Objectives (Background): The purpose was to verify the validity of the dual pathway model of eating pathology among female middle school, high school, and university students, and to compare the influence of various variables on eating pathology across developmental stages.

Subjects and Methods: A questionnaire survey was conducted targeting 300 female students from middle school, high school, and university, respectively.

Results: The dual pathway model of eating pathology was found to be valid across developmental stages. In high school and university female students, dieting behavior had the greatest negative impact on eating behavior disorders, while in middle school female students, negative emotions had the greatest influence.

Discussion: These results provided a basis for developing preventative interventions targeting risk factors included in the model, particularly as adolescence, when the risk of developing eating disorders begins to increase. It serves as foundational information for optimizing preventative interventions tailored to each developmental stage.

Conclusion: This study is particularly significant in that it extends the dual pathway model of eating pathology, which had primarily focused on female university students, to include female middle school and high school students.

Background: The COVID-19 pandemic has significantly affected the daily lives of children and adolescents. This study aims to clarify the actual eating disorder-related behaviors of children and adolescents in the school settings during the pandemic and to use the findings to strengthen collaboration between education and health systems.

Subjects and Methods: The online survey was conducted nationwide in Japan among Yogo teachers (school nurses in Japan) regarding eating disorder-related behaviors in the school setting. Data were analyzed using a mixed-methods approach, focusing on the changes in students with eating disorders during the pandemic and the impact of social media on the onset and exacerbation of the disorders.

Results: Approximately 60% of respondents had experience of students with eating disorders, and 13% felt that the number of students with eating disorders increased during the pandemic. Yogo teachers recognized a mixture of changes in eating disorders due to the pandemic and consistent trends from before the pandemic. In addition, students often obtained information from social network services, but lacked the ability to critically evaluate it.

Discussion: Lifestyle changes brought about by the pandemic have influenced the onset and exacerbation of eating disorders among students. This study highlights the need to strengthen the education to Yogo teachers regarding awareness of eating disorders. Effective dissemination of the guideline for schools on eating disorders and a support system tailored to the needs of Yogo teachers are essential. Furthermore, the impact of social media on students’ eating behaviors suggests the need for enhancing digital literacy education.

Conclusion: This study sheds light on the state of eating disorders in school settings during the COVID-19 pandemic. To better support students, it is crucial to strengthen support systems in schools, increase dissemination of the guideline for schools on eating disorders, and improve digital literacy education.

Objectives: This study evaluated the psychological impact of a three-session online psychoeducation group designed for families of individuals with eating disorders.

Subjects and Methods: The study included 39 participants who completed a 19-item questionnaire administered before and after the program. These participants were selected from among 52 individuals who attended online psychoeducation groups conducted by Shizuoka Prefectural Support Base Hospital for Eating Disorders between April 2020 and March 2023. The questionnaire was developed based on feedback from in-person family psychoeducation groups and the content of the online sessions. Statistical analysis was performed using the Wilcoxon signed-rank test, with p-values adjusted using the Bonferroni correction.

Results: The comparison of pre- and post-program responses revealed significant improvements in 11 of the 19 questionnaire items. Notably, the participants showed increased knowledge and understanding of eating disorders, enhanced coping skills (including externalization techniques), and reduced psychological distress. Despite reporting a sense of safety and closeness within the group, they did not experience a significant reduction in feelings of isolation.

Discussion: The findings indicate that online family psychoeducation groups are effective, although certain limitations were noted. The lack of reduction in isolation may stem from the unique challenges inherent in online formats, where sustaining relationships after the sessions can be difficult. Additionally, the program may have been limited in its ability to foster cooperation among families. This study also highlighted the importance of encouraging the participation of multiple family members during recruitment. Future research could explore intervention improvements by involving peer supporters who have recovered from eating disorders to deliver more impactful presentations and by providing evidence-based information on the mental health challenges faced by families of individuals with eating disorders. This approach could help them better recognize the need for their own stress management.

