Eating disorder symptoms among undergraduate and graduate students at 12 U.S. colleges and universities

Stress, hardiness and eating disorder symptoms in military academy cadets

Eating disorders are a persistent and debilitating problem, especially among college age men and women. This problem is exacerbated in occupations such as the military, where maintenance of strict standards regarding weight, fitness and appearance is important for job retention and promotion. Also, previous research confirms that stress is a contributing element to eating disorders. It is thus important to identify factors that may assist individuals to remain resilient and avoid stress-related health and eating difficulties. The present study utilizes historical data to examine the impact of stress on health and eating disorder symptoms in a representative sample of West Point military academy cadets, while testing the role of gender and hardiness as stress moderators in this relation. A survey containing measures of stress, hardiness and eating disorders symptoms was completed by 387 cadets in the fall and spring of 2000-2001. Moderation effects were tested with advanced conditional process analysis procedures developed recently by Hayes (2022). Results show that hardiness was a significant moderator, with cadets low in hardiness showing increased eating disorder symptoms and more general health symptoms. While gender was not a significant moderator with respect to eating disorder symptoms, it was significant for general health symptoms; female cadets showed more stress-related health symptoms than their male counterparts. These results suggest that eating disorder symptoms in military academy cadets and college students more generally may be reduced through programs aimed at developing hardiness attitudes and stress coping approaches.

Testing Theory-Based Expressive Writing Interventions to Reduce Disordered Eating Behaviors and Cognitions

Disordered eating includes both behaviors and cognitions and can cause many of the same negative health outcomes as clinically diagnosed eating disorders (e.g., growth retardation, nutritional deficiencies, and psychosocial disturbances). Compared to the general population, disordered eating is more common in college-age women. An experiment was conducted to test 8 expressive writing interventions in the context of disordered eating. Interventions were drawn from theory-based prevention programs, which included cognitive behavioral therapy, peer and media risk reduction, and cognitive dissonance theory. Dependent variables included emotions (e.g., sadness and hope), evaluation of the expressive writing interventions (e.g., engagement, clarity, ease, and interest), and re-evaluation of disordered eating behaviors and cognitions. Results show that 62.90% of participants had observed disordered eating in their peers. Sadness, with an action tendency related to increased inward evaluation, was the most typical emotional response upon completion of the expressive writing tasks. Interventions that were based on the principles of cognitive behavioral therapy led to the most positive outcomes including engagement and re-evaluation of current disordered eating behaviors and cognitions. Overall, it was concluded that expressive writing interventions are effective in eliciting emotions and causing a re-evaluation of harmful behaviors and cognitions in the context of disordered eating.

The relationships among food neophobia, mediterranean diet adherence, and eating disorder risk among university students: a cross-sectional study

BACKGROUND

Food neophobia, characterized by the fear of unfamiliar foods, can be influenced by environmental, cultural, and genetic factors, leading to decreased consumption of novel or diverse foods. Understanding the impact of Mediterranean diet adherence and eating disorders on dietary behaviors is crucial, particularly for young adults who are developing lifelong eating patterns.

METHODS

The aim of this study was to investigate the relationships among food neophobia, Mediterranean diet adherence, and eating disorders in university students aged 18-24 years. A cross-sectional study was conducted with 1277 students (67.2% female) via an online questionnaire to assess sociodemographic characteristics, food neophobia (Food Neophobia Scale, FNS), Mediterranean diet adherence (KIDMED), and eating disorder risk (Eating Disorder Examination Questionnaire, EDE-Q).

RESULTS

Most participants (67.7%) had a normal body mass index (BMI), 19.3% were classified as overweight, and 3.7% were classified as obese. Compared with male students, female students had significantly higher FNS scores (40.8 ± 9.21) (38.5 ± 10.97, p < 0.05), indicating greater food neophobia among women. Similarly, men's EDE-Q scores (3.5 ± 3.32) were significantly lower than those of women (4.4 ± 4.05, p < 0.05). Most participants (69.5%) did not experience food neophobia, and underweight individuals (11.0%) were more neophobic than obese individuals (4.4%). No significant differences were observed according to BMI (p > 0.05). A positive correlation was found between age and KIDMED adherence, whereas a negative correlation was observed between BMI and EDE-Q scores regarding food neophobia. The effects of BMI on food neophobia and the risk of eating disorders were found to vary by sex.

CONCLUSIONS

These findings suggest that food neophobia may harm Mediterranean diet adherence and increase the risk of eating disorders among university students. Targeted interventions addressing food neophobia could promote healthier eating habits, such as the Mediterranean diet, thereby reducing disordered eating behaviors and associated risks. Further research is needed to confirm these findings, improve population nutritional habits and mental health outcomes, and develop effective public health strategies.

The role of negative evaluation fears on associations between societal appearance pressures and disordered eating in university students

Objective: Previous research demonstrates that sociocultural appearance pressures and internalization of appearance ideals lead to disordered eating (DE); however, only a subset of individuals exposed to these influences develop clinically significant DE. Identifying moderators of these associations may increase efficacy of targeted preventions for eating disorders. This study investigated whether the fear of negative evaluation (FNE) moderates these associations. Participants: 567 university students participated between November 2019 and 2020. Methods: Participants completed self-report questionnaires assessing appearance pressures, internalization of appearance ideals, FNE, and DE. Results: There was a significant interaction between appearance pressures and FNE in relation to DE. Individuals with high appearance pressures and high FNE had the highest levels of DE. The interaction between internalization of appearance ideals and FNE did not significantly contribute to DE. Conclusions: Eating disorder prevention programs that address FNE and appearance pressures may have beneficial effects, particularly for university students with heightened FNE.

Alcohol use disorder, cannabis use disorder, and eating disorder symptoms among male and female college students

BACKGROUND AND OBJECTIVES

Eating disorders (EDs) and substance use disorders are prevalent among college students in the United States, with underlying common mechanisms suggesting co-occurrence of these in the student population. As treatment prognosis of EDs improves when they are identified and treated with early intervention, it is essential to understand which substance use behaviors associate with EDs in students.

METHODS

Using a sample of 471 college students recruited for a study on high risk drinking (i.e., students needed to pregame regularly to be included), we explored the associations between ED symptomatology and two common substances used in this population: alcohol and cannabis. As most research on EDs focuses on female students only or does not separate out males and females, we examined whether sex assigned at birth moderated the association between ED symptomatology and substance use outcomes.

RESULTS

About one-third (32.4%) of the sample screened positive for an ED, with females significantly more likely to screen positive. Males were significantly more likely to screen positive for an alcohol or cannabis use disorder. Screening positive for an ED associated with cannabis use frequency and cannabis use disorder symptoms, but not with alcohol outcomes. Sex moderated the association between ED and cannabis use disorder symptoms, with positive ED screen male students experiencing the highest cannabis use disorder symptoms.

DISCUSSION AND CONCLUSIONS

It is necessary to further assess how sex differences in substance use and ED symptomatology inform each other.

SCIENTIFIC SIGNIFICANCE

Findings underscore the need to assess and screen for cannabis use disorder among students who screen positive for an ED, and, more specifically, with focused attention on male students with ED symptoms.

Cognitive restraint and body dissatisfaction are more strongly related to muscle building behaviors for men than women

Muscle building behaviors are an understudied eating disorder (ED) symptom increasing in prevalence, especially among men. However, little is known about the cognitive ED correlates that may underlie muscle building behaviors and whether these associations differ by gender. We examined associations between cognitive ED symptoms and muscle building behaviors, and whether these associations differ between men and women. In a sample of college students (N = 258), we investigated cross-sectional associations between two core cognitive ED symptoms, body dissatisfaction and cognitive restraint, with muscle building behaviors, and whether binary gender moderated these associations. Data were analyzed using two linear regression models in which muscle building behaviors was entered as the outcome variable. In Model 1, body dissatisfaction, BMI, gender, and the interaction term of body dissatisfaction by gender were entered as predictors. In Model 2, cognitive restraint, BMI, gender, and the interaction term of cognitive restraint by gender were entered as predictors. Results of Model 1 indicated that muscle building behaviors were significantly and independently associated with body dissatisfaction and gender and the association between muscle building and body dissatisfaction was stronger for men. Results of Model 2 indicated that muscle building behaviors were significantly and independently associated with cognitive restraint and gender and the association between muscle building and cognitive restraint was stronger for men. Findings suggest that cognitive restraint and body dissatisfaction may be important prevention and intervention targets for maladaptive muscle building behaviors, particularly among men.

