Preface

A little more than a year ago, Andrés Martin, the former Consulting Editor of Child and Adolescent Psychiatry Clinics of North America, asked us to act as Guest Editors for a special issue on eating disorders. We were both very delighted and surprised. Two researchers from Germany receiving the chance to co-edit an issue of this prestigious journal that publishes top expert reviews for application in clinical practice. We felt honored by this offer and at the same time were quite aware of the challenges that lay ahead of us. In our initial outline, we agreed to include obesity as one of the disorders covered in the issue.

Eating disorders and obesity are among the most prevalent clinical disorders of childhood and adolescence. They often take a chronic and disabling course with high morbidity and eventually mortality rates; the personal toll is high.

We were well aware of the fact that obesity cannot readily be viewed as an eating disorder; the clinical aspects and research issues differ. Nevertheless, several commonalities apply. Obesity in itself is a risk factor for the development of bulimia nervosa and is frequently associated with binge eating disorder. The elucidation of the pathways underlying appetite and weight regulation has resulted in a paradigm shift of our understanding of these disorders; we are now able to better grasp the neurobiologic complexity of these disorders, which in turn is beginning to influence our attitude toward patients. Environmental factors are of obvious importance in the development of both obesity and eating disorders. Today's environment reflecting the pursuit of thinness promotes dieting behavior, particularly among young females; current evidence suggests that this a major risk factor for eating disorders and that it may also contribute to the development of overweight and obesity.

Despite our vastly improved knowledge of epidemiology and neurobiology, including the discovery of major genes and polygenes involved in obesity, our treatment results for both eating disorders and obesity have not improved concomitantly. Children and adolescents with obesity, anorexia, or bulimia nervosa much too often become adults in whom these disorders persist.

It was our aim to provide readers with a comprehensive and up-to-date overview of three areas: (1) diagnostic and classification issues in eating disorders and obesity, especially in light of the preparation of DSM-V; (2) important research findings in the neurobiology of both fields; and (3) the difficulty of finding effective treatment methods and prevention strategies.

Section I pertains to diagnostic issues and psychiatric and psychologic symptoms of eating disorders and obesity, with a focus on developmental aspects. In the first article, Hebebrand gives a general overview on definitions of both underweight and overweight, which serve as the basis for diagnosing both anorexia nervosa and obesity. He argues for use of body mass index (BMI) and BMI percentiles for defining both weight categories. The next article by Nicholls and Bryant-Waugh covers eating disorders of infancy and childhood, thereby elucidating the difficulty of applying DSM-IV criteria to eating disorders in younger subjects. In the third article, Herpertz-Dahlmann gives a brief overview on the different eating disorders in adolescence and points out the growing importance of “eating disorders not otherwise specified,” the most common eating disorders encountered in clinical practice. In the last article of this section, Hebebrand and Herpertz-Dahlmann present data on the psychiatric comorbidity of obese children and adolescents in clinical and epidemiologic samples. They also address the emerging knowledge that depression in childhood may be associated with obesity in adulthood.

In Section II, we highlight the most recent etiologic and neurobiologic findings. Mazzeo and Bulik describe the interplay of “nature” and “nurture,” providing their interpretation of formal genetic findings in eating disorders and discussing the implications for treatment. Hebebrand and Hinney summarize currently known genetic and environmental risk factors for the etiology of childhood obesity. In the third article, Van den Eynde and Treasure give a very thorough overview of recent findings obtained with modern neuroimaging techniques and their implications for further research. In the last article of the second section, Müeller and colleagues address important aspects of the neurobiology of anorexia nervosa by describing the role of the hormone leptin in the somatic and behavioral adaptation to the starvation process.

Section III comprises a selection of articles that summarize different treatment modalities and new findings pertaining to prevention strategies.

Although much progress has been made in improving treatment, there is still a rather high proportion of patients with anorexia nervosa who fail to respond to any kind of therapy. This dilemma (and its implications for treatment research) is addressed in the article by Herpertz-Dahlmann and Salbach. The article by Schmidt covers recent data and emerging new ideas in cognitive behavioral therapy for adolescents who have eating disorders, while Le Grange and Eisler summarize their extensive knowledge on family therapy and interventions. Powers and Bruty outline state-of-the-art pharmacotherapy for eating disorders and obesity—an area requiring much more research to improve the evidence basis for the use of currently employed medications, and potentially more important in the effort to come up with novel and more effective medications. Stewart and colleagues focus on the behavioral treatment of childhood and adolescent obesity; they provide a very practical overview of the different behavioral strategies. Further research is required to address the effectiveness of such interventions. The important and promising domain of prevention is presented by Shaw, Stice, and Black Becker for eating disorders and by Swinburn for obesity. Steinhausen concludes this issue with a review on recent data about outcome in eating disorders.

After our work has been finished, we would like to express our considerable gratitude to all contributors of this issue. This book is not a solo effort, but the work of many leading experts in the field of eating disorders and obesity who were willing to share their time, wisdom, and expertise. We have learned much by obtaining deep insight into the topics discussed.

We wish to thank Andrés Martin for his confidence in both of us to compile this issue, Harsh Trivedi for his editorial advice, and Sarah Barth at Elsevier for her constant and extraordinary support. Last but not least, we want to thank our patients and their families for teaching us about their disorders and their struggles.

We both hope that this issue will be valuable for all professionals in clinical practice who want to help their patients to find a way out of their disorder.