Cardiovascular disease (CVD) is the leading cause of death, major morbidity, and disability among men and women in the United States, with an estimated 6 million people having symptomatic coronary heart disease.¹ The prevalence of major depression is about 20% in patients with a recent myocardial infarction (MI)^2-4 and about the same for minor depression.³ In patients who experience an acute MI (AMI), depression is a risk factor for recurrent nonfatal infarction and cardiac mortality, independent of cardiac disease severity.^5,6

Approximately 2% to 4% of the young adult female population has full-syndrome eating disorders (EDs) (anorexia nervosa [AN], bulimia, or binge-eating disorder [BED]).^1,2 The peak age at onset appears to be around 16 to 20 years of age, about the time when young women begin leaving home and starting college.² In addition, rates of subthreshold or partial-syndrome EDs likely exceed those of full-syndrome EDs,³ suggesting that the combined rates easily exceed 4%. Furthermore, subthreshold or partial-syndrome EDs exist on a continuum with full-syndrome EDs and represent similar levels of functional impairment.³

The unprecedented COVID‐19 crisis presents an imperative for mental health care systems to make digital mental health interventions a routine part of care. Already because of COVID‐19, many therapists have rapidly moved to using telehealth in place of in‐person contact. In response to this shift, Waller and colleagues compiled a series of expert recommendations to help clinicians pivot to delivering teletherapy to address eating disorders during COVID‐19. However, numerous barriers still impede widespread adoption and implementation of digital interventions. In this commentary, we aim to extend the recommendations for clinicians offered by Waller and colleagues by presenting a roadmap of the systems‐ and policy‐level requirements that are needed. We advocate for addressing barriers associated with training, licensing, safety, privacy, payment, and evaluation, as these factors have greatly limited use of these promising interventions. We also indicate that longer‐term goals should include introducing truly innovative digital mental health practices, such as stepped‐care models and simultaneously providing preventive and self‐management services in addition to clinical services, into the health care system. Now is the time to catalyze change and comprehensively address the barriers that have prevented widespread delivery of these efficacious digital services to the millions of people who would benefit.

The authors examined factors prospectively associated with age of onset of partial syndrome eating disorders over a 4-year interval in a community sample (N = 877) of high school-age adolescent girls. Four percent developed a partial syndrome eating disorder over the interval. A measure of weight concerns was significantly associated with onset in a multivariate Cox proportional hazard analysis (p < .001). Girls scoring in the highest quartile on the measure of weight concerns had the highest incidence (10%) of partial syndrome onset, whereas none of the girls in the lowest quartile developed eating disorder symptoms. This finding is consistent with both theoretical and clinical perspectives and may represent a useful step toward the establishment of a rational basis for the choice of a prevention intervention target.

Background: Numerous longitudinal studies have identified risk factors for the onset of most eating disorders (EDs). Identifying women at highest risk within a high-risk sample would allow for focusing of preventive resources and also suggests different etiologies.Method: A longitudinal cohort study over 3 years in a high-risk sample of 236 college-age women randomized to the control group of a prevention trial for EDs. Potential risk factors and interactions between risk factors were assessed using the methods developed previously. Main outcome measures were time to onset of a subthreshold or full ED.Results: At the 3-year follow-up, 11.2% of participants had developed a full or partial ED. Seven of 88 potential risk factors could be classified as independent risk factors, seven as proxies, and two as overlapping factors. Critical comments about eating from teacher/coach/siblings and a history of depression were the most potent risk factors. The incidence for participants with either or both of these risk factors was 34.8% (16/46) compared to 4.2% (6/144) for participants without these risk factors, with a sensitivity of 0.75 and a specificity of 0.82.Conclusions: Targeting preventive interventions at women with high weight and shape concerns, a history of critical comments about eating weight and shape, and a history of depression may reduce the risk for EDs.

OBJECTIVE—This study evaluated the efficacy of a nurse-care management system designed to improve outcomes in patients with complicated diabetes. RESEARCH DESIGN AND METHODS—In this randomized controlled trial that took place at Kaiser Permanente Medical Center in Santa Clara, CA, 169 patients with longstanding diabetes, one or more major medical comorbid conditions, and HbA_lc >10% received a special intervention (n = 84) or usual medical care (n = 85) for 1 year. Patients met with a nurse-care manager to establish individual outcome goals, attended group sessions once a week for up to 4 weeks, and received telephone calls to manage medications and self-care activities. HbA_lc, LDL, HDL, and total cholesterol, triglycerides, fasting glucose, systolic and diastolic blood pressure, BMI, and psychosocial factors were measured at baseline and 1 year later. Annualized physician visits were determined for the year before and during the study. RESULTS—At 1 year, the mean reductions in HbA_lc, total cholesterol, and LDL cholesterol were significantly greater for the intervention group compared with the usual care group. Significantly more patients in the intervention group met the goals for HbA_1c (<7.5%) than patients in usual care (42.6 vs. 24.6%, P < 0.03, χ²). There were no significant differences in any of the psychosocial variables or in physician visits. CONCLUSIONS—A nurse-care management program can significantly improve some medical outcomes in patients with complicated diabetes without increasing physician visits.