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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    • "In order to accomplish this, prevention and early-intervention programs must focus on reducing established modifiable risk factors, such as dieting and weight and shape concerns. When coupled with negative affect, teasing, and compensatory behaviors, the risk of developing an ED increases significantly (Jacobi et al., 2011; Taylor et al., 2006). These risk factors have been shown to predict future eating pathology (Field et al., 1999; Killen et al., 1996; Stice, 2001; Wertheim et al., 2001; Wichstrøm, 2000) and, if present, should be concurrently addressed in preventive interventions. "
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    ABSTRACT: Objective: Eating disorders and subclinical eating disorders are serious and disabling diseases with high prevalence rates on college campuses. Many symptomatic students are never screened nor formally diagnosed with an eating disorder and do not receive mental health treatment. Method: This pilot study examines the feasibility, acceptability, and short-term efficacy of a 10-week online intervention, StudentBodies-Eating Disorders, designed to reduce eating disorder symptoms, related psychopathology, and weight and shape concerns. A total of 65 participants were randomized to the online intervention or waitlist control. Results: Results indicate that for study completers, the intervention had large effects for reduction of eating-related psychopathology (. d=. 1.5), weight concerns (. d=. .7), and psychosocial impairment (. d=. .7). Those who completed it rated the program very acceptable. This pilot study suggests the potential efficacy of StudentBodies-Eating Disorders as a self-help intervention for subclinical eating disorders in a non-clinical setting.
    Internet Interventions 11/2015; 2(4). DOI:10.1016/j.invent.2015.10.004
    • "Problematic drinking, gambling and eating behaviors are particularly frequent among university students (Dancyger and Garfinkel 1995; Wechsler et al. 2002; Neighbors et al. 2002; Martens et al. 2005; Ferrier and Martens 2008) and have been the focus of specially designed interventions (e.g. Cronce and Larimer 2011; Taylor et al. 2006; Manwaring et al. 2008)). However, data on whether these behaviors co-occur at rates greater than chance among university and college student populations are inconsistent, with some studies showing moderate links and others not (Dunn et al. 2002; Fischer et al. 2008; Piran and Robinson 2011). "

    International Journal of Mental Health and Addiction 10/2015; DOI:10.1007/s11469-015-9598-2 · 0.99 Impact Factor
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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.
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