Patterns of compensatory behaviors and disordered eating in college students

Examining compulsive exercise as a risk factor for eating disorder symptoms in first-year college students using a latent change score modeling approach

OBJECTIVE

Research suggests that both compulsive exercise and eating disordered behaviors increase during college. Despite strong cross-sectional associations between compulsive exercise and eating disorders, it is unknown if compulsive exercise is a variable risk factor for eating disorders or simply a correlate. It was hypothesized that increases in compulsive exercise would significantly and prospectively predict increases in overall number of eating disorder symptoms over the study period.

METHOD

A total of 265 first year college students who did not meet criteria for a full or subthreshold eating disorder diagnosis at Time 1 (age M = 18.15; SD = 0.42; 122 female [46%] at Time 1) completed reports of compulsive exercise and eating disorder symptoms via online questionnaires at four timepoints over the 9-month 2021-2022 academic year (76% retention rate). Hypotheses were tested using a bivariate latent change score model.

RESULTS

Hypotheses were not supported. Change in compulsive exercise did not predict change in number of eating disorder symptoms. Change in number of eating disorder symptoms also did not predict change in compulsive exercise.

CONCLUSIONS

Compulsive exercise did not emerge as a variable risk factor for the development of eating disorder symptoms among first year college students. The relationship between these behaviors should be investigated at different developmental timepoints, such as early adolescence, and potential third variables that may explain the observed co-occurrence should be explored.

PUBLIC SIGNIFICANCE

This study investigated whether increases in compulsive exercise predicted increases in number of eating disorder symptoms among first year college students. Compulsive exercise did not significantly predict number of eating disorder symptoms. Additional research is warranted to clarify the relationship between compulsive exercise and eating disorder symptoms.

Anxiety, body dissatisfaction, and exercise identity: Differentiating between adaptive and compulsive exercise

OBJECTIVE

Little is known about psychosocial variables that may be differentially associated with compulsive exercise versus adaptive exercise. The current study simultaneously examined associations of exercise identity, anxiety, and body dissatisfaction with both compulsive and adaptive exercise behaviors and investigated which construct may account for the most unique variance in compulsive and adaptive exercise. Hypotheses were that: 1) body dissatisfaction, anxiety, and exercise identity would be significantly associated with compulsive exercise and 2) exercise identity would be significantly associated with adaptive exercise.

METHOD

A total of 446 individuals (50.2 % female) completed reports of compulsive exercise, adaptive exercise, body dissatisfaction, exercise identity, and anxiety via an online survey. Multiple linear regression and dominance analyses were used to test hypotheses.

RESULTS

Exercise identity, body dissatisfaction, and anxiety were all significantly associated with compulsive exercise. Only exercise identity and anxiety were significantly associated with adaptive exercise. Dominance analyses suggested that exercise identity accounted for the largest proportion of variance in compulsive (Dominance R² = 0.27) and adaptive exercise (Dominance R² = 0.45).

CONCLUSION

Exercise identity emerged as the strongest predictor of both compulsive and adaptive exercise. The simultaneous presence of exercise identity, body dissatisfaction, and anxiety may contribute to high risk for engagement in compulsive exercise. Incorporating exercise identity into established eating disorder preventions and treatments may contribute to the reduction of compulsive exercise behaviors.

The influence of disordered eating and social media's portrayals of pregnancy on young women's attitudes toward pregnancy

BACKGROUND

Given the heightened emphasis on physical appearance and the prevalence of social media in young women, they are particularly vulnerable to experiencing negative body image and disordered eating. Therefore, modified social media portrayals of pregnancy could cause young women to have negative attitudes toward a potential pregnancy and subsequently not properly utilize care and resources. The present study examined the influence of disordered eating and modified portrayals of pregnancy on young women's attitudes toward a potential pregnancy and various feelings associated with pregnancy.

METHODS

The sample consisted of 154 women aged 18-30, who were given the Eating-Attitudes Test-26, randomly shown either modified or unmodified social media portrayals of pregnancy, then given the Attitudes Toward Potential Pregnancy Scale and the Gestational Weight Gain Psychosocial Risk Assessment Tool.

RESULTS

A series of hierarchal regressions revealed that there were no significant main effects or interactions for young women's attitudes toward potential pregnancy. However, women who viewed modified portrayals of pregnancy had higher self-efficacy, and women with higher levels of disordered eating had lower self-efficacy, more positive attitudes toward gestational weight gain, and lower current body image satisfaction.

CONCLUSIONS

These results highlight the myriad of different attitudes that young women have toward a potential pregnancy and how these attitudes are influenced by disordered eating and social media. Our findings can be used for educating caregivers and implementing intervention strategies for women.

Body image and compulsive exercise: are there associations with depression among university students?

