Prevention of Eating Disorders in At-Risk College-Age Women

Department of Psychiatry, Stanford University Medical School, Stanford, CA 94305-5722, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 09/2006; 63(8):881-8. DOI: 10.1001/archpsyc.63.8.881
Source: PubMed


Eating disorders, an important health problem among college-age women, may be preventable, given that modifiable risk factors for eating disorders have been identified and interventions have been evaluated to reduce these risk factors.
To determine if an Internet-based psychosocial intervention can prevent the onset of eating disorders (EDs) in young women at risk for developing EDs.
San Diego and the San Francisco Bay Area in California.
College-age women with high weight and shape concerns were recruited via campus e-mails, posters, and mass media. Six hundred thirty-seven eligible participants were identified, of whom 157 were excluded, for a total sample of 480. Recruitment occurred between November 13, 2000, and October 10, 2003. Intervention A randomized controlled trial of an 8-week, Internet-based cognitive-behavioral intervention (Student Bodies) that included a moderated online discussion group. Participants were studied for up to 3 years.
The main outcome measure was time to onset of a subclinical or clinical ED. Secondary measures included change in scores on the Weight Concerns Scale, Global Eating Disorder Examination Questionnaire, and Eating Disorder Inventory drive for thinness and bulimia subscales and depressed mood. Moderators of outcome were examined.
There was a significant reduction in Weight Concerns Scale scores in the Student Bodies intervention group compared with the control group at postintervention (P < .001), 1 year (P < .001), and 2 years (P < .001). The slope for reducing Weight Concerns Scale score was significantly greater in the treatment compared with the control group (P = .02). Over the course of follow-up, 43 participants developed subclinical or clinical EDs. While there was no overall significant difference in onset of EDs between the intervention and control groups, the intervention significantly reduced the onset of EDs in 2 subgroups identified through moderator analyses: (1) participants with an elevated body mass index (BMI) (> or =25, calculated as weight in kilograms divided by height in meters squared) at baseline and (2) at 1 site, participants with baseline compensatory behaviors (eg, self-induced vomiting, laxative use, diuretic use, diet pill use, driven exercise). No intervention participant with an elevated baseline BMI developed an ED, while the rates of onset of ED in the comparable BMI control group (based on survival analysis) were 4.7% at 1 year and 11.9% at 2 years. In the subgroup with a BMI of 25 or higher, the cumulative survival incidence was significantly lower at 2 years for the intervention compared with the control group (95% confidence interval, 0% for intervention group; 2.7% to 21.1% for control group). For the San Francisco Bay Area site sample with baseline compensatory behaviors, 4% of participants in the intervention group developed EDs at 1 year and 14.4%, by 2 years. Rates for the comparable control group were 16% and 30.4%, respectively.
Among college-age women with high weight and shape concerns, an 8-week, Internet-based cognitive-behavioral intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of EDs, at least in some high-risk groups. To our knowledge, this is the first study to show that EDs can be prevented in high-risk groups.

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Available from: Roxanne Elizabeth Rockwell, Oct 04, 2015
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    • "Weight and shape concerns represent the most potent and consistently supported risk factor for the onset of eating disorders (ED) on the basis of longitudinal research (Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004), and predicting the onset of ED in high-risk samples (Jacobi et al., 2011). Studies in high-risk subjects which include college age women with high weight concerns showed that some 10% of them develop a full or a partial eating disorder (Jacobi et al., 2011; Taylor et al., 2006). Additional psychosocial factors have been examined which may contribute to why only some girls living in a weight-obsessed culture develop weight concerns and why only some girls with weight concerns develop eating disorders, as Keel & Forney (2013) examined it. "
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    ABSTRACT: Epidemiological data in Romania indicate an increase of eating disorders during the last two decades. Weight concerns, disordered eating and some cognitive characteristics were identified as risk factors for developing eating disorders. We investigated 196 Romanian and 110 German female students as well as a group of 31 female anorexia nervosa patients with the Eating Disorders Inventory. The findings might question the patterns of how weight concerns and ineffectiveness may predict eating disorders. Further replication and cross-cultural studies may highlight why and how for Romanian young women being thin appears to be more “normal” than being normal-weight.© 2015 The Authors. Published by Elsevier Ltd.Peer-review under responsibility of the Scientific Committee of PSIWORLD 2014.
    Procedia - Social and Behavioral Sciences 05/2015; 187:402-407. DOI:10.1016/j.sbspro.2015.03.075
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    • "In recent years, the number of Internet-based prevention programmes for EDs has increased. Some recent findings show promise for these programmes (Taylor et al., 2006). Previous initiations such "
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    ABSTRACT: Objective The ProYouth programme focuses on the promotion of mental health and the prevention of eating disorders (EDs) among young people. The aim of our study was to explore whether the programme can address individuals who are at risk for developing EDs. This study is designed as an online cross-sectional survey (n = 664, 12.2% men, 87.8% women, mean age: 24.9 years, SD = 5.4 years, range: 18–40 years). Measures included demographic data, self-reported weight and height, the Patient Health Questionnaire for Depression and Anxiety, Short Evaluation of Eating Disorders, Weight Concerns Scale and previous/current treatment for EDs. ResultsIn terms of severity of EDs, 22.9% (n = 152) of the screened participants were symptom free, 48.8% (n = 324) had considerable concerns about their weight, 11.1% (n = 74) were slightly impaired, 15.1% (n = 100) had severe impairment and 2.1% (n = 14) of participants are currently under treatment for EDs. In total, 56.3% of users (n = 374) registered in the programme. According to our results, those who had considerable concerns about their weight and individuals who were severely impaired registered with a greater odds to the programme than those who were symptom free [odds ratio (OR) = 1.64, p = .021 and OR = 1.90, p = .023, respectively]. Furthermore, those who previously received treatment for their ED registered to the programme with greater odds than those who did not (OR = 2.40, p = .017).Conclusion ProYouth successfully addressed those who have elevated concerns about their weight and who also registered with greater odds to the programme than those who were symptom free regarding EDs. The screening results show that there is a greater need for specialized care targeting EDs in Hungary than what is currently available. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 01/2015; DOI:10.1002/erv.2345 · 2.46 Impact Factor
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    • "Vengono utilizzate tecniche di automonitoraggio e l'interazione avviene via internet, in un gruppo di discussione moderato dallo staff dei ricercatori. In un ampio trial di valutazione, randomizzato e controllato (Taylor et al., 2006), si è verificata una significativa riduzione dell'insoddisfazione corporea, della spinta alla magrezza e della patologia alimentare, rispetto al gruppo di controllo (lista d'attesa). I risultati sono stati confermati al follow-up a un anno. "
    Manuale di Psicologia Preventiva, Edited by Becciu M., Colasanti A.R., Pozzi M., 01/2015: chapter prevenzione dei disturbi del comportamento alimentare; Franco Angeli.
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