Context 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. Objective To determine if an Internet-based psychosocial intervention can prevent the onset of eating disorders (EDs) in young women at risk for developing EDs. Setting San Diego and the San Francisco Bay Area in California. Participants 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. Main Outcome Measures 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. Results There was a significant reduction in Weight Concerns Scale scores in the Student Bodies intervention group compared with the control group at postintervention ( P P P 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) (≥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. Conclusions 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.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/668198/YOA60019.pdf

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

In the present study, the validity of the Eating Disorder Inventory (EDI) in a Dutch nonclinical female school population was established. The data were analyzed in two ways. In the first analyses, the factorial integrity of the questionnaire, and the internal consistencies of the subscales were not found to be very satisfactory. The data showed an impressive lack of variability. It was suggested by the authors that in a nonclinical population the variability of the EDI data is being suppressed as a result of the fact that, in concordance with the manual, the original 6-point EDI items were transformed into 4-point items. In the second analyses, this item transformation was ejected. The psychometric properties of all EDI subscales in the present study improved. Implications for the use of the untransformed EDI as a screening instrument were discussed.

Validation of the eating disorders inventory in a nonclinical population using transformed and untransformed responses

In this article the relationship among acculturation, body image, self-esteem, and eating disorder symptomatology in 120 Mexican American adolescent women was investigated. Surprisingly, acculturation levels were not related to anorexic or bulimic symptomatology, self-esteem, body dissatisfaction or thinness of ideal and attractive figures. Lower levels of self-esteem predicted higher levels of anorexic and bulimic symptomatology. Body mass was positively related to bulimic scores. In contrast to Lester and Petrie (1995), body dissatisfaction was significantly related to eating-disorder symptomatology. The high levels of disordered eating attitudes and behaviors found in this study suggest that rather than exclusively being an Anglo, middle-to upper-class phenomenon, eating-disordered behavior also exists within lower socioeconomic status Mexican American adolescent women.

Acculturation, Body Image, Self-Esteem, And Eating-Disorder Symptomatology In Adolescent Mexican American Women:

Although body dissatisfaction is a strong predictor of disordered eating among women, a majority of women report substantial body dissatisfaction but do not concomitantly report severe levels of eating disorder symptomatology. Third variables, then, may interact with body dissatisfaction to influence its relation to eating disorder symptomatology. Seven theoretically relevant variables were investigated as to whether they moderated this relation within 2 samples (n = 304, n = 373) of college women. As anticipated, body surveillance, neuroticism, and having a family member and friend with an eating disorder intensified the primary body dissatisfaction-eating disorder symptomatology relation. Contrary to hypotheses, social insecurity and appearance control beliefs did not moderate this relation, and poor impulse regulation weakened the relation between body dissatisfaction and 1 component of eating disorder symptomatology (i.e., drive for thinness).

The Relation Between Body Dissatisfaction and Eating Disorder Symptomatology: An Analysis of Moderating Variables

On the basis of predictions from social comparison theory (L. Festinger, 1954) and informed by findings from the social comparison and eating disorder literatures, hypotheses were tested regarding the social comparison behaviors of women with eating disorder symptoms and their asymptomatic peers. Re

Rochelle I. Frank

Papers

Body dissatisfaction and eating-related problems on the college campus: Usefulness of the Eating Disorder Inventory with a nonclinical population