A 30-year-old male with a history of rumination of food which began in junior high school, due to the pleasure and reassurance he feels when food passes through his throat. Upon entering high school, he joined the track and field club and began to restrict his diet in an attempt to achieve better results as a long-distance runner, which led him to engage in binge eating and vomiting. Suspected of having an eating disorder, he received treatment from a nearby psychiatrist, which led to weight recovery and cessation of binge eating and vomiting, but without improving the rumination. Once he entered university, stress from interpersonal relationships triggered a relapse of binge eating and vomiting, which worsened due to job-related stress once he began working. His weight loss and leukopenia were noted during a routine check-up at his company, which resulted in him visiting an internal medicine specialist who suspected an eating disorder and referred him to a psychiatrist within the same hospital. This psychiatrist then further referred him to our hospital due to our specialization in eating disorders. With a diagnosis of anorexia nervosa binge-purge type, we initiated nutritional therapy, which reduced the binge eating and vomiting, but not the rumination. We did not actively treat the rumination, instead recommending social adjustments including those relating to his eating environment. Given the rare nature of male cases where rumination disorder precedes anorexia nervosa, we report this case with a literature review.

The COVID-19 epidemic, which originated in Asia in late 2019, spread rapidly across the globe, prompting the World Health Organization to declare it a pandemic. Governments around the world imposed lockdowns, drastically altering daily life and social interactions. While these measures effectively controlled virus transmission, they also exacerbated social isolation and mental health problems, particularly among children and adolescents, who experienced increased anxiety, depression and suicidal tendencies. In the area of eating disorders, the pandemic exacerbated the conditions of existing patients and increased the number of new cases. The disruption to traditional medical services necessitated a shift to telemedicine, which was essential but also challenging. This transition affected routine medical practices, creating barriers to effective treatment. The prevalence of eating disorders in Japan has increased, with younger patients becoming more common, underscoring significant changes in the medical environment surrounding eating disorders.

Epidemiological studies prior to COVID-19 indicated that the prevalence of eating disorders varied and was influenced by economic and cultural factors. Across all eating disorder subtypes, the number of patients showed a marked upward trend until the 2000s, after which the numbers plateaued. During the pandemic, there was a significant increase in newly diagnosed cases of eating disorders in the United States and Europe, particularly among adolescent females. The clinical characteristics of eating disorder patients also changed after the pandemic, with more severe symptoms and lower target weights. In Japan, about one-third of the onset of symptoms in eating disorder patients was associated with the pandemic, with new cases tending to be younger. Patients with pre-existing eating disorders experienced a worsening of symptoms as a result of the pandemic. One European study reported an increase in hospital admissions and symptom severity, particularly in patients with anorexia nervosa. The impact of the pandemic varied by cultural context and disorder subtype, with regional differences in psychological and eating behavioural problems.

The COVID-19 pandemic has highlighted the importance of optimising early diagnosis and access to treatment for eating disorders. Delays in diagnosis and treatment are often due to complex care pathways and lack of awareness among patients and healthcare providers. Research shows that early intervention and streamlined care pathways can significantly improve outcomes. Healthcare costs could be reduced by more than half by incorporating three elements into the care pathway for eating disorders: reducing waiting times for outpatient treatment at specialist centers, ensuring that patients see a specialist center after their first contact with a provider, and providing support for transition through treatment after the first contact with a provider.

In conclusion, the COVID-19 pandemic has had a significant impact on the prevalence and treatment of eating disorders, requiring a re-evaluation of current health care approaches to effectively address these challenges.

Exercise brings significant benefits for both physical and mental health. However, athletes are prone to eating disorders, relative energy deficiency, osteoporosis, and amenorrhea due to demanding training environments, social pressures, and the necessity to maintain or change body weight. There is often reluctance among athletes with eating disorders to openly discuss their symptoms, seek professional guidance, or engage in treatment. Therefore, understanding the risk factors for eating disorders in athletes and implementing appropriate measures, including prevention and early detection, are imperative. The present study focuses on athletes and eating disorders, offering insights from previous studies and proposing recommendations.

The issue of dieting and the underlying social culture of thinness is widely known as a factor in the development of eating disorders, and fashion models exposed in the media have a great influence on the values of thinness. In Western countries, following a series of reports on the sudden deaths of fashion models due to eating disorders since 2006, laws and fashion organizations have regulated ultra-thin models. In Italy and Israel, models with a BMI lower than 18.5 and in Spain, models with a BMI lower than 18.0 are no longer allowed to appear in fashion shows, and in France, legal regulations have been in effect since 2017. Although there is no clear data on the effectiveness of the regulation of ultra-thin models, it is thought that the fashion industry’s response, the appearance of plus-size models, and the body-positive movement are gradually encouraging society to accept a diversity of body shapes beyond thinness, but change in Japan has been scarce.