In the last ten years, research regarding quality of life in patients with eating disorders has increased (Ackard, Richter, Egan, Engel, & Cronemeyer, 2014). Quality of life refers to people’s perception of their broad life functioning across physical, emotional, cognitive, and social domains; experiences of pain; and general wellbeing. Such research helps us understand the broader impacts that disordered eating can have on a person’s life
Eating disorders and disordered eating are characterized by an unhealthy preoccupation with eating, exercise, body weight, or shape, which greatly impacts on one’s day-to-day life (Fairburn, 2008). Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorders (American Psychiatric Association, 2013). Disordered eating often precedes the development and diagnosis of an eating disorder. Disordered eating can include behaviors such as skipping meals; self-induced vomiting; fasting or chronically restrained eating; laxative, diuretic, or diet pill misuse; and misuse of steroids and Creatine. Both eating disorders and disordered eating produce significant distress and impairment in one’s daily life (Jenkins, Hoste, Meyer, & Blissett, 2011).
People with eating disorders report poorer quality of life than the general population. De la Rie, Noordenbos, and Van Furth (2005) found that people diagnosed with any eating disorder experienced poorer mental health, physical and social functioning, vitality, and general health, as assessed by the Medical Outcomes Study 36-Item Short Form (Ware, Snow, Kosinski, & Gandek, 1993).Similarly, most health domains assessed by the Assessment of Quality of Life Questionnaire (AQOL) show reduced quality of life (and particularly mental health quality of life) for people with eating disorders (Hay, 2003).
In addition to examining general quality of life functioning, it is recognized that people with different disease states are likely to experience health related issues, impairment, and treatment effects that are specific to their condition (Engel, Adair, Hayas, & Abraham, 2009).These specific issues are unlikely to be appropriately assessed using general measures such as the AQOL (Häuser, Gold, Stallmach, Caspary & Stein, 2007). Importantly, general measures do not contain assessment of neither nutritional quality of life, nor questions that provide an in-depth account of how one’s eating or weight impact psychological, physical, cognitive, social, and emotional domains.
To address this shortcoming, a limited number of eating disorder specific quality of life measures have begun to emerge. One example is the Clinical Impairment Assessment (CIA; Bohn et al., 2008). The CIA assesses how symptoms of disordered eating (e.g., eating habits, exercising, feelings about shape or weight) impact on a person’s cognitive abilities (e.g., concentration, decision making), psychological experience (e.g., feelings of shame or guilt), and social activities (e.g., ability to meet friends or eat out).It has shown more sensitivity to quality of life changes caused by eating disorders compared to general measures of quality of life. For example, the CIA has been able to distinguish between subtypes of eating disorders. Eating disorders with binge-purge features were related to lower quality of life scores than were eating disorders with features of food restriction only (DeJong et al., 2013).The CIA has also detected differences in quality of life between people who experience a loss of control over their eating and those that do not (Jenkins, Conley, Rienecke Hoste, Meyer, & Blissett, 2012).
There is far less research regarding nutritional quality of life and few assessment tools that enable assessment of the way diet, and changes in diet, affect quality of life. The Quality of Life Related to Dietary Change Questionnaire (QOL-DC) was originally developed to assess quality of life during nutritional treatment for high cholesterol (Delahanty, Hayden, Ammerman, & Nathan, 2002). It assesses taste, cost, convenience, and the perception that one is taking care of oneself. The QOL-DC has not been used to assess how nutritional quality of life might alter due to dietary changes associated with eating disorders. This is an important area to assess because past research shows that disordered eating can affect taste sensations (Frank et al., 2006). In addition, taste perception has a key role to play in modulating food intake (Rolls, 2006). People recovering from binge eating have reported that mindfulness directed towards taste increases their food satisfaction and decreases the potential to engage in binge eating behavior (Kristeller, Wolever, & Sheets, 2014).Evaluating changes in nutritional quality of life for people experiencing disordered eating is therefore an important area of research.
It is important to assess general quality of life in people affected by disordered eating; however disease specific measures are also necessary to provide more information about which aspects may be responsive to targeted intervention. For this reason, assessing quality of life using eating disorder specific and nutritional measures is also important. Furthermore, the manner in which sub-clinical disordered eating behavior affects quality of life is less well understood. It is important to examine how quality of life may be compromised in populations that do not display diagnosable eating disorders, but who sometimes struggle with some aspects of disordered eating behavior.
