C. Alix Timko

Objective: Program‐led and focused models may overcome structural barriers to accessing ED care, such as limited availability, for youth with EDs by prioritizing strategic, evidence‐based care delivered through a structured approach. The Rapid Intervention to Support Eating Issues (RISE) pilot aimed to promote weight restoration and prevent hospitalization among malnourished adolescents at risk for hospitalization. We used a “home hospital” approach, integrating medical oversight, family‐based treatment principles, and nutritional support via structured outpatient care. Methods: Participants completed 4–5 visits with adolescent medicine and nutrition over 8 weeks. They received psychoeducation and support in implementing home hospital. Vital signs, anthropometrics, dietary intake, ED behaviors, and cognitions were assessed. Results: A total of 27 patients participated. Patients experienced low hospitalization rates ( n = 1 throughout; 3.7%) and significant weight gain (M _{end of treatment} = +2.7 kg from baseline, 95% CI: 2.6–4.7). There were statistically significant increases in calorie intake (M _baseline = 43.3% of recommendation; M _{end of treatment} = 76.0% of recommendation; dz = 0.98, 95% CI: 0.45–1.50) and decreases in the report of disordered weight control behaviors ( n reporting at baseline = 10 [37%], n reporting at end of treatment = 3 [11.1%]; paired RD = −1.00, 95% CI: −1.00–−0.33). Discussion: This program‐led and focused intervention produced meaningful outcomes and circumvented hospitalization for youth at high risk in a short time frame. This approach offers promise for scalable, early ED care that leverages programmatic expertise, consistent with evolving models of mental health service delivery.

Objective: Research suggests executive functioning (EF) inefficiencies contribute to anorexia nervosa (AN) onset and maintenance. Identifying EF subtypes in adolescents and adults with AN compared to healthy controls (HC) may provide insights into differences in illness severity, risk for prolonged illness, and highlight who could respond best to different treatments. Method: We conducted secondary analysis of 751 participants: adolescents ( n = 559) and adults with AN ( n = 74), and adolescent HC ( n = 118). Latent profiles of six Delis Kaplan Executive Function System scores measuring EF constructs implicated in AN were derived. Differences across profiles on demographics, eating disorder cognitions (EDE/EDE‐Q score), BMI/BMI z ‐score, length of illness, weight suppression, and full‐scale IQ were examined. Results: A three‐profile solution best fit the data: Profile 1 ( n = 324)—‘high verbal’, Profile 2 ( n = 349)—‘average’, and Profile 3 ( n = 78)—‘low flexibility and inhibition’. The low flexibility and inhibition profile comprised 10.6% of adolescents with AN, 30.0% of adults with AN, and 1.7% of adolescent HCs. Compared to other profiles, this profile was older, had a longer illness duration, higher EDE global scores, lower BMI z ‐scores, and lower full‐scale IQ scores. No profile differences emerged in BMI or EDE‐Q global scores. Discussion: Only a small subset of our sample showed marked difficulties in flexibility and inhibition, challenging the notion that EF difficulties are a core feature of AN. Adolescents with AN in this profile showed greater illness severity, suggesting vulnerability to a more prolonged course of illness. These findings are a first step towards developing tailored treatment strategies based on EF profiles.

Intelligence Quotient (IQ) scores, typically considered stable throughout life, may be impacted by anorexia nervosa (AN). This study investigated whether IQ scores change following treatment in adolescents with AN (N = 110; age = 14.65 ± 2.49 years; 85% female). We analyzed changes in vocabulary, matrix reasoning, and full-scale IQ (FSIQ-2) scores on the Wechsler Abbreviated Scale of Intelligence, with developmental weight suppression and duration of illness as covariates. Results indicated end of treatment improvements in vocabulary (F(1, 107) = 7.46, p = .01, η_p² = .07), matrix reasoning (F(1, 107) = 4.44, p = .04, η_p² = .04), and FSIQ-2 (F(1, 107) = 11.00, p < .01, η_p² = .09) scores. A shorter illness duration was associated with greater gains in vocabulary (p = .04) and FSIQ-2 (p = .02) scores. These findings suggest that IQ scores can improve throughout treatment, with shorter illness duration linked to greater improvements, underscoring the importance of early nutritional intervention.