The moderating effect of weight loss intentions on dynamic associations between weight suppression and disordered eating

OBJECTIVE

Weight suppression refers to the difference between one's current and highest previous weight in adulthood and has been associated with development of eating pathology. Previous research has been agnostic as to whether reported weight suppression reflects deliberate weight control behavior, and few studies have assessed whether weight loss that occurs unintentionally (e.g., due to illness) is longitudinally associated with eating pathology.

METHOD

Undergraduates at a Canadian university (N = 661; 81.4 % female) completed three online surveys over six months. Longitudinal multilevel models examined the interaction of within-person fluctuations in weight suppression and between-person differences in weight loss intentions on binge eating, dietary restriction, and body dissatisfaction.

RESULTS

Of participants who reported weight suppression at baseline, 47.6 % indicated that their weight loss was unintentional. Compared to participants endorsing unintentional weight suppression, participants endorsing intentional weight suppression showed greater body dissatisfaction and binge eating across the assessment period (β = 3.64, p ≤ .001 and β = 2.32, p ≤ .001). Significant within-person effects were found only for restriction, indicating that when individuals reported greater weight suppression, they also reported more restrictive eating (β = 0.89, p = .004). Contrary to hypotheses, associations between within-person fluctuations in weight suppression and disordered eating outcomes did not differ by weight loss intentions.

DISCUSSION

Findings suggest that whether weight suppression is intentional may influence mean levels of disordered eating but may have limited influence on within-person fluctuations in weight suppression and disordered eating severity in a non-clinical sample.

The Association of Intake of Omega-3-Fatty Acid Sources with Psychological Distress and Binge Eating Disorder Among Female College Students in Saudi Arabia

University students are often exposed to various stressors related to academic demands, which increases their susceptibility to psychological distress. Intake of omega-3 fatty acid (N-3 FA) has been found to be negatively correlated with both depression and eating disorder symptoms in non-Saudi individuals. The objective of this study was to evaluate the following among female undergraduate students in Jeddah, Saudi Arabia: (1) prevalence of psychological distress and binge eating disorder (BED); (2) Association between intake of N-3 FA sources and psychological distress; (3) Association between intake of N-3 FA sources and BED. This is a cross-sectional study including 149 female students enrolled in King Abdulaziz University. Participants completed an online questionnaire consisting of previously validated questions that evaluate psychological distress (Kessler 10), BED (Eating Disorders Diagnostic Scale), and N-3 FA intake. Descriptive statistics and logistic regression analysis were performed to analyze the data. The prevalence of mild, moderate, and severe psychological distress was 21.5%, 28.9%, and 28.20%, respectively. The prevalence of BED was 3.40%. Participants who consumed fish at least once per week for 6 months had significantly lower odds of moderate or severe psychological distress (odds ratio (OR): 0.34, 95% confidence interval (CI): 0.13, 0.86, P-value: .02). We did not detect significant associations between intake of N-3 FA sources and BED. Prevalence of psychological distress was higher what has been previously reported in other studies. However, prevalence of BED in our Saudi sample was lower than what has been previously found in other samples. Intake of N-3 FA from fish sources might be associated with lower odds of psychological distress but not with BED. Future studies are needed in order to further establish the need for developing educational programs to enhance N-3 FA intake for promoting mental wellbeing particularly among female young adults.

Gender Differences in Dietary Patterns and Eating Behaviours in Individuals with Obesity

BACKGROUND/OBJECTIVES

Obesity is a global health problem with significant chronic disease risks. This study examined gender differences in eating behaviour, body composition, eating frequency and time of hunger in an Italian cohort with obesity (BMI ≥ 30) to inform gender-specific management strategies.

METHODS

A retrospective analysis of 720 adults (51.5% female, mean age 44.4 ± 13.8 years) assessed body composition and eating behaviour using principal component analysis (PCA) to classify eating profiles (structured, irregular, social and disordered/impulsive eaters).

RESULTS

Males showed higher weight, abdominal circumference and fat mass, while females showed higher fat mass percentages (p < 0.001). Gender differences were observed in the frequency of meals (e.g., 54.7% of males and 64.7% of females consumed 4-5 meals per day, p = 0.0018) and the time of hunger (males: before dinner; females: morning hunger, p = 0.005). The PCA profiles revealed that the 'structured eaters' had a healthier body composition, whereas the 'disordered/impulsive eaters' had a higher fat mass. Irregular eaters were predominantly male (41.0%), while disordered eaters were predominantly female (39.9%) (p = 0.0016).

CONCLUSIONS

Gender-specific eating patterns influence obesity outcomes. Structured eating was associated with healthier profiles, whereas impulsive or irregular patterns were related to higher fat mass. The retrospective design and non-validated questionnaire for dietary behaviour assessment limit generalisability, warranting further research for tailored interventions.

REGISTRATION

ClinicalTrials.gov (NCT06654674).

Negative Affect as a Mediator Between Exposure to Fitspiration and Thinspiration and Disordered Eating Behaviors: An Ecological Momentary Assessment Study

OBJECTIVE

Although social media use, such as Instagram, has been associated with ED pathology, mechanisms connecting social media use to disordered eating behaviors (DEBs) remain largely unevaluated. Based on Dual Process, Tripartite, and Affect Regulation models of ED pathology, we proposed a moderated mediation model evaluating impacts of exposure to fitspiration/thinspiration on Instagram.

METHOD

We evaluated a hypothesized pathway from exposure to fitspiration/thinspiration (i.e., ED-salient content) on Instagram to disordered eating mediated by negative affect and tested individual differences in weight bias internalization, trait self-esteem, and trait self-comparison as moderators. We recruited 173 undergraduate women who reported engaging in DEBs on average at least once per week over the past 3 months. Participants completed a seven-day ecological momentary assessment protocol, during which they reported their ED-salient content exposure on Instagram, affect, and engagement in DEBs.

RESULTS

Multilevel modeling was used to assess moderated mediation. Negative affect partially mediated associations between viewing ED-salient content and subsequent engagement in objective binge eating and restricting but did not mediate the pathway to purging or excessive exercise. Higher weight bias internalization intensified the association between viewing ED-salient content and negative affect.

DISCUSSION

The association between viewing ED-salient content and engaging in objective binge eating and restricting may be a partial consequence of elevated negative affect; however, effects were small. Individuals with higher weight bias internalization may be more vulnerable to negative consequences from viewing ED-salient content. Findings suggested that reducing negative affect responses (e.g., via emotion regulation) could reduce negative consequences of viewing ED-salient content.

The future of the eating disorder field: Inclusive, aware of systems, and personalized

Eating disorders are serious psychiatric illnesses associated with large amounts of suffering, high morbidity, and high mortality rates, signifying a clear need for rapid advancements in the underlying science. Relative to other fields of clinical psychological science, the eating disorder field is new. However, despite the fields' late beginnings, there is growing science in several important areas. The current paper discusses the current literature in three primary areas of importance: (a) diversity and inclusion, (b) systemic and social factors, and (c) treatment personalization. We discuss how these areas have huge potential to push both eating disorder and clinical psychological science in general forward, to improve our underlying understanding of psychological illness, and to enhance treatment access and effectiveness. We call for more research in these areas and end with our vision for the field for the next decade, including areas in need of significant future research.

Examination of Energy Needs and Low Energy Availability Among Historically Black College and University Female Student-Athletes

Low energy availability (LEA) is common among female student-athletes and contributes to reduced bone mineral density and hormonal dysfunction. However, limited research exists on student-athletes of color, making it difficult to generalize results across populations, particularly Historically Black Colleges and Universities (HBCUs) student-athletes.

OBJECTIVES

This study examined the energy needs and LEA prevalence, with or without eating disorder (ED) risk, among HBCU female student-athletes.

METHODS

Twenty-seven female student-athletes (age = 19 ± 1 year; height = 166.9 ± 7.6 cm; weight = 68.8 ± 11.3 kg) completed baseline measures, including the Eating Disorder Inventory-3 (EDI-3), EDI-3 symptom checklist (EDI-SC), anthropometric measures, and resting metabolic rate (RMR). Participants maintained a dietary log to measure energy intake and wore a heart rate monitor to estimate exercise energy expenditures for 7 days. LEA was defined as <30 kcal/kg of fat-free mass (FFM)/day.