The purpose of this study is to assess general mental health and disease-specific quality of life as it pertains to disordered eating symptoms in a non-clinical sample of Australian university students. Participants who fell above the 50th percentile on a global measure of disordered eating (the Eating Disorders Examination Questionnaire; EDE-Q) were compared to participants that fell below the 50th percentile, on a variety of general and eating disorder-specific health-related quality of life measures. The quality of life domains examined were (a) general mental health quality of life, (b) nutritional quality of life and (c) eating disorder specific quality of life. Consistent with the research reviewed above, the following three hypotheses have been developed:
Alternate Hypothesis: Average Assessment of Quality of Life (AQOL-8D) of low disordered eating is significantly higher compared to high disordered eating participants based on global EDE-Q score.
Alternate Hypothesis: Average Nutritional quality of life as measured by QOL-DC of low disordered eating is significantly lower compared to high disordered eating participants based on global EDE-Q score.
Alternate Hypothesis: Average eating disorder specific quality of life (CIA), is significantly different for the participants with low disordered eating and high disordered eating participants based on global EDE-Q score.
The scholar selected the participants through an advertisement in the School of Psychology of ACU (Brisbane, Melbourne). The criterion for selection was advertised as the student enrolled in a first-year in the School. Students were then requested to complete an online survey outside of class in Strathfield campuses. The selected students were assessed before considering for the purpose of the study. Students with a prior knowledge of similar study were excluded. Students with certain disease were also rejected for the consistency of the research. Selected participants were made to sign the ethical form approved by the School.
A total of 140 participants were selected for the purpose of the research, where 26 were male (P = 18.6%) and 113 were females (P = 80.7%) with one participant not disclosing the information about the gender (P = 0.7%). On the whole, the average age of the participants was 20.07 years (SD = 3.00 years). Average age of males (M = 21.67, SD = 3.85) were found to be little aged than female (M = 19.66, SD =2.61) participants. The overall average BMI index (M = 24.10, SD = 3.95) was analogous to that of the males (M = 24.45, SD = 3.08), and females (M = 24.00, SD = 4.15). The distribution of age (M = 20.07, Med = 19.00) and BMI (M = 24.10, Med = 23.61)of the participants were found to be slightly negatively skewed or almost normal.
Demographics: Participants were asked to provide general demographic information such as age, gender, weight (kg), and height (cm). Weight and height information were used to compute BMI (kg/m2).
Eating Disorder Examination Questionnaire (EDE-Q): The EDE-Q is a 28-item questionnaire that assesses eating disorder symptoms including restraint, eating concern, shape concern, and weight concern over the past 28 days. The EDE-Q also produces data concerning frequency of binge eating and episodes of loss of control over eating. Items contributing to the subscales are scored on a 7-point Likert scale. Example items include “Over the past 28 days, on how many days have you eaten in secret?” and “Has your weight influenced how you think about (judge) yourself as a person?” (Fairburn & Beglin, 1994) The EDE-Q produces four subscales and a global measure of the severity of disordered eating with higher scores representing greater levels of symptomatology. Norms and population percentiles (Mond, Hay, Rodgers, & Owen, 2006) were used to categorize the level of disordered eating as high (above the 50th percentile) or low (at or below the 50th percentile).
Assessment Quality of Life (AQoL-8D): The AQol-8D is a 35-item measure which assesses general quality of life across the past week in the domains of independent living, senses, pain, mental health, happiness, self-worth, coping, and relationships. Items are rated on Likert scales ranging from 4 points to 6 points. The AQoL-8D produces eight health domain scores and a global health-related quality of life score. In this study, only the Mental Health domain score was used to assess general mental health quality of life. An example item is “Do you normally feel calm and tranquil, or agitated?” (Richardson, Iezzi, Khan, & Maxwell, 2014) Higher scores represent a better mental health quality of life.
Clinical Impairment Assessment (CIA): The CIA is a 16-item measure which assesses the severity of psychosocial impairment as a result of eating disorder features across the past 28 days (Bohn & Fairburn, 2008).Items are rated on a 4-point scale from “not at all” to “a lot”. An example item is “Over the past 28 days, to what extent have your eating habits, exercising, or feelings about your eating, shape or weight, stopped you from going out with others?” The CIA produces a global score. Higher scores represent greater dysfunction in quality of life due to symptoms of eating disorders (worse quality of life).