Objective: Inefficiencies in cognitive flexibility (CF) are a potential vulnerability trait for anorexia nervosa (AN). Yet, much of the research on CF in AN has been conducted in adult samples, with mixed results from research on adolescents. Knowledge of the prevalence of low scores on assessments can help avoid erroneous interpretations of test scores. The current study examined the prevalence of low scores on the Delis Kaplan Executive Function System (D‐KEFS) in adolescents and adults with AN and adolescent healthy controls.Method: We conducted a secondary analysis of D‐KEFS data from 739 participants (552 adolescents with AN [aged 15.39 ± 1.91, 92% female], 69 adults with AN [aged 26.5 ± 6.1, 98.6% female], and 118 adolescent healthy controls [HC] [aged 15.09 ± 2.14, 98.3% female]).Results: Low scores on the D‐KEFS were common across all groups. Adults with AN exhibited the highest proportion of individuals with abnormally low scores, followed by adolescents with AN and adolescent HC. Adolescents with a higher proportion of low scores had a lower BMI z‐score and longer length of illness.Conclusions: Results highlight differences between adults and adolescents and lend support to the hypothesis that inefficiencies in flexibility are either a marker of persistent course or a scar of AN illness.

Background: Significant funding and attention are directed toward school-based health and nutrition interventions. Less attention is given to the potential unintended consequences of these policies, especially those that target children and adolescents. This systematic review aimed to elucidate the unintended consequences of school-based health and nutrition policies in the United States.Methods: We conducted a systematic review, adhering to PRISMA guidelines, to analyze quantitative, qualitative, and mixed methods research conducted between January 2013 and September 2023. The search strategy encompassed three databases, identifying 11 articles that met the inclusion criteria.Results: Unintended consequences were organized into four themes: disordered weight control behaviors, parental discomfort or encouragement of disordered weight control behaviors, eating disorder triggers, and financial losses. The analysis of disordered weight control behaviors indicates limited impact on youth, and we noted limited consensus in the assessment of these behaviors. We observed parent concerns about BMI screening and reporting as well as apprehensions about privacy and efficacy. There were fewer articles addressing eating disorder antecedents, although there was evidence that some youths with eating disorders considered school health class a trigger of their disorder. One study was identified that found an increase in food waste following replacement of sugar-sweetened beverages.Implications: Findings underscore the importance of comprehensive evaluation and consideration of unintended consequences in the development and implementation of school-based health policies. Recommendations include further longitudinal research, integrating obesity prevention with eating disorder prevention, and de-implementation when unintended consequences potentially outweigh benefits, such as in BMI screening and surveillance.Systematic Review Registration: Identifier CRD42023467355. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=467355

Objective: Inefficiencies in executive functioning (EF), more specifically cognitive flexibility and an overly detailed processing style, are frequently observed in individuals with Anorexia Nervosa (AN) and have been identified as potential targets in treatment. Cognitive Remediation Therapy (CRT) is an adjunctive treatment approach specifically designed to have a positive impact on EF. Mainly evaluated in adults, CRT has been criticized for its perceived ineffectiveness in promoting weight restoration or directly reducing eating disorder symptoms.Method: We argue that we need to refocus our conceptual framework for using CRT as an adjunctive treatment and specifically explore its potential benefit in adolescents.Results: Adolescence is a critical window for EF development during which CRT has the potential to have the most impact. While it may not specifically ameliorate eating disorder symptoms and directly improve weight gain, CRT may mitigate the impact of malnutrition on adolescent brain development, reduce attrition rates in treatment, and improve cognitive flexibility and (indirectly) other maintaining factors, thereby improving global functioning.Discussion: More research needs to be done to understand the development of EF in adolescents with AN and how best to employ CRT as an adjunctive treatment to support development and target maintaining factors. The current article broadly reviews findings on executive functioning inefficiencies in adolescents with AN and discusses the purpose and role of CRT in treating AN. Finally, we highlight key critiques of using CRT and pose questions for future research.Public Significance: Treatments targeting executive functioning in adolescents with AN are limited. We need to better understand how CRT can benefit adolescents in treatment. Increasing treatment options, including adjunctive treatments, is necessary to reduce the long‐term impact of AN.