RESULTS

The mean energy availability (15.9 ± 10.1 kcal/kg FFM/day) indicated 92.6% of participants (n = 25) displayed LEA; of those, 60% (n = 15) had LEA with ED risk. ED risk was identified in 59.3% of student-athletes (n = 13; EDI-3: n = 2; SC: n = 3; Both: n = 11). Interestingly, of the two student-athletes without LEA, one was identified at risk for EDs using both the EDI-3 and SC.

CONCLUSIONS

HBCU female student-athletes face high risks of LEA and EDs, with most showing signs of both. This underscores the need for culturally sensitive interventions to improve EA and support mental health in this underserved group. Clinicians should focus on nutrition education and early ED identification to enhance long-term health and athletic performance.

Core psychopathology underlying disordered eating behaviors and nonsuicidal self-injury in university students: a network analysis

OBJECTIVE

Disordered eating behaviors (DEBs) and nonsuicidal self-injury (NSSI) frequently co-occur in university students, yet what underlies this co-occurrence remains unknown. Network analysis was used to identify psychosocial correlates that may link DEBs and NSSI in university students and test whether networks were similar across gender.

PARTICIPANTS

Four hundred and seventy college women and 473 college men (aged 18-25 years).

METHODS

Participants completed online questionnaires. Networks were estimated for men, women, and a combined sample.

RESULTS

The networks for men and women were invariant. The most central nodes in the combined network were difficulties in emotion regulation and body dissatisfaction. Interoception and difficulties in emotion regulation were directly associated with past-month NSSI and strongly associated with body dissatisfaction, linking DEBs and NSSI in the network.

CONCLUSIONS

Difficulties in emotion regulation, interoception, and body dissatisfaction may play critical roles in the comorbidity of DEBs and NSSI in university students.

The role of body weight in college students' perceptions of anorexia nervosa and atypical anorexia nervosa

Objective: The present experimental study assessed college students' ability to recognize an eating disorder across various body weights. Participants: Undergraduate students (N = 428) from a midsized public university. Methods: Participants completed an online questionnaire and were randomized to read one of four vignettes describing a woman with anorexia nervosa symptoms who was underweight, average weight, overweight, or obese. Participants completed a survey to assess body image, eating concerns, and ability to recognize an eating disorder. Results: Results showed participants in the underweight condition were significantly more likely to correctly identify an eating disorder (adjusted residual = 2.5) and showed fewer incorrect identifications than would be expected (adjusted residual = -2.5). In the underweight condition, 83.78% correctly recognized an eating disorder, followed by average weight (76.84%), obesity (69.16%), and overweight (68.89%). Conclusions: College students may have a harder time recognizing an eating disorder in someone with a higher body weight.

The need for more inclusive measurement to advance equity in eating disorders prevention

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

Relationship between college lifestyle variables, eating disorder education, and eating disorder risk

Objective: This study examined relationships between eating disorder risk (EDR), lifestyle variables (e.g., exposure to healthy eating media), and differences among male and female college students. Participants: College students (N = 323) completed survey questionnaires (Fall, 2016). Fifty-three participants retook the survey at a later time. Methods: Participants completed a survey measuring EDR using EDI-3 subscales and 10 college lifestyle variables. Female and male EDR and Time 1 and Time 2 EDR were compared. Relationships between EDR and college life-style variables were examined. Results: Exercise, fewer daily meals, less face-to-face interactions, more digital interactions, less exposure to healthy eating media, and having conversations about body image were associated with EDR risk. Male college students showed an increase in EDR over time. Conclusions: Several lifestyle factors predicted EDR in college females and males. These lifestyle factors are modifiable and may be addressed by colleges during orientation and within the campus environment.

Momentary fluctuations in emotional intelligence and stress predict changes in disordered eating

Objective: Low emotional intelligence and symptoms of disordered eating are connected, however, whether daily fluctuations in emotional intelligence predict daily changes in disordered eating symptoms has not been examined, nor has stress been explored as a potential moderator of this relationship. Participants: Participants were undergraduate students (n = 100). Methods: Participants completed baseline questionnaires, then responded to random ecological momentary assessment prompts 3 times daily for 2 weeks. Results: Results indicated that when individuals had higher momentary emotional intelligence, they had lower disordered eating at the same time point (within subjects estimate = -0.30, p < .001) and following time point (within subjects estimate = -0.08, p = 0.03). Momentary stress moderated the relationship between baseline emotional intelligence and momentary disordered eating (b = -0.02, p < .01). Conclusions: Changes in emotional intelligence predict day-to-day changes in disordered eating, and stress moderates the connection between emotional intelligence and disordered eating.

A snapshot of eating behaviors in undergraduate college students living in South Florida

Objective: To examine a) whether college students' eating behaviors are different by students' sex and/or body mass index (BMI) categories and b) the correlations between college students' eating behaviors and the degree to which they rely on internal bodily signals for food intake. Participants: Undergraduate college students 18-24 years old at a public university located in South Florida. Methods: Eligible students answered questionnaires to examine interoception, intuitive eating, and eating behaviors including emotional eating, restrained eating, cognitive restraint, external eating, and uncontrolled eating. Pearson correlation and independent t test were used (significance: p < 0.05). Results: Females reported lower interoception, intuitive eating, and higher emotional eating than males. Students with lower BMI had higher intuitive eating and lower restrained eating. Interoception was positively correlated with intuitive eating and negatively correlated with emotional, uncontrolled, restrained, and external eating. Conclusion: College students who have a better connection with their bodily signals have healthier eating behaviors and lower BMI.

Addressing the gap of early intervention for eating disorders in primary health care

AIM

Only one in four individuals with eating disorders (EDs) seek help, with many barriers to treatment-seeking present. Placing an early intervention model in primary mental health care settings is one approach to reducing these barriers. To date, only one model (emerge-ED) has been evaluated in the literature.

METHODS

We aimed to replicate findings from the initial emerge-ED evaluation. We report on treatment outcomes in a new cohort and their views on barriers to treatment-seeking. We then examine how this early intervention model in primary health care has evolved to overcome the barriers to treatment delivery cited by health professionals in the initial evaluation.

RESULTS

Eighty participants commenced treatment between July 2020 and March 2022 and completed a mean of 8.98 sessions, 70 (87.5%) completed >1 sessional measure on ED cognitions and behaviours, but only 31% (n = 24) completed lengthier assessments. Findings replicated initial emerge-ED outcomes, with small to moderate effect size decreases in the ED sessional measure at 70 days since treatment commencement for cognitions (d = .63) and ED behaviours (d = .09., .69). The most cited barrier by participants was "belief that my problem is not bad enough", reflective of denial of illness. Lastly, to overcome barriers to treatment delivery clinicians had to deviate from treatment protocols and work collaboratively with other healthcare providers.

CONCLUSIONS

Our findings replicated the initial emerge-ED evaluation and highlight the importance of considering primary health care settings as an essential site in delivering early intervention services for EDs.

Eating Behaviors Associated With Suicidal Behaviors and Overall Risk

OBJECTIVE

Maladaptive eating behaviors remain prevalent in the US population, and a significant percentage of US college students acknowledge engaging in maladaptive eating. Formally defined eating disorders (EDs) have one of the highest mortality rates among all mental illnesses. Suicide risk is substantially elevated among individuals diagnosed with EDs, and even subclinical levels of maladaptive eating behaviors are associated with suicidality. The current study examined associations between specific problematic eating behaviors measured dimensionally (eg, purging, binging, laxative use) and specific suicide-related constructs and behaviors as well as overall suicide risk.

METHODS

College students (N=188; 62% women) completed the Eating Disorder Examination-Questionnaire, a well-established measure of dysfunctional eating, as well as several self-report measures of theoretical components of suicidality, and, finally, a semistructured clinical interview to specify suicide risk category.

RESULTS

Results showed a general pattern of moderate and strong associations between the subscales and the overall score of the Eating Disorder Examination-Questionnaire and core suicide constructs of the interpersonal-psychological theory of suicide. Many substantive correlations were found between specific eating behaviors and specific suicide-related behaviors; for example, purging was the highest correlate of overall suicide risk (ρ=0.36).

