Table 1.

Summary of original studies on eating disorders in India

Authors	Subjects	Study settings	Sampling type	Assessment tools	Methodology	Major findings
King and Bhugra, 1989 Yamuna Nagar[13]	574 school girls aged between 14-23 years	Two schools and two colleges	Quota sampling	Hindi version of EAT-26	Abnormal eating attitude and behavior was assessed by a score of more than 20 on EAT-26	About 29% (n=167) had disordered eating or probable eating disorder
Srinivasan et al., 1995 Chennai[14]	Medical students Step1: 602 Step 2: 210	Medical college	Convenient sampling	EAT-40 BITE DSM-III criteria	Two step procedure Step 1: Screening of probable cases. They were defined as :  Scoring >30 on 40-item EAT  Scoring >10 on 33-item BITE Step 2: Clinical assessment and diagnosis of eating disorder as per DSM-III in all probable subjects as well as 1/3 of screen negative subjects selected by random sampling	About 28 students had scored more than cut offs as per EAT or BITE in Step 1 None of the subjects had syndromal eating disorder diagnosis on clinical evaluation About 14.8% subjects (n=31) could be diagnosed with syndrome of EDS, subsyndromal eating disorder
Srinivasan et al., 1998 Chennai[15]	Medical students Step1: 210 Step 2: 146	Medical college	Convenient sampling	SQ-EDSSQ - EDS) SRQ-20	Step 1: 15 item SQ-EDS was made based on the study by Srinivasan et al., 1995 on 210 subjects	Among 210 subjects assessed individually, no criterion-based diagnosis of AN or BN could be made. About 14.8% of subjects were identified as having EDS which did not fit into any of the standard diagnostic criteria for major eating disorders
					Step 2: The questionnaire was validated in another set of 146 students against 20-item SRQ-20
						In Step 2, none of the subjects could be diagnosed with AN, BN, or partial syndrome of AN or BN.
						About 11% of subjects were diagnosed with EDS
Mammen et al., 2007 Vellore[16]	Medical charts of 3274 patients attending child and adolescent psychiatry unit	Hospital child guidance clinic	Consecutive sampling	ICD-10	Retrospective chart review of patient records of consecutive children and adolescents availing. Child and Adolescent Psychiatry Unit services from 2000-2005.	After chart review, 41 cases were identified. About 1.25% had an eating disorder. 85.4% (35 cases) had psychogenic vomiting. 14.6% (6 cases) had AN psychogenic vomiting (F: M=2:1.5) and AN (F: M=5:1) was predominantly seen in females.
					The case records diagnosed with eating disorder (F 50.0-50.9) as per the ICD-10 were reviewed by a psychiatrist
						The mean age was around 11.2 (4.3) years. About 44% had psychiatric co-morbidity
Kurpad et al., 2010 Bengaluru[17]	n=73 outpatients of psychosis (schizophrenia/psychosis NoS) on treatment	Hospital	Purposive sampling	Eating behavior questionnaire DSM-IV	Eating behavior questionnaire as well as DSM-IV criteria were used for diagnosing.	None of the patients had BED
					BED in patients of psychosis
Balhara et al., 2012 New Delhi[18]	n=97 female nursing students	Government nursing college affiliated with tertiary care hospital	Quota sampling	EAT-26, BSQ	Disordered eating attitude and behavior was assessed by a score of more than 20 on	About 4% (n=3) had disordered eating or probable eating disorder.
						A significant correlation was obtained between EAT-26 and BSQ
					EAT-26.
					BSQ was used to assess attitude regarding body shape
Chellappa and Karunanidhi, 2013 Chennai[19]	n=200 undergraduate female students	Five premier colleges affiliated to the University of Madras	Convenience sampling	EAT-26, State Trait Anxiety Inventory BDI	Abnormal eating attitudes were assessed by EAT-26. Anxiety and depression were assessed by the State Trait Anxiety Inventory and BDI, respectively	30% of students had abnormal eating attitudes.
						Participants in the abnormal eating attitude category had exhibited higher scores on depression and anxiety when compared to those with normal eating attitudes