Research suggests a link between autoimmune illnesses (AI) and eating disorders (ED). We retrospectively reviewed charts of adolescent patients presenting for eating disorder treatment. We compared the presentation and treatment course for those with an ED and comorbid AI [with (GI-AI, N = 59) or without (non-GI, N = 21) gastrointestinal inflammation] with matched ED-only cases. The sample was overwhelmingly female, with an average age of 15.40. Weight gain trajectories differed across groups, with similar rates of weight gain between controls and non GI-AI cases and with a lower rate of weight gain for individuals with comorbid GI-AI. Over half (56%) of patients reported an AI diagnosis prior to ED; 38% reported an AI diagnosis following ED, and 6% reported ED and AI simultaneous diagnosis. On presentation, ED-only controls had higher rates of comorbid anxiety than cases in either AI group, while those with non-GI AI were more likely to report depression. Mean total GI symptoms, % goal weight at presentation, vital sign instability, and markers of refeeding syndrome did not differ across groups. Health care professionals treating patients with either condition should have a low threshold for asking additional questions to identify the presence of the other condition.

Objective: Eating disorders are characterized by disturbances in nutritional intake and abnormal mealtime behaviors. Laboratory eating paradigms offer a unique opportunity to accurately measure dietary intake and eating behaviors, however, these studies have predominantly occurred in adults. This paper describes the development and preliminary psychometric examination of the Buffet Challenge, a laboratory-based meal task for youths with an eating disorder. Method: We recruited and assessed 56 participants as part of a randomized controlled trial of Family-Based Treatment for adolescents with anorexia nervosa. Adolescents completed the Buffet Challenge at baseline, midway through treatment (~ week 16 of a 6 months course), and end of treatment. Participants and their parents also reported eating disorder symptomatology and treatment related variables of interest were recorded. Results: All adolescents were willing to complete the Buffet Challenge at all time points, although one refused to give up their cellphone, and there were no significant adverse events recorded. Preliminary results are presented. Conclusions: Our initial pilot of this task in adolescents with anorexia nervosa demonstrates its acceptability, although investigation of our hypotheses was hindered by significant missing data due to COVID-related research shutdowns. Future studies should replicate procedures in a larger sample to ensure analyses are adequately powered.

Objective: Inefficiencies in executive functioning (EF), more specifically cognitive flexibility and an overly detailed processing style are frequently observed in adult individuals with Anorexia Nervosa (AN); however, they are not regularly observed in youth with AN. Executive functioning is still developing during adolescence, when AN typically onsets. We highlight the importance of cognitive flexibility and the role that it can play in illness maintenance and treatment. Cognitive remediation therapy (CRT) has been suggested as an adjunctive treatment approach that targets EF; yet CRT is often criticized for its perceived ineffectiveness in promoting weight restoration or directly reducing eating disorder symptoms. Method: The current article broadly reviews findings on executive functioning inefficiencies in individuals with AN. Next, we discuss the purpose and role of CRT in the treatment of AN. We highlight key critiques of the use of CRT and pose questions for future research. Results: CRT has been shown to improve targeted EF skills for various psychiatric disorders. In adolescents with AN, we may need to refocus our conceptual framework for using CRT as an adjunctive treatment. Instead of focusing on ameliorating eating disorder symptoms and directly improving weight gain, CRT may have an indirect impact on remission by influencing maintenance factors and improving global functioning.Discussion: More research needs to be done to understand the role of EF in AN and the role of CRT in treating AN and other eating disorders.