DISCUSSION

These results are discussed in terms of consistency with the interpersonal-psychological theory of suicide as well as practical implications for intervention.

Deciphering Blood Flow Restriction Training to Aid Lipid Lowering in Obese College Students through Untargeted Metabolomics

(1) Objective: The aim of this study was to observe the lipid-lowering effects of blood flow restriction training (BFR) combined with moderate-intensity continuous training (MICT) in obese college students by observing lipid-lowering hormones and untargeted metabolomics. (2) Methods: In this study, 14 obese college students were convened into three groups-MICT, MICT+BFR, and high-intensity interval training (HIIT)-for a crossover experiment. Blood was drawn before and after exercise for the analysis of lipolytic agents and untargeted metabolomics. The study used a paired t-test and ANOVA for statistical analyses. (3) Results: The lipolytic agent results showed that MICT+BFR was superior to the other two groups in terms of two agents (p = 0.000 and p = 0.003), namely, GH and IL-6 (difference between before and after testing: 10,986.51 ± 5601.84 and 2.42 ± 2.49, respectively), and HIIT was superior to the other two groups in terms of one agent (p = 0.000), i.e., EPI (22.81 ± 16.12). No advantage was observed for MICT. The metabolomics results showed that, compared to MICT, MICT+BFR was associated with the upregulated expression of xanthine, succinate, lactate, N-lactoylphenylalanine, citrate, ureido acid, and myristic acid after exercise, with the possibility of the involvement of the citric acid cycle, alanine, aspartic acid, glutamate metabolism, butyric acid metabolism, and the histidylate metabolism pathway. (4) Conclusions: The superior lipid-lowering effect of MICT+BFR over MICT in a group of obese college students may be due to the stronger activation of GH and IL-6 agents, with the citric acid cycle and alanine, aspartate, and glutamate metabolic pathways being associated with this type of exercise.

A pilot study evaluating online training for therapist delivery of interpersonal psychotherapy for eating disorders

OBJECTIVE

Individuals with eating disorders (EDs) often do not receive evidence-based care, such as interpersonal psychotherapy (IPT), partly due to lack of accessible training in these treatments. The standard method of training (i.e., in-person workshops) is expensive and time consuming, prompting a need for more scalable training tools. The primary aim of this pilot and open trial was to examine the effects of an IPT online training platform on training outcomes (i.e., IPT fidelity, knowledge, and acceptance) and, secondarily, whether online training was different from in-person training (using a comparative sample from a separate study) in terms of training outcomes and patient symptoms.

METHOD

Participants were therapists (N = 60) and student patients (N = 42) at 38 college counseling centers. Therapists completed baseline questionnaires and collected data from a student patient with ED symptoms. Therapists then participated in an IPT online training program and completed post-training assessments.

RESULTS

Following online training, acceptance of evidence-based treatments, therapist knowledge of IPT, therapist acceptance of IPT, and treatment fidelity increased; acceptance of online training was high at baseline and remained stable after training. Using the 90% confidence interval on outcome effect sizes, results suggested IPT online training was not different from in-person training on most outcomes. Results are based on 60% of therapists who originally enrolled due to high dropout rate of therapist participants.

CONCLUSIONS

Findings from this preliminary pilot study support the use of IPT online training, which could increase access to evidence-based ED treatment and improve patient care.

PUBLIC SIGNIFICANCE

Lack of accessible therapist training has contributed to many therapists not delivering, and therefore many patients not receiving, evidence-based treatment. This study evaluated a highly disseminable online training and compared outcomes to traditional in-person training and found that training and patient outcomes were not different. Online training has the potential to enhance access to evidence-base care, which could in turn optimize patient outcomes.

'I've learned a lot about myself this year': Young student women's perceptions of their cumulative use of digital fitness technologies across the Covid-19 pandemic

Many young women turned to digital fitness technologies (DFT) to support their health and wellbeing during the covid-19 pandemic. The present study explores young student women's retrospective perceptions of their cumulative engagement with DFT, across periods of restriction and easing (March 2020-2021). Seventeen UK-based women (Age M = 20.29, SD = 1.72); Ethnicity White = 94.12% participated in one-on-one interviews using an adapted scroll-back technique. Data was analysed using narrative-informed reflexive thematic analysis. Three themes were developed: My lockdown #fitnesstransformation: DFT as information and inspiration, My unrealistic expectations: DFT as a source of comparison and concern and My new body positive and resilient self: DFT as a catalyst to self-development. Themes highlight how perceptions of DFT changed over time as a consequence of repeat engagement, sociocultural context and psychological meaning-making. Crucially, findings underscore the importance of examining the collective and cumulative effects of DFT engagement on health and wellbeing, both positive and negative.

Food approach and avoidance craving: A partial test of the Ambivalence Model of Craving

Accumulating evidence from both cross-sectional and cue-reactivity studies supports the application of the Ambivalence Model of Craving (AMC) from the substance use literature to food craving. The focus of this extant work has been on the association between the two dimensions of food craving (approach and avoidance) and disordered eating behaviors. The present study extended existing validity data by investigating approach and avoidance food craving profiles and their associations with 1) disordered eating behaviors and 2) thinness/restriction and eating expectancies - a risk factor for disordered eating that is explicitly described by the AMC. It was anticipated that food craving profiles would parallel those defined by the AMC (i.e., approach oriented, avoidance oriented, ambivalent, indifferent) and that profiles defined by high avoidance food craving would be higher in compensatory behaviors, restricting behaviors, and thinness/restriction expectancies, while those defined by high approach food craving would be higher in binge eating and eating expectancies. A sample of 407 undergraduate students (54% female, 47% non-Hispanic White; Mage = 21 years) reported demographics, food craving disordered eating behaviors, and thinness/restriction and eating expectancies via an anonymous online survey. Latent profile analysis was used to test hypotheses. Hypotheses were partially supported. Four profiles were identified, but similar levels of approach and avoidance food craving were observed in each profile, with the intensity of the cravings increasing across the four profiles. Endorsement of disordered eating behaviors and expectancies also increased in intensity across the profiles. Findings suggest an additive, rather than interactive, effect of food craving.

Using item response theory to identify key symptoms of insomnia in a sample of university students with probable eating disorders

PURPOSE

Researchers have theorized that interactions between appetitive and circadian disruptions result in increased eating disorder (ED) symptoms and insomnia. However, it is unclear how specific insomnia symptoms present among people with EDs and if the latent structure of insomnia in this population is similar to that of people with insomnia disorder.

METHODS

We conducted a secondary analysis of data collected on ED and insomnia symptoms using a subset of students (N = 547; 79.52% female) with probable EDs at a large Midwestern American university. Item response theory (IRT) for polytomous items was performed to identify item difficulty, discrimination, and information parameters for the Insomnia Severity Index (ISI). IRT parameters were compared to those established in a 2011 study of people diagnosed with insomnia disorder by Morin and colleagues.

RESULTS

Clinically significant insomnia symptoms were common among students with ED pathology and symptom endorsement for each ISI item ranged from 40.77 to 86.65%. ISI items assessing insomnia-related impairment and distress showed better discriminative capacities and had higher item information than items assessing sleep behavior alterations (i.e., difficulties falling asleep, difficulties maintaining sleep, waking too early). Item discrimination was largely similar among the ED sample compared to previous IRT analyses in an insomnia disorder sample.

CONCLUSION

Insomnia symptoms are common among university students with probable EDs and similar to those reported by people with insomnia disorder. When considering insomnia assessment, items assessing sleep behaviors alone are likely inadequate to provide information about insomnia severity among people with EDs.

LEVEL V

Evidence obtained from a cross-sectional descriptive study.

Additional Validation of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) Eating Concerns Scale

Maladaptive eating behaviors are typically associated with significant impairment in psychological functioning more broadly. The Minnesota Multiphasic Personality Inventory (MMPI) family of instruments has traditionally been the most frequently used psychological assessment of psychopathology by clinical psychologists. The most recent version, the MMPI-3, features a new Eating Concerns (EAT) scale that screens for the presence of problematic eating behaviors. The goals of the current study were (a) to independently replicate validity correlations reported from the college sample during EAT scale development, (b) to evaluate the utility of EAT scale item-level correlations with other substantive MMPI-3 scales, and (c) to evaluate the ability of the EAT items to predict specific frequency counts of dysfunctional eating behaviors. The current study examined the MMPI-3 assessment of dysfunctional eating behaviors among 188 undergraduate participants. Results indicated that the EAT scale is meaningfully associated with core symptom dimensions of maladaptive eating, including binging, vomiting, restricting, and concerns about weight and shape. In addition, this study identified meaningfully distinct patterns of correlations with personality and psychopathology constructs, and specific behavioral frequencies, across the five individual EAT scale items. These results contribute to the enhanced utility of this important screening scale in clinical settings.

