|College Women at Risk for Eating Disorder May Benefit From
A long-term, large-scale study has found that an Internet-based intervention
program may prevent some high risk, college-age women from developing an eating
The study, funded by the National Institutes of Health’s (NIH) National Institute
of Mental Health (NIMH), was published in the August 2006 issue of the Archives
of General Psychiatry.
The researchers conducted a randomized, controlled trial of 480 college-age
women in the San Francisco Bay area and San Diego, Calif., who were identified
in preliminary interviews as being at risk for developing an eating disorder.
The trial included an eight-week, Internet-based, cognitive-behavioral intervention
program called “Student Bodies,” which had been shown to be effective in previous
small-scale short-term studies. The intervention aimed to reduce the participants’ concerns
about body weight and shape, enhance body image, promote healthy eating and weight
maintenance, and increase knowledge about the risks associated with eating disorders.
The online program included reading and other assignments such as keeping an
online body-image journal. Participants also took part in an online discussion
group, moderated by clinical psychologists. Participants were interviewed immediately
following the end of the online program, and annually for up to three years thereafter
to determine their attitudes toward their weight and shape, and measure the onset
of any eating disorders
“Eating disorders are complex and particularly difficult to treat. In fact,
they have one of the highest mortality rates among all mental disorders,” said
NIMH Director Thomas Insel, M.D. “This study shows that innovative intervention
can work, and offers hope to those trying to overcome these illnesses."
Over the course of a lifetime, about 0.5 to 3.7 percent of girls and women will
develop anorexia nervosa, and about 1.1 to 4.2 percent will develop bulimia nervosa.
About 0.5 percent of those with anorexia die each year as a result of their illness,
making it one of the top psychiatric illnesses that lead to death.
Anorexia generally is characterized by a resistance to maintaining a healthy
body weight, an intense fear of gaining weight, and other extreme behaviors that
result in severe weight loss. People with anorexia see themselves as overweight
even when they are dangerously thin. Bulimia generally is characterized by recurrent
episodes of binge eating, followed by self- induced purging behaviors. People
with bulimia often have normal weights, but like those with anorexia, they are
intensely dissatisfied with their bodies. All eating disorders involve multiple
biological, behavioral and social factors that are not well understood.
The intervention appeared to be most successful among overweight women who had
elevated body mass indexes (BMIs) of 25 or more at the start of the program.
In fact, among these women in the intervention group, none developed an eating
disorder after two years, while 11.9 percent of the women with comparable baseline
BMIs in the control group did develop an eating disorder during the same time
frame. BMI is a reliable indicator of a person’s body fat by measuring his or
her weight and height.
The program also appeared to help women in the San Francisco Bay area who had
some symptoms of an eating disorder at the start of the program, such as self-induced
vomiting; laxative, diet pill or diuretic use; or excessive exercise. Of those
in the intervention group with these characteristics, 14 percent developed an
eating disorder within two years, while 30 percent of those with these characteristics
in the control group developed an eating disorder during the same time frame.
The authors suggest that the intervention helped these high-risk women become
less concerned about their weight and shape, while also helping them understand
healthier eating and nutrition practices.
“This is the first study to show that eating disorders can be prevented among
high-risk groups,” said lead author C. Barr Taylor, M.D., of Stanford University. “The
study also provides evidence that elevated weight and shape concerns are causal
risk factors for developing an eating disorder,” he added.
The study suggests that relatively inexpensive options such as Internet-based
interventions can have lasting effects on women at high risk of developing an
eating disorder. However, the authors note that the results cannot be generalized
widely because there were differences in the women’s baseline characteristics
and treatment responses between the two sites used in the study.
Also, the rate at which the women stuck with the program was very high — nearly
80 percent of the online program’s Web pages were read — suggesting that
the participants were unusually motivated. “Women who are less motivated may
be less likely to participate in or stick with this type of long-term intervention,” added
In addition, women with restricted or no access to computers would not be able
to benefit from an online intervention program. However, the authors conclude
that such Internet-based programs may be a good first step in a diligent program
designed to screen women for potential eating disorder risks.
Additional study authors are Susan Bryson, MS, MA of Stanford University; Kristine
H. Luce, PhD of Stanford University; Darby Cunning, MA of Stanford University;
Angela Celio, PhD of the University of Chicago; Liana B. Abascal, MA of San Diego
State University; Roxanne Rockwell of San Diego State University; Pavarti Dev,
PhD of Stanford University; Andrew J. Winzelberg, PhD of Stanford University;
and Denise E. Wilfley, PhD of Washington University Medical Center.
The National Institute of Mental Health (NIMH) mission is to reduce the burden
of mental and behavioral disorders through research on mind, brain, and behavior.
More information is available at the NIMH website, http://www.nimh.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research
Agency — includes 27 Institutes and Centers and is a component of
the U.S. Department of Health and Human Services. It is the primary federal
agency for conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments, and cures for both common
and rare diseases. For more information about NIH and its programs, visit www.nih.gov.