Charleston Area Medical Center, Charleston, West Virginia, USA.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Int J Eat Disord. 2022 Apr;55(4):423-454. doi: 10.1002/eat.23699. Epub 2022 Mar 14.
Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020.
We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability.
Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade.
We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices.
Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.
饮食失调（ED）曾经被认为主要影响富裕的白人女性，这种误解在多年来一直影响着研究和实践。大量证据现在驳斥了这种刻板印象，但目前还不清楚现有的“基于证据”的治疗方法是否在受 ED 影响的个体多样性样本中进行了评估。我们的目标是评估 2020 年之前美国 ED 心理治疗随机对照试验（RCT）中社会人口统计学变量的报告、纳入和分析。
我们对美国 ED 心理治疗 RCT 进行了系统回顾，检查了纳入参与者的性别认同、年龄、种族/民族、性取向和社会经济地位（SES）的报告和纳入情况，以及招募方法、功效分析以及对局限性和普遍性的讨论。
我们的搜索结果包括 58 项符合纳入标准的研究，可追溯至 1985 年。报告有时不完整、缺失或集中在种族/性别多数群体上。没有研究报告性别多样化的参与者，男性和少数族裔普遍代表性不足，不同诊断之间存在差异。少数论文在分析中考虑了社会人口统计学变量，或承认与样本特征相关的局限性。几十年来取得了一些进展，研究越来越多地提供完整的种族和族裔数据，并且随着时间的推移，纳入的男性人数也越来越多。尽管种族和族裔多样性有所改善，但在过去十年中似乎停滞不前。
我们总结了研究结果，考虑了 RCT 研究人员的背景和挑战，并就提高代表性、报告和分析实践为研究人员、期刊编辑和审稿人提供了建议。
美国饮食失调心理治疗的随机对照试验越来越多地报告了完整的种族/民族数据，但 SES 信息不一致，性取向信息缺失。白人女性仍然占参与者的绝大多数，男性和少数族裔人数很少，也没有性别多样化的个体。研究结果强调需要改进报告并增加代表性，以确保基于证据的治疗方法在不同群体中都有效。