Insecure attachment and eating disorder symptoms: Intolerance of uncertainty and emotion regulation as mediators

OBJECTIVE

Literature on eating disorder (ED) symptoms of Black, Indigenous, and People of Color (BIPOC) group is extremely scarce. This study aimed to understand the mechanisms underlying the associations between insecure attachment and ED symptoms and examine whether these mechanisms differed between White and BIPOC groups.

METHOD

The study investigated direct and indirect relationship between attachment anxiety/avoidance and ED symptoms via intolerance of uncertainty (IU) and emotion regulation strategies of suppression and reappraisal. Further, we examined whether the proposed mechanisms equally represented White versus BIPOC using Multigroup Structural Equation Model (MG-SEM). A total of 1227 college students (48.50% BIPOC and 51.50% White) completed research questionnaires.

RESULTS

Results showed that IU and suppression mediated the relations between insecure attachment and ED symptoms for both White and BIPOC groups. Uniquely, reappraisal mediated the relations between insecure attachment and ED symptoms for the White group, but not for the BIPOC group.

DISCUSSION

The implications of the findings for culturally informed practice are discussed, including targeting increasing tolerability of uncertainties and improving emotion regulation to mitigate ED symptoms for those with insecure attachment.

Reciprocal relations between body dissatisfaction and excessive exercise in college women

Objective: Body dissatisfaction elevates the risk for disordered eating behaviors. Excessive exercise is prevalent among college women and associated with harm. Risk theory posits a bidirectional relationship between risk factors for disordered eating behaviors and the behaviors themselves. This study investigated the longitudinal, reciprocal relationship between body dissatisfaction and excessive exercise.

Participants and methods: College women (n = 302) assessed in August (baseline) and November (follow-up).

Results: Baseline body dissatisfaction significantly predicted increases in excessive exercise endorsement at follow-up, controlling for baseline excessive exercise endorsement and body mass index (BMI). Baseline excessive exercise endorsement predicted increases in body dissatisfaction at follow-up, controlling for baseline body dissatisfaction and BMI.

Conclusions: Findings support the presence of a positive feedback loop between body dissatisfaction and excessive exercise; both predict increases in risk for the other, regardless of weight status. Future research should test whether this process is ongoing and predicts further distress.

Obesity in Saudi Medical Students and Alignment with Eating Disorders: A Stratified Random Cross-Sectional Investigation

As a result of the increasing global incidence of obesity and related diseases, this study aims to investigate the prevalence of obesity and its correlation with eating disorder (ED) screening among medical students to develop effective prevention strategies and provide better outcomes for these students. We conducted a quantitative analytical cross-sectional study at the College of Medicine at King Saud University between November 2023 and February 2024. A stratified random sampling technique was utilized, enrolling a net number of 415 participants. Participants were asked several questions, including demographic information, weight, height, and past medical history, and were given a validated screening tool for EDs. Participants' mean age was 21.4 ± 1.67 years, and 17.6% were considered obese. The prevalence of positive screening for EDs was 27.7%; it was more common in females (p = 0.013) and those who earned more than 1000 SAR per month (p = 0.011). Female students also exhibited almost twice the odds of having EDs than males (AOR = 1.957; 95% CI = 1.218-3.146; p = 0.006). Furthermore, non-obese students showed decreased odds of having EDs compared with obese students by at least 48% (AOR = 0.517; 95% CI = 0.287-0.929; p = 0.027). Our study revealed a concerning prevalence of ED symptoms and obesity among medical students, suggesting profound implications. Therefore, multicenter studies are needed to assess the generalizability of the results and apply the findings to targeted national campaigns and interventions tailored specifically to medical students.

"If You Don't Eat, You Can Get Drunk Faster": A Qualitative Investigation of Food and Alcohol Disturbance (FAD) Expectancies

Background: Food and alcohol disturbance (FAD; i.e., use of any compensatory behavior within the context of a drinking episode to offset alcohol-related calories and/or enhance the effects of alcohol) is prevalent among U.S. college students and associated with negative consequences. Expectancies for anticipated outcomes of alcohol use and thinness/restriction behaviors, which comprise FAD, serve as promising targets of intervention for these behaviors individually; however, no study to date has identified or examined FAD expectancies, specifically. Objectives: The purpose of this study was to qualitatively examine the positive and negative FAD expectancies described by students experienced with FAD. Methods: Semi-structured open-ended interviews were conducted with 22 undergraduates with a lifetime history of FAD behavior (72.7% female, 77.3% white non-Hispanic, Mage=20.14). Results: Positive FAD expectancy themes included: Mood Improvement, Appearance/Weight-related Benefits, Alcohol Enhancement, and Social Approval and Connectedness. Negative FAD expectancy themes included: Reputational and Social Concerns, Negative Physical Consequences, Negative Psychological Consequences, and Cognitive and Behavioral Impairment. Conclusions: Results suggest that while there are many similarities, FAD expectancies are distinct from existing alcohol and thinness/restriction expectancies. Specifically, the Mood Improvement theme conceptualizes mood-related improvement within the context of both positive and negative reinforcement and both the Social Approval and Connectedness and Social and Reputational Consequences themes focus on the ways in which one's peers may view and interact with others. Findings lay the groundwork for identifying expectancies that underlie FAD behaviors and provide directions for future research and intervention efforts.

A qualitative analysis of college women's experiences with dieting

OBJECTIVE

Dieting is a known risk factor for disordered eating, yet many college women engage in this behavior. Given the popularity of diets, and the risks associated with dieting, it is important to enhance understanding of dieters' experiences. This study utilized a qualitative approach to investigate college women's experiences of dieting.

PARTICIPANTS

Eighty-four woman-identifying undergraduates [42% White, 24% Asian, 20% Black, 14% other; Mage = 19.18 (1.77)] who endorsed dieting were included in the study.

METHODS

Participants provided short-answer responses to open-ended questions. Data were analyzed using a thematic analysis approach.

RESULTS

The following themes were identified: A complicated relationship, variability of experiences, and social factors. Subthemes highlighted the complexity of college women's dieting behavior.

CONCLUSIONS

Results provide important insight into college women's dieting experiences and their consequences. Future qualitative research should aim to understand how to apply these findings to eating disorder prevention efforts.

Persistent and Changing Food Insecurity Among Students at a Midwestern University is Associated With Behavioral and Mental Health Outcomes

PURPOSE

To assess associations between persistent and changing food insecurity and behavioral and mental health outcomes in college students.

DESIGN

Online surveys conducted November 2018 and March 2019 (freshman year), and March 2020 (sophomore year) were used to assess food insecurity, which was then used to create 4 food security transitions: persistent food insecurity, emergent food insecurity, emergent food security, and persistent food security.

SETTING

Large Midwestern university.

SAMPLE

593 students completing all 3 surveys.

MEASURES

Dietary intake and behavioral and mental health outcomes (eating disorders, anxiety, depression, sleep quality) were assessed using validated instruments.

ANALYSIS

Associations between food security transitions and dietary intake, behavioral, and mental health outcomes were examined using generalized linear models.

RESULTS

Compared to persistent food security, emergent and persistent food insecurity was associated with lower (7% and 13% respectively) intake of fruits and vegetables combined; persistent food insecurity was associated with 17% lower intake of fruits, 6% lower intake of fiber and 10% higher intake of added sugar from beverages. Compared to persistent food secure students, eating disorder symptom risk was higher for emergent food insecure (OR = 7.61, 95% CI: 3.32, 17.48), and persistent food insecure (OR = 6.60, 95% CI: 2.60, 16.72) students; emergent (OR = 2.05, 95% CI: 1.14, 3.71) and persistent (OR = 2.55, 95% CI: 1.34, 4.87) food insecure students had higher odds of poor sleep quality, and persistent food insecure, emergent food insecure, and emergent food secure students had higher odds of anxiety and depression (OR range 2.35-2.85).

