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Clinical · Special populations

Follow-up: History of disordered eating and why it changes the conversation

LW
l.wikstromTL221 Apr 2025#1

Posting this under the heading it deserves: History of disordered eating and why it changes the conversation Everything below is what sits behind that.

What changes if the standard account of History of disordered eating is wrong? I ask because I have been treating it as settled and I noticed this week that I could not say why.

Working through the consequences rather than the evidence, since others here are better placed on the evidence.

7 likes 15mo
FD
f.demirTL2Regular26 Apr 2025#2

My position on History of disordered eating is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.

11 likes 15mo
AI
a.iyerTL229 Apr 2025#3
l.wikstrom, post #1: Posting this under the heading it deserves: History of disordered eating and why it changes the conversation Everything below is what sits behind that. What changes if the standard account of History of disordered eating is wrong? I ask because I have been treating it as settled and I noticed this week that I could not say why. Working… Go to post

Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input.

I would be glad to be shown a cleaner way of putting this.

32 likes in reply to #1 15mo
RM
r.mcalisterTL3Regular2 May 2025#4

I read post #2 twice before replying, because I had assumed the opposite.

A note on how History of disordered eating gets discussed rather than on History of disordered eating itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.

0 likes 15mo
RN
r.nakamuraTL25 May 2025#5
DT
dexa_twice_yearlyTL3Regular8 May 2025 · edited#6

That reframing is the whole thing. The facts I already had.

7 likes 15mo
HF
h.friskTL210 May 2025#7
l.wikstrom, post #1: Posting this under the heading it deserves: History of disordered eating and why it changes the conversation Everything below is what sits behind that. What changes if the standard account of History of disordered eating is wrong? I ask because I have been treating it as settled and I noticed this week that I could not say why. Working… Go to post

The most useful contribution here is usually a citation to whichever published document comes closest, with a plain statement of how far it is from the question.

24 likes in reply to #1 15mo
GP
g.pemberton_ukTL3Regional · UK13 May 2025#8

Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done.

0 likes 15mo
NB
n.boatengTL215 May 2025#9

Counterpoint on History of disordered eating, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.

10 likes 14mo
CR
crossover_reviewTL3Regular17 May 2025#10
f.demir, post #2: My position on History of disordered eating is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly. Go to post

Where I part company with post #7, and it is a narrow parting.

On History of disordered eating I would separate what is worth knowing from what is worth acting on. The first list is long and the second is short, and conflating them is how threads get heated.

23 likes in reply to #2 14mo
BT
b.teixeiraTL220 May 2025#11

Agreed, and I will stop repeating the version of this I had been repeating.

9 likes 14mo
K
KStephanopoulosTL3Regular22 May 2025#12
dexa_twice_yearly, post #6: That reframing is the whole thing. The facts I already had. Go to post

Genetic and ancestry-related differences in response are asked about regularly and the published evidence is thin enough that the honest answer is short.

For what it is worth, the same held on the two occasions I checked.

2 likes in reply to #6 14mo
AK
ar.kravchenkoTL224 May 2025#13

Dedicated trials in under-studied populations are the only real remedy and several are ongoing, which is worth saying rather than speculating.

0 likes 14mo
G
GSwinburneTL1Member26 May 2025#14

Post #13 is right about the mechanism and I think understates the practical bit.

Disordered eating history: a history of anorexia nervosa, bulimia, or other eating disorders changes the risk-benefit calculation because appetite suppression might trigger relapse. This population requires specialist input.

28 likes 14mo
SO
s.oyelaranTL228 May 2025#15

Worth separating two things that post #13 runs together.

The number people quote for History of disordered eating is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.

0 likes 14mo
M
MJayawardenaTL3Regular30 May 2025#16

This follows post #13 rather than contradicting it.

History of disordered eating was covered in the wiki last year and the page has a review date on it, which is a better starting point than my memory of a thread.

29 likes 14mo
RC
r.coelhoTL21 Jun 2025#17
a.iyer, post #3: Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input. I would be glad to be shown a cleaner way of putting this. Go to post

Body weight at the extremes of the studied range affects exposure and the trials rarely reported enough to say by how much.

I would call that likely rather than established.

15 likes in reply to #3 14mo
EM
endpoint_marginTL2Member3 Jun 2025#18

Nothing in this subcategory is medical advice and the questions asked here are precisely the ones that need an individual assessment.

21 likes 14mo
TV
to.vargaTL25 Jun 2025#19

Being outside the studied population does not mean a treatment is unsafe. It means the usual evidence is not available and the reasoning has to be explicit.

0 likes 14mo
CD
cohort_driftTL3Regular7 Jun 2025#20

The arithmetic in post #17 is right; the assumption feeding it is the part to check.

Whatever the answer on History of disordered eating turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction.

22 likes 14mo
HF
h.ferrariTL29 Jun 2025#21

Gastroparesis: pre-existing severe delayed gastric emptying can worsen with compounds that slow it further. Discussion with a clinician is prudent if this history exists.

The conclusion is tentative; the arithmetic underneath it is not.

5 likes 14mo
EL
e.lehtinenTL211 Jun 2025#22
endpoint_margin, post #18: Nothing in this subcategory is medical advice and the questions asked here are precisely the ones that need an individual assessment. Go to post

Post #20 describes the usual case. This is about the unusual one.

I have been on both sides of the History of disordered eating argument in this category within eighteen months, which should tell you how strong the evidence for either side is.

15 likes in reply to #18 14mo
KC
k.chukwuTL213 Jun 2025#23
r.mcalister, post #4: I read post #2 twice before replying, because I had assumed the opposite. A note on how History of disordered eating gets discussed rather than on History of disordered eating itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often. Go to post

That is clearer than the version I had in my head. Thank you.

0 likes in reply to #4 13mo
RF
r.friskTL215 Jun 2025#24

Adding a small correction to the History of disordered eating summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.

0 likes 13mo
KK
k.kimaniTL217 Jun 2025#25

Genetic and ancestry-related differences in response are asked about regularly and the published evidence is thin enough that the honest answer is short.

It is the kind of thing that is obvious once and never again.

3 likes 13mo
FF
f.fenwickTL3Regular19 Jun 2025 · edited#26
endpoint_margin, post #18: Nothing in this subcategory is medical advice and the questions asked here are precisely the ones that need an individual assessment. Go to post

The thing about History of disordered eating that took me longest to accept is that a plausible mechanism is not evidence of an effect. It is a reason to look, not a result.

10 likes in reply to #18 13mo
SH
s.hartmannTL221 Jun 2025#27

Post #26 is right about the mechanism and I think understates the practical bit.

Posting my History of disordered eating numbers with the method attached so they can be discounted properly. Uncontrolled, unblinded, and collected by someone who wanted a particular answer.

29 likes 13mo
K
KForsbergTL2Member23 Jun 2025#28

Coming back to post #24, because the follow-up matters more than the original answer.

Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done.

0 likes 13mo
PW
PharmNotes_WhitfieldTL4Pharmacist24 Jun 2025#29

What I would check first on History of disordered eating is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.

14 likes 13mo
NK
n.kuuselaTL226 Jun 2025#30

Filing a mild objection to the consensus on History of disordered eating. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit.

28 likes 13mo