PURPOSE

Mental health problems among university students have been reported to be significantly increasing and suggested to be associated with college drop-out. Body dissatisfaction and compulsive exercise are both constructs relevant for mental health problems in general and eating disorders in particular. This study examined associations between body dissatisfaction, compulsive exercise and self-reported symptoms of depression among Swedish university students.

METHODS

Participants (n = 4262) are students in an ongoing cohort study, and data from the baseline assessment were used. Four linear regression models were built to explore the associations between body dissatisfaction, compulsive weight control exercise and depressive symptoms.

RESULTS

Our findings showed that females reported higher levels of body dissatisfaction than males. Body dissatisfaction and compulsive exercise were associated with self-reported symptoms of depression in this non-clinical population. Results showed that compulsive exercise was negatively associated with reported symptoms of depression, while body dissatisfaction was positively associated with symptoms of depression.

CONCLUSION

In line with previous research, there was a gender difference in body dissatisfaction where females displayed higher levels of dissatisfaction than males.  Body dissatisfaction was  positively associated with reported symptoms of depression, suggesting support of previous research indicating body dissatisfaction to increase mental health problems. Compulsive exercise was negatively associated with symptoms of depression suggesting a behavior negatively reinforced, supporting both constructs to be of interest for reported symptoms of depression in a non-clinical population of Swedish university students.

LEVEL OF EVIDENCE

III, cohort study.

TRIAL REGISTRATION

http://clinicaltrials.gov/ID : NCT04465435.

Compulsive exercise and vaping among a sample of U.S. College students aged 18-26 years

PURPOSE

To determine the association between compulsive exercise and vaping among college students aged 18-26 years, and to characterize the type of vaping used among participants who report compulsive exercise.

METHODS

Cross-sectional, pooled data from two survey years (2018-2020; N = 2125) of the national (U.S.) Healthy Minds Study were analyzed. Compulsive exercise was measured based on number of occurrences in the past 28 days (analyzed continuously and among those who reported  ≥ 1 and ≥ 20 occurrences). Vaping was measured based on reported use in the past 30 days. Most recent type of vaping was assessed only among participants who reported vaping. Logistic regression analyses were conducted to estimate the associations between compulsive exercise and vaping, while adjusting for covariates.

RESULTS

For every additional occurrence of compulsive exercise reported by participants, their odds of also reporting vaping increased by 5% (95% CI 1.01-1.09). Participants who reported 20 or more occurrences of compulsive exercise in the past 28 days, a clinical threshold, had 3.71 (95% CI 1.28-10.76) higher odds of vaping in the past 30 days. Among participants who endorsed vaping, nicotine vaping was the most common recent type for those who reported any (76.2%) or 20 or more (50.2%) occurrences of compulsive exercise.

CONCLUSION

Compulsive exercise is associated with vaping in a national, U.S. sample of college students, with nicotine vaping being the most common type used. Screening for both compulsive exercise and vaping, particularly if either is reported, among college-age young adults is necessary to implement prevention and intervention strategies.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Compulsive exercise among college students: 5-year time trends in prevalence and demographic, substance use, and mental health correlates

PURPOSE

To provide 5-year time trends in prevalence and demographic, substance use, and mental health correlates of compulsive exercise among a national sample of college men and women.

METHODS

We analyzed 4 academic survey years (2016-2020; N = 8251) of the national (USA) Healthy Minds Study. Compulsive exercise was measured by self-report of any occurrence of "compulsive" exercise in the past 4 weeks. Unadjusted prevalence of compulsive exercise in the past 4 weeks was estimated across the 4 survey years by sex. Multiple logistic regression analyses were conducted among the pooled sample and stratified by sex to estimate the associations between compulsive exercise in the past 4 weeks and demographic, substance use, and mental health correlates.

RESULTS

Among the pooled sample, 11% (95% confidence interval [CI] 9.60-12.42%) of men and 17% (95% CI 15.86-18.24%) of women reported compulsive exercise in the past 4 weeks. Prevalence across the 4 survey years remained stable among men and women. Higher body mass index was associated with greater odds of any compulsive exercise in the past 4 weeks among men, while any sports participation was associated with greater odds of any compulsive exercise in the past 4 weeks among women. Compulsive exercise in the past 4 weeks was associated with greater odds of all mental health symptoms and illicit drug use among men and women, and higher odds of alcohol use among women.

CONCLUSION

Compulsive exercise is relatively common among college men and women and is associated with substance use behaviors and poor mental health symptoms.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Is weight stigma associated with physical activity? A systematic review

OBJECTIVE

Weight stigma is associated with impaired health, attributed in part to reductions in health-promoting behaviors. This review analyzed evidence of the association between weight stigma and physical activity (PA) in adults and youth.

METHODS

Three databases were searched for terms related to weight stigma and PA. Eligible studies reported the quantitative association between at least one measure of weight stigma and one behavioral measure of PA.