CONCLUSION

Food security transitions were associated with aspects of low diet quality and poorer behavioral and mental health outcomes among college students.

Family pressure and support on young adults' eating behaviors and body image: The role of gender

Families play a key role in establishing eating habits of children, yet whether families continue to influence eating behaviors of young adults remains an open question. It is also not clear whether associations between family variables (i.e., support and pressure) are similar for adult sons and daughters regarding eating pathology. The present cross-sectional study examined family correlates on disordered eating, body satisfaction, and drive for muscularity. The aim was to examine the associations of family support and family pressure with eating pathology, and to determine whether gender moderated the associations. Among 365 undergraduates (Mage = 18.9 years, 62 % Caucasian, 48 % female), neither family pressure nor family support were significantly associated with the drive for muscularity, whereas both were associated with disordered eating, and family pressure was associated with body satisfaction. Gender moderated the relationship of family pressure and body satisfaction (p = 0.03) and, unexpectedly, the relationship of family support and disordered eating (p = 0.02). Contrary to prediction, family pressure had stronger associations with body satisfaction for men (i.e., men had a more robust association (beta = -0.31, p < .001) than women (beta = -0.19, p = 0.004)). For women, the relationship of family support and disordered eating was not significant (beta = 0.07, p = 0.452); but, was significant for men (beta = -0.25, p < .001). These findings suggest that family pressure and support are associated with eating pathology among young adults, and that in some instances the associations were larger for men, thus highlighting the importance of including men in eating pathology research. Pending replication, these results suggest that family attitudes, behaviors, and support may be necessary topics to address when designing prevention programs for young adults.

Visceral sensitivity, hunger responsiveness, and satiety responsiveness: Associations between facets of gastrointestinal interoception and disordered eating profiles in an undergraduate sample

This preregistered study examined associations between empirically derived profiles of disordered eating in a diverse nonclinical sample and three facets of gastrointestinal (GI) interoception (visceral sensitivity, hunger responsiveness, satiety responsiveness). University students (n = 591; 53.3% women; 23.0% Hispanic) completed the Visceral Sensitivity Index, Adult Eating Behavior Questionnaire, and Eating Pathology Symptom Inventory. Latent profile analysis was conducted in Mplus v8.3 with four behavioral indicators (restricting, binge eating, excessive exercise, purging [binary]). Facets of GI interoception predicting odds of disordered eating profile membership compared to an asymptomatic group were evaluated. Five profiles were identified. Facets of GI interoception differentially predicted odds of membership in disordered eating profiles. However, higher scores on all three facets of GI interoception were associated with increased odds of membership in a high disordered eating profile. The relationship between distinct facets of GI interoception and specific disordered eating patterns appears nuanced, though individuals displaying a range of disordered eating behaviors may exhibit broad GI interoceptive dysfunction. Findings are consistent with the recent emphasis on idiographic treatment approaches for disordered eating and may have implications for screening among university students. Prospective longitudinal work and extension to clinical samples is needed.

The role of self-reliance and denial in the help-seeking process for eating disorders among university students

OBJECTIVE

This study investigated how self-reliance and denial influence the relationship between help-seeking attitudes and behaviour.

METHOD

Australian university students (N = 406) completed an online survey and females with elevated eating disorder (ED) concerns and high impairment were included in the study (N = 137). Participants completed measures of help-seeking attitudes, perceived barriers, and actual help-seeking behaviour. Via moderated logistic regression, we examined self-reliance and denial as perceived barriers to help-seeking.

RESULTS

Of the total sample, over 33.7% of university students reported substantial ED concerns and impairment of whom 65.0% believed they needed help. While a majority reported that help-seeking would be useful (85.4%), only a minority of participants had sought professional help for their concerns (38.7%). Self-reliance and denial were frequently endorsed barriers and moderated the relationship between help-seeking attitudes and behaviours.

CONCLUSION

ED concerns are common among university students and perceived barriers play a moderating role between attitudes and help-seeking. Future prevention and early intervention programs should address students' denial, while the importance of reaching out for professional help (rather than relying on themselves) could be highlighted with peer support.

Associations between disordered eating and body focused repetitive behaviors in college students

Objective: College students with disordered eating (DE) are at increased risk of body focused repetitive behaviors (BFRBs). Both DE and BFRBs are described as impulsive and compulsive. However, the associations of impulsive DE with impulsive BFRBs and compulsive DE with compulsive BFRBs have not been examined. Methods: 191 college-aged students completed a survey of BFRBs and DE. Results: Participants who reported hair pulling were twice as likely to report clinically significant DE than those who denied hair pulling (p = .022). Participants who endorsed distressing hair pulling (p = .026), skin picking (p = .052), and nail biting (p = .094) were twice as likely to report clinically significant DE than those who were not distressed by these behaviors. Evidence did not support the association of BFRBs and DE along an impulsive/compulsive continuum. Conclusions: Results suggest that BFRBs and DE often co-occur, and the role of impulsivity and compulsivity in these behaviors is complex.

Restrained eating and alcohol use: Testing drinking to cope and impulsivity as moderators

The association between restrained eating and alcohol use remains poorly understood among undergraduates. Consistent with tension reduction theory, individuals with disordered eating may be motivated to drink alcohol to cope with negative emotionality. Perhaps what pushes them to drink despite restriction goals is impulsivity. The combined impact of drinking to cope and impulsivity on the theoretically complex link between restrained eating and alcohol outcomes has not been previously examined. The current study tested the moderating effect of drinking to cope and impulsivity on the association between restrained eating and alcohol use and problems. Undergraduates (N = 1,619) self-reported on eating disorder symptoms, alcohol use motives, impulsivity, and alcohol outcomes. A moderation model revealed that restrained eating predicted past 30-day alcohol use, but only for women high in both drinking to cope and impulsivity. These findings help characterize alcohol misuse risk among young adults who restrict their eating, thereby, results may inform interventions.

Cross-sectional and longitudinal associations between higher weight and eating disorder risk among collegiate athletes

OBJECTIVES

To examine whether higher weight status is associated with increased eating disorder risk in athletes.

DESIGN

Study 1 used cross-sectional (N = 942) and longitudinal (N = 483) data collected over a five-year period from Division I athletes at a Midwestern university. Study 2 used cross-sectional data from athletes competing at various levels at universities across the United States (N = 825).

METHODS

Weight and height were measured in Study 1 and self-reported in Study 2; higher weight was defined as body mass index ≥ 25 kg/m2. Eating disorder risk was assessed with preliminary (Study 1) and final (Study 2) versions of the Eating Disorders Screen for Athletes. Study 1 examined weight status in relation to both concurrent and one-year changes in Eating Disorder Screen for Athletes score. Study 2 examined weight status in relation to both the Eating Disorders Screen for Athletes score and elevated eating disorder risk using the established Eating Disorders Screen for Athletes cut-off. All models adjusted for gender and sport type; Study 2 additionally adjusted for race/ethnicity, age, and competition level.

RESULTS

Across studies, higher weight status was significantly associated with increased eating disorder risk among athletes. This association was observed both cross-sectionally and longitudinally, and the prevelence of elevated eating disorder risk was 43 % greater among athletes with higher weight status than among those without higher weight status.

CONCLUSIONS

Despite existing stereotypes that eating disorders tend to occur with low weight status, findings highlight the importance of screening all athletes for eating disorders, regardless of their weight status.

Eating disorder-related functional impairment predicts greater depressive symptoms across one semester of college

Eating disorder (ED) behaviors and depression are associated with numerous negative outcomes, including lower quality of life and functional impairment. College women are at elevated risk for both. Prior research indicates ED behaviors, including binge eating, self-induced vomiting, and fasting, predict increases in future depressive symptoms. However, symptom heterogeneity in EDs is common, and all disordered eating, or its associated distress, cannot be captured by the endorsement of behaviors. Impairment that results from ED behaviors may be a comparable, or stronger, predictor of depressive symptoms. We sought to characterize the longitudinal relationship between ED-related functional impairment, ED behaviors, and depressive symptoms. College-aged women [N = 304; 72 % white, mean (SD) age = 18.45 (0.88)] completed an online survey in August (baseline), and then three months later in November (follow-up). Baseline ED-related functional impairment, but not baseline ED behaviors, significantly predicted depressive symptoms at follow-up, controlling for baseline depressive symptoms, negative affect, and body mass index. Findings indicate ED-related functional impairment is a risk factor for increases in depressive symptoms across one semester of college, irrespective of ED behavior engagement, weight status, and dispositional negative affect. Intervening upon ED-related functional impairment may reduce or prevent future depressive symptoms among college-aged women.

Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students

OBJECTIVE

Research on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups.

METHOD

United States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non-eating-disorder controls (NCs, n = 5876). Generalized and linear mixed-effects models assessed group differences in eating and internalizing symptom trajectories, and logistic regression compared groups on sex and race/ethnicity distributions.

RESULTS

Atypical AN participants demonstrated elevated eating disorder and internalizing symptoms compared to NCs during college, but less severe symptoms than AN and BN participants. Although all eating disorder groups showed signs of improvement in fasting and driven exercise, purging and depression remained elevated. Atypical AN participants showed increasing anxiety and stable binge-eating trajectories compared to AN and/or BN participants. The atypical AN group comprised significantly more people of color than the AN group.

DISCUSSION

Findings underscore that atypical AN is a severe psychiatric disorder. As atypical AN may present as less severe than AN and BN and disproportionately affects people of color, clinicians should be mindful of biases that could delay diagnosis and care.

PUBLIC SIGNIFICANCE

College students with histories of atypical AN, AN, and BN demonstrated improvements in fasting and driven exercise and stable purging and depression levels. Atypical AN students showed worsening anxiety and stable binge-eating trajectories compared to favorable changes among AN and BN students. A higher percentage of atypical AN (vs. AN) students were people of color. Findings may improve the detection of atypical AN in college students.

It appears on my feed! Differences in intentionality of fitspiration exposure by weight/shape concerns, disordered eating, and self-compassion in women

Viewing fitspiration (fitness inspiration) has been found to increase body dissatisfaction and negative affect; however, minimal research has examined how body dissatisfaction and related variables differ based on intentionality of fitspiration exposure. This study's aim was to examine differences in levels of weight/shape concerns, disordered eating, and self-compassion according to type of fitspiration exposure. Participants included 234 female undergraduate students who completed online questionnaires. We created three groups of fitspiration exposure based on their self-report of Instagram exposure: unexposed (neither view nor post fitspiration; n = 43), incidentally exposed (report seeing fitspiration content unintentionally; n = 119), and intentionally exposed (intentionally view and/or post fitspiration; n = 72). Weight/shape concerns, disordered eating, and self-compassion were significantly worse in the intentionally exposed group and incidentally exposed group compared to the unexposed group. These results suggest that exposure to fitspiration, regardless of intention, may be problematic and should be limited.

Intersectionality of demographic characteristics in self-reported anorexia nervosa, bulimia nervosa, and probable eating disorders among college students

OBJECTIVE

To investigate associations between identity intersectionality, with a primary focus on minority identity, and probable eating disorders (EDs) within the US college student population.

METHOD

Data consisting of n = 414,299 college students' responses to the American College Health Association's National College Health Assessment between fall 2015 and spring 2019 were utilized for this study. Overall and stratified adjusted odds ratios (aORs) were used to assess the association between different facets of identity (i.e., race/ethnicity, gender identity, and sexual orientation) and probable EDs.

RESULTS

Among all, in our analytic sample, 7.15% reported a probable ED. Interactions between all three identity variables were significant, and thus stratified odds ratios were evaluated. Transgender men were significantly more likely to report probable ED than cisgender male peers within the following racial/ethnic groups: non-Hispanic White (aOR: 3.33; 95% CI: 2.79, 3.96; p < .0001), non-Hispanic Black (aOR: 3.29; 95% CI: 1.72, 6.28; p = .0003), Hispanic (aOR: 2.31; 95% CI: 1.55, 3.43; p < .0001), Asian or Pacific Islander (aOR: 2.19; 95% CI: 1.45, 3.30; p = .0002), Biracial or Multicultural (aOR: 3.36; 95% CI: 2.17, 5.22; p < .0001), and other (aOR: 4.19; 95% CI: 2.25, 7.79; p < .0001).

CONCLUSIONS

This study underscores the importance of increasing our understanding of interactions between marginalized identities and the ways in which minority identity informs ED risk.

PUBLIC SIGNIFICANCE

The impact of multiple marginalized identities on ED outcomes is not well understood. Our study expands on previous ACHA-NCHA studies by addressing identity intersectionality, looking at more than one identity at a time (i.e., specifically race/ethnicity, gender identity, and sexual orientation). Our results contribute unique risk profiles for students who identify with multiple marginalized groups. Further, they indicate that that these associations vary based on the compounded effect of the demographic factors considered.

Cultural adaptation of an integrated eating disorders prevention and healthy weight management program

BACKGROUND

Both eating disorder (ED) prevention and weight management interventions often focus on the thin ideal. Yet, many Black and Latina women do not view thinness as their body ideal. This study used focus groups to investigate the influence of race, ethnicity, and culture on appearance ideals and inform the cultural adaptation and integration of two established programs addressing EDs and weight management: the Body Project, and Healthy Weight Interventions.

METHODS

White (n = 10), Black (n = 14), and Latina (n = 6) women participated in racially and ethnically homogenous focus groups.

RESULTS

Thematic analysis identified several themes, including: (1) diverse beauty standards across groups, (2) lack of acknowledgement of racialized beauty standards in prevention and cultural appropriation, (3) culturally-specific impacts of standards, (4) harm of appearance-related comments, (5) limitations of available resources, (6) stigma/minimization of mental health, (7) barriers to inclusive programming, and (8) facilitators of inclusive programming.

CONCLUSIONS

Results suggested that current programs' emphasis on thinness limit their relevance for women of color, and perpetuate the misconception that EDs primarily affect White women. Findings highlight the need for culturally responsive prevention.

Gender similarities and differences in associations between weight discrimination, shape/weight concerns, and eating disorder symptoms among post-9/11 veterans

OBJECTIVE

Weight discrimination, defined as mistreatment of people based on body weight, is associated with body image concerns and eating disorder (ED) symptoms. Military veterans are particularly vulnerable to developing ED symptoms, which may be due to experiences of weight discrimination resulting from the military's strict weight and fitness requirements. However, no previous study has examined these associations among veterans. We investigated relationships between weight discrimination during and after military service and shape/weight concerns and ED symptoms in post-9/11 veterans. Based on evidence for gender differences in weight discrimination, body image, and ED symptoms, we also examined whether gender moderated these associations.

METHOD

Participants were randomly selected from the population of post-9/11 U.S. veterans who had been discharged from the military within the previous 18 months. A total of 1494 veterans completed the Everyday Discrimination Scale, Eating Disorders Examination-Questionnaire, and the Eating Disorder Diagnostic Scale-5.

RESULT

Women were more likely to report weight discrimination and had higher levels of ED symptoms and shape/weight concerns than men. Weight discrimination in and after leaving the military were positively associated with shape/weight concerns and ED symptoms in the full sample and among men and women. Gender moderated the association between weight discrimination after leaving the military and shape/weight concerns such that the association was stronger among men.

DISCUSSION

Both male and female veterans may be vulnerable to developing ED symptoms, in part due to weight discrimination experienced during and after military service. Our findings emphasize the need to address weight discrimination and its consequences in veterans.

Reduction in eating disorder symptoms among adults in different weight loss interventions

Restriction of food intake and counting calories as part of weight loss programs are thought to trigger eating behaviors and attitudes which can lead to eating disorders. We have developed a treatment model, Regulation of Cues (ROC), that targets appetitive traits, including food responsiveness and satiety responsiveness, which could address overeating at an implicit level and reduce risk of detrimental behaviors and attitudes. This manuscript evaluates eating disorder symptoms, attitudes, and behaviors among adults with overweight or obesity randomized to ROC, behavioral weight loss (BWL), a combination of ROC + BWL (ROC+) and an active comparator (AC). Participants included 271 adults with a body mass index of 25 to 45, age 18 to 65 years, and a lack of comorbidities that could interfere with participation. Assessments occurred at baseline, mid-treatment (6 months), post-treatment (12-months) and 6- and 12-month follow-up. During treatment, participants in all four arms showed decreases in Eating, Weight, and Shape concerns on the Eating Disorder Examination-Questionnaire and binge eating symptoms on the Binge Eating Scale which were maintained at 6-month follow-up but increased at the 12-month follow-up. Both the ROC+ and BWL arms showed increases in Restraint during treatment which dissipated after treatment ended. This study contributes to a growing body of literature demonstrating that weight loss programs are not associated with increases in eating disorder symptoms. Future studies should evaluate interventions to maintain improvements in eating disorder symptoms following weight loss programs.

