Review of Disordered Eating Behaviors in Cystic Fibrosis

CF transmembrane conductance regulator (CFTR) modulators are available for 90% of people with cystic fibrosis (PWCF), which has contributed to substantial nutritional changes. PWCF identify differences in their relationship with food, as well as alterations in body size and image when taking CFTR modulators. This has led to increasing risks relating to issues with body image, disordered eating behaviors (DEBs), and eating disorders (EDs). DEBs can be an early indication of an ED. CF care has traditionally emphasized body mass index and weight gain, which may have heightened the critical focus of body habitus. Prior to CFTR modulators, the "legacy diet" was often promoted and after years of encouragement to eat high volumes of calorically dense foods, PWCF on modulators have shared that the subsequent body changes have been challenging. Given the body changes that PWCF may have experienced, CF care team nutritional guidelines are evolving. The prevalence and etiology of EDs is largely unknown. Therefore, interventions designed to reduce risk factors for EDs and enhance protective factors against the development of DEBs need to be prioritized. To date, there are no reliable and validated screening tools in the United States to identify DEBs for PWCF. The purpose of this paper is to (1) review eating behaviors and disordered eating in PWCF, and (2) discuss important future directions for the assessment and treatment of DEBs to improve quality of life for PWCF.