 1% reported never consuming whole grains. 27% of respondents reported daily protein consumption, 20% did so occasionally, and 8% reported never consuming protein. 46% of respondents reported an occasional consumption of processed food, while 34% consumed it weekly, 14% daily, and 6% never consumed processed food.

In terms of mood after the consumption of food, 37% reported experiencing changes occasionally, 23% did so weekly, 18% daily, and 22% never reported changes.

Association between Mental Health and Eating

Disorders: Analysis indicated strong relationships between variables and various eating behaviors. Rule-driven eating was significantly related (F = 3.367, p = 0.039). On the other hand, relationships were significant for variables related to concentration and food thoughts (F = 5.333, p = 0.006) and concentration, worries about thoughts of shape and weight (F = 5.538, p = 0.005), losing control of eating (F = 3.349, p = 0.039), and judgment of oneself in relation to one's weight (F = 4.172, p = 0.018). A review of the participants' diets showed that there was a regular intake of healthy foods; however, the intake of processed foods and emotional eating were also found. Many participants reported mood changes due to cravings after eating, which suggests dietary habits may impact one's emotional state. The EDE-Q suggested that concerns over body weight and shape exceeded concerns over eating restraint. This implies that dissatisfaction with one's body image is essential to the development of disordered eating. Mental health, in this case, interacted with maintaining strict eating rules, thinking about food, worrying about shape and weight, fearing a loss of control over eating, and selfjudgment based on weight. This suggests that the cognitive and emotional symptoms of an eating disorder are more damaging to mental health when compared to the behavioral symptoms. This study also aims to show the impact of disordered eating on a person's overall psychological state and the importance of early therapeutic, nutritional, and mental health interventions targeted at this population to reduce disordered eating symptoms.

Conclusion

The present study suggests that although participants were mostly educated, middle-class youth with almost healthy physical and BMI, there were worrying features of eating behavior and mental health. A large number of participants showed symptoms of moderate to severe anxiety and stress and depressed mood. Participants demonstrated good eating habits with a high frequency of healthy eating, but there was serious concern about and preoccupation with emotional eating and shape and weight control. There was little knowledge and a lack of concern about biochemical health control. From the statistical analysis, it was clear that the cognitive and emotional factors that concerned eating and body image had a greater impact than the behaviors themselves. The study findings highlight the necessity and importance of focusing on physical and mental health.

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