How Does an Eating Disorder Affect Your Physical and Mental Health and How It Is Related to Sleeve Gastrectomy?

Background Obesity is the pandemic of this era. At the same time, the commercialisation of thinness has also increased its adversity. Dissatisfaction with body shape is leading to many eating disorders. These disorders further cause several health problems. It has been found that individuals with eating disorders experience insomnia, depression, and anxiety. It also affects the endocrine system and digestive systems of the body. The surgical approach provides a more efficient treatment of obesity with sustainable results. Sleeve gastrectomy is the most popular surgical treatment. Sleeve gastrectomy is one of the prominent bariatric surgeries. Patients going through sleeve gastrectomy not only lose weight but also improve their mental health. Objective This study assesses the relationship between obesity, eating disorders, and physical health. It also focuses on the prevalence of sleeve gastrectomy procedures in such individuals and their outcomes. Methods This study used a cross-sectional design and a convenient sampling technique. The obese individuals who had eating disorders residing in Medina Al-Munawara and Riyadh city were taken as the samples. Online questionnaires were shared with participants to collect their perspectives on their weight, eating disorders, and their impact on physical health. The study collected both retrospective and present data. Results A total sample of 335 participants was taken, of which 181 (54%) were females and 154 (46%) were males, with a mean BMI of 28.85±2.57. The fear of weight gain was found among 265 (79%) of participants, 151 (45%) were feeling guilt while eating, 275 (82%) were weighing themselves daily, 325 (97%) were unable to stop eating even when complete, and 117 (35%) were unable to control themselves when they have food. As per the methods of avoiding weight gain, 166 (49.6%) were skipping a meal, 157 (47%) were following a diet, 17 (5%) were inducing vomiting, and 16 (4.8%) reused laxatives and diuretics. A total of 158 (47.2%) were involved in sports, but it was reduced to 61 (18.25%) upon sickness. Only 24 (7%) participants had undergone sleeve gastrostomy, and 181 (54%) believed that their cravings had increased, 238 (71%) complained of dizziness, and 151 (45%) believed that fast food caused gut unrest. Conclusion Obese individuals who are going through eating disorders are psychologically and physically compromised. They consider skipping meals to be the most efficient means of weight loss, and only a small percentage prefer to go for sleeve gastrectomy.

Motives and food craving: Associations with frequency of hyper-palatable food intake among college students

BACKGROUND

College food environments provide wide access to hyper-palatable foods (HPF). Palatable eating motives and craving are individual factors that may impact HPF intake. Nevertheless, no study to date has examined the relationship between these factors and frequency of HPF intake in a dormitory all-you-can-eat-style cafeteria meal, a typical college food setting.

METHODS

College students (N = 218) self-reported frequency of HPF intake at a college cafeteria meal and their frequency of HPF intake in the overall diet. Quasipoisson and logistic regression models tested whether palatable eating motives (assessed via the Palatable Eating Motives Scale) and craving (assessed via the Food Craving Inventory) were associated with the rate of HPF intake during the cafeteria meal and excess frequency of HPF intake in the overall diet.

RESULTS

Craving was associated with a 19% higher rate of HPF intake during the cafeteria meal (RR = 1.19; p = .015) and a >2-fold higher likelihood of excess frequency of HPF intake the overall diet (OR = 2.69; p < .001). Coping motive was associated with an 87% higher likelihood of excess frequency of HPF intake in the overall diet (OR = 1.87; p = .002), but not in the cafeteria meal. Reward enhancement, social and conformity motives were not significantly associated with the frequency of HPF intake in either setting.

CONCLUSIONS

Results highlight the role of craving and coping motive in the frequency of HPF intake among college students. Prevention efforts may consider targeting craving and eating to cope to potentially address frequency of HPF intake among college students.

"Eat more protein, build more muscle": A grounded theory study of muscle-building behaviors among Canadian adolescents and young adults

Unique risk factors for the development of muscle dissatisfaction and engagement in muscle-building behaviors have been described by theoretical frameworks and supported by empirical research. What remains unknown are the unique processes, including catalysts and facilitators, which underpin engagement in muscle-building behaviors. Therefore, this study used a grounded theory methodology to elucidate the process of engagement in muscle-building behaviors. Thirty-three individual semi-structured interviews with Canadian adolescents and young adults ages 16-30 years were conducted. Transcripts were analyzed using initial and focused coding to identify themes that explained the grounded theory. The core theme underpinning the grounded theory was balancing aesthetic, health, and functional goals in relation to participants' engagement in muscle-building behaviors. Participants described experiences that encompassed several unique phases of muscle-building engagement, including the initiation phase, beginner phase, preservation phase, and intensification phase. Participants also described unique methods of gathering information on muscle-building behaviors, and their own analysis and decision-making processes driving their behaviors. Findings from this study extend prior theory and research by conceptualizing a novel process theory of engagement in muscle-building behaviors among adolescent and young adults, resulting in important implications for research and practice.

Prevalence and predictors of binge eating disorder symptoms among a sample of university students in Bangladesh: A cross-sectional survey

Background and Aims

There is a dearth of information about binge eating disorder (BED) among Bangladeshi university students, who may be more susceptible to BED due to the rise in unhealthy lifestyles and food habits. Therefore, the purpose of this study was to assess the prevalence and associated factors of BED symptoms among Bangladeshi university students.

Methods

Students (N = 525) from three public universities in Bangladesh participated in this cross-sectional study between November 2022 and March 2023. Face-to-face interviews were conducted using a structured paper-based questionnaire that included two validated survey tools; the binge eating disorder screener and the patient health questionnaire-9. To identify the factors associated with BED symptoms, multiple logistic regression analysis was conducted, with sociodemographic and behavioral information (e.g., age, sex, smoking status, etc.) considered as covariates.

Results

The prevalence of BED symptoms among participants (mean age 21.28 years, 50.3% male and 49.7% female) was 20.6%. Male students had a 2.28 times higher likelihood of having BED symptoms compared to female counterparts (adjusted odds ratio [AOR] = 2.28; 95% CI: 1.33-3.89). Older students (AOR = 3.56, 95% CI: 1.80-7.05), students who were overweight or obese (AOR = 3.32, 95% CI: 1.87-5.89), and students reporting higher depressive symptoms (AOR = 2.69, 95% CI: 1.66-4.35) were at greater risk for developing BED compared to their respective counterparts.

Conclusions

This study provides new insights into the prevalence of BED symptoms and its contributing factors among Bangladeshi students. Approximately 1-in-5 university students reported having BED symptoms. University students who are older, overweight, or obese, and who report depressive symptoms may be at greatest risk. Future longitudinal studies are needed to determine the causal factors underlying BED. Findings from this study can assist policymakers and public health professionals in developing effective and targeted strategies to mitigate the risks associated with BED among Bangladeshi university students.

Psychosocial Factors, Technology Use, and Disordered Eating in College Students During the COVID-19 Pandemic

The current cross-sectional study aimed to evaluate the effects of psychosocial factors and technology use on disordered eating in college students (aged 18 to 23 years) during the coronavirus disease 2019 (COVID-19) pandemic. An online survey was distributed between February and April 2021. Participants completed questionnaires on eating disorder behaviors and cognitions, depressive symptoms, anxiety, impacts of the pandemic across personal and social domains, social media use, and screen time. Of all participants (N = 202), 40.1% of students reported moderate or greater depressive symptoms and 34.7% endorsed moderate or greater anxiety symptoms. Higher depressive symptoms were associated with increased odds of bulimia nervosa (BN) (p = 0.03) and binge eating disorder (p = 0.02). People with higher COVID-19 infection scores were at increased odds of reporting BN (p = 0.01). Mood disturbances and COVID-19 infection history were associated with increased eating disorder psychopathology in college students during the pandemic. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 29-38.].