Jugale et al., 2014 Bengaluru[20]	n=117 females aged between 20-25 years	Five professional college hostels	Convenience sampling	SCOFF	A score of 2 or more on the SCOFF questionnaire was used for diagnosing disordered eating. Score more than 2 on	About 42.7% (n=50) had suspected eating disorders.
						They had a significantly higher prevalence of periomylolysis, dental caries, and tooth sensitivity
					SCOFF signifies suspected eating disorder.
					Dental hygiene was assessed by dental professional
Upadhyah et al., 2014 Meerut[21]	n=120 females aged between 13-17 years	School	Convenience sampling	EAT-26	Disordered eating attitude and behavior was assessed by a score of 20 or more on EAT-26	Nearly 26.67% (n=32) had disordered eating
Ramaiah, 2015 Bellur[22]	n=172 medical students	Tertiary care rural medical college	Convenience sampling	EAT-26 BSQ	Disordered eating attitude and behavior was assessed by a score of 20 or more on EAT-26. BSQ was used to assess attitude regarding body shape	About 16.9% (n=29) had disordered eating. A significant correlation was obtained between EAT-26 and BSQ
Lal et al., 2015 New Delhi[4]	Indian patients of eating disorder=30 outpatient Australian patients of eating disorder (outpatients=30, inpatients=30) All patients were females of age range 1626 years	Private mental health clinics in India and Australia	Convenience sampling	QOL EDs questionnaire DSM-IV	The diagnostic profiles and the quality of life was assessed by the QOL EDs questionnaire Eating disorder was diagnosed as per the DSM-IV	No significant difference was noted in global ED-QOL score. Indians compared to Australian patients had:
						Higher beliefs that they overeat more frequently
						Similar frequency of restriction of food, vomiting, use of laxatives
						Lesser frequency of beliefs of fears of loss of control over intake of food and having preoccupations with the body or food intake
Singh et al., 2016 Manipal[6]	n=550 students	Pre-university colleges	Convenience sampling	EAT-26	The tendency to develop an eating disorder was assessed by a score of more than 20 on EAT-26	Nearly 31.09% (n=171) had affinity to develop eating disorder
Shashank et al., 2016 Mandya[23]	n=134 medical students	Tertiary care medical college and hospital	Convenience sampling	EAT-26 SCOFF	EAT-26 and SCOFF questionnaire was used to assess disordered eating attitude and behavior.	29.2% and 17.2% of students had disordered eating behavior as per EAT-26 and SCOFF, respectively
					Disordered eating was determined by a cut-off of 20 and 2 on EAT-26 and SCOFF, respectively
Gupta et al., 2017 Chandigarh[24]	n=250 medical students	Government Medical College	Convenience sampling	Hindi version of EAT-26 BSQ	Hindi version of 26 item EAT-26 BSQ was used to assess disordered eating attitudes and body shape attitude	Females scored significantly greater on dieting subscale of EAT-26 and BSQ. BSQ was found to be a significant predictor of eating disorder
Vijayalakshmi et al., 2017 Bengaluru[25]	n=241 medical students n=213 nursing students	Medical college	Convenient sampling	EAT-26 SCOFF Patient health questionnaire	SCOFF questionnaire was used to assess disordered eating behaviors	Males (45.4%) scored higher on the cut-off for SCOFF questionnaire compared to female (31.1%).
					Score more than 2 signifies suspected eating disorder	Males (16.5%) scored higher on the cut-off for EAT-26 compared to female (8.7%)

AN – Anorexia nervosa; BDI – Beck’s Depression Inventory; BED – Binge eating disorder; BITE – Bulimia investigatory test; BSQ – Body shape questionnaire; BN – Bulimia nervosa; DSM-IV – Diagnostic and Statistical Manual of Mental Disorders Version IV; DSM-III – Diagnostic and Statistical Manual of Mental Disorders Version III; EAT – Eating attitudes test; EDS – Eating distress syndrome; ICD-10 – International Classification of Diseases; QOL EDs – Quality-of-life for eating disorders questionnaire; SCOFF – Sick, Control, One-stone (14 lbs/6.5 kg), Fat, Food; SRQ – Self-report questionnaire; SQ-EDS – Screening questionnaire for eating distress syndrome