Quality of Life Related to Dietary Change Questionnaire (QOL-DC): The QOL-DC is a 31-item measure that assesses quality of life with respect to one’s diet across the domains of taste, convenience, cost, self-care and the impact on one’s social life. Items are rated on a 4-point Likert scale. In this study, only the Taste subscale was used to assess nutritional quality of life. An example item is “In general are you satisfied or not satisfied with the taste of the food you eat?” (Delahanty et al., 2002) Higher scores represent greater dysfunction in nutritional quality of life (worse quality of life).
Participants were invited to complete a 75-minute online survey as a part of their coursework for an undergraduate psychology subject. The survey presented the measures listed above amongst other measures as part of a larger study. All students were given the opportunity to participate. Participants could opt out of contributing their data to the study, or choose to contribute their data and receive course credit for participation.
The average Assessment of Quality of Life (AQOL-8D) for low disordered eating participants were found to be higher compared to that of the high disordered eating participants. The assessment was tested at 5% level of significance by independent t-test in SPSS 20 software. Previous to the t-test inference, normality assumption was checked by Shapiro-Wilk test (W (140) = 0.975, p < 0.05) and the null hypothesis assuming the normality of the distribution was rejected at 5% level (Yockey, 2017). The homogeneity of the variances of two disordered eating groups (EDE_Q) were tested by Levene’s test and found that (F= 0.2, P =0.656) the null hypothesis assuming equality of variances could not be rejected at 5% level of significance. The average Assessment of Quality of Life (AQOL-8D) for low disordered eating participants were found to be significantly different (higher) compared to that of the high disordered eating participants(t(138) = 4.739, p < 0.05). Consequently, the null hypothesis was rejected at 5% level.
The average Nutritional quality of life as measured by QOL-DC for low disordered eating participants were found to be different (slight higher) than that of the high disordered eating participants. Normality assumption was checked by Shapiro-Wilk test (W (140) = 0.884, p < 0.05) and the null hypothesis assuming the normality of the distribution was rejected at 5% level. The homogeneity of the variances of two disordered eating groups (EDE_Q) were tested by Levene’s test and found that (F= 0.0, P =0.999), and the null hypothesis assuming equality of variances could not be rejected at 5% level of significance. No significant difference between the average Nutritional quality of life (QOL-DC) for low disordered eating participants, and that of the high disordered eating participants(t(138) = 1.3, p = 0.196) was observed. Consequently, the null hypothesis could not be rejected at 5% level.
The average eating disorder specific quality of life (CIA), for low disordered eating participants was found to be lower than that of the high disordered eating participants. Normality assumption was checked by Shapiro-Wilk test (W (140) = 0.884, p < 0.05) and the null hypothesis assuming the normality of the distribution was rejected at 5% level. The homogeneity of the variances of two disordered eating groups (EDE_Q) were tested by Levene’s test and found that (F= 9.48, P < 0.05), and the null hypothesis assuming equality of variances could was rejected at 5% level of significance. Significant difference between the average Nutritional quality of life (QOL-DC) for low disordered eating participants, and that of the high disordered eating participants(t(100) = -7.589, p < 0.05) was observed. Consequently, the null hypothesis could was rejected at 5% level, and it was concluded that average eating disorder specific quality of life was significantly lower for low disordered eating participants compared to that of the high disordered eating participants.
The present article investigated the difference in Assessment of Quality of Life (AQOL-8D), Nutritional quality of life (QOL-DC), and Eating disorder specific quality of life (CIA) between low disordered and high disordered eating people. It was instituted that QOL-DC was identical for the two eating disorder groups. Whereas, AQOL-8D was significantly lower in high eating disorder patients, and CIA was significantly lower for low eating disorder patients. Dietary problems and confusing dietary habits come from eating, exercise, weight or fitness, which affects our daily lives. People with nutritional problems report less personal satisfaction than the rest of the community. Despite the analysis of the general personal satisfaction at work, it is observed that the individuals are in a state in which the impedance and the effects of the treatment are specific to their state. It is absolutely necessary to obtain general personal satisfaction from people affected by a confused diet; however, it is also important that specific measures of the disease indicate the angles that may be subject to specific intercessions.
Basically as a limitation, general measures do not include the assessment of un-nourishing personal gratification or problems that are top-down records of how to cook or weight someone’s psychological, physical, social and enthusiastic areas. Future research could provide detailed cross sectional analysis with consideration of the very fact.
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