RESULTS

A total of 38 studies met eligibility criteria. Of the 29 studies of adults, 3 used objective PA measures, and 79% used an observational, cross-sectional design. Findings of the relationship between weight stigma and PA were mixed. Everyday weight discrimination and internalizing weight stigma were associated with reduced PA in most studies. Several studies found indirect, and not direct, effects of weight stigma on PA when analyses included other individual-level factors. In the nine studies of youth, two used objective PA measures, all were observational, and only one study was longitudinal. Most youth studies found a relationship between weight-based teasing and reduced PA.

CONCLUSIONS

Weight teasing, everyday discrimination, and internalization were associated with reduced PA. However, associations were inconsistent and often indirect. Future studies should include objective PA measures with larger samples and longitudinal assessments.

Acculturative stress and eating disinhibition among Asian young adults: The role of depressive symptoms and gender

Acculturative stress is associated with health behaviors that have downstream consequences for health outcomes. Eating disinhibition, a behavior characterized by eating emotionally and uncontrollably in the presence of disinhibiting stimuli, has been consistently associated with acculturative stress, but the underlying mechanism is not well-understood. The current study sought to test the role of depressive symptoms and gender on these associations. Asian undergraduate students (N = 477; 78% female) participated in an online cross-sectional study. Higher acculturative stress was associated with higher eating disinhibition (b = 3.45, 95% CI = [0.75, 6.15]), and depressive symptoms showed a partial indirect effect on this association (indirect effect = 0.57, 95% CI_boot = [0.13, 1.34]). Among male young adults (b = 0.98, 95% CI_boot = [0.24, 2.39]), the indirect correlation was stronger than among female young adults (b = 0.44, 95% CI_boot = [0.05, 1.20]; non-significant trend), implying individual differences underlying the indirect effect of depressive symptoms in the acculturative stress and eating disinhibition correlation. The Intercultural Relations dimension of acculturative stress appeared to drive the observed associations. This study is among the first highlighting the role of acculturative stress, depressive symptoms, and gender in eating disinhibition and provides evidence that can inform health professionals to target at-risk Asian individuals with eating problems.

Predicting probable eating disorder case-status in men using the Clinical Impairment Assessment: Evidence for a gender-specific threshold

The Clinical Impairment Assessment (CIA) is a widely used self-report measure of the psychosocial impairment associated with eating-disorder symptoms. Past studies recommended a global CIA score of 16 to identify clinically significant impairment associated with a probable eating disorder (ED). However, to date, research on the properties of the CIA has been conducted in majority-women samples. Preliminary research on gender differences in CIA scores suggested men with EDs report less impairment on the CIA relative to women with EDs. Thus, the purpose of this study was to test if a different impairment threshold is needed to identify cases of men with EDs. We hypothesized that a lower CIA threshold, relative to that identified in majority-women samples, would most accurately identify men with EDs. Participants (N = 162) were men from our university-based and general community-based ED participant registry who completed the CIA and Eating Disorder Diagnostic Scale. Both precision-recall and receiver operating characteristic curves assessed what CIA global score threshold most accurately identified men with EDs. Both analytic approaches indicated that a CIA global score of 13 best predicted ED case-status in men. Consistent with past research, men with a clinically significant ED appear to report lower impairment on the CIA. Results have implications for screening and assessing for substantial ED-related impairment in men. Additionally, past research using the CIA to identify men with EDs may have under-identified men with clinically significant symptoms.

College campuses' influence on student weight and related behaviours: A review of observational and intervention research

Research indicates that most college students are not meeting dietary and physical activity guidelines, and the average student gains an estimated 1.6-3.0 kg during 4 years of study. College administrations are well-positioned to influence student weight-related health behaviours by ensuring that campus environments/policies promote health. However, to date, campus health interventions have largely addressed individual and interpersonal factors rather than environmental/policy-level changes. Using an ecological perspective, this narrative review synthesizes the literature on campus environmental/policy-level factors (e.g., food availability, physical activity requirements) associated with student diet, physical activity and weight, as well as campus interventions to address these factors. Web of Science and PubMed databases were searched between December 2018 and November 2019. Results indicate that campus food environments may contribute to overconsumption and weight gain, and the number of campuses requiring students to participate in physical activity courses is in decline. Eight examples of environmental/policy-level campus interventions are presented: nutrition labels in dining halls, campus-wide healthy choice marketing campaigns, restricted payment methods for à la cart dining, trayless dining, health-themed residence halls, peer health education programmes, active classroom spaces and physical activity course requirements. Implications for research and health promotion programmes/policies in the field of college health are discussed.

Examining the contribution of weight-bias internalization to the associations between weight suppression and disordered eating in undergraduates

Weight suppression (WS) is consistently, positively associated with eating disorder (ED) symptoms, but variables that contribute to these associations remain understudied. The current study examined weight-bias internalization as a potential contributor to the link between weight suppression (WS) and disordered eating in an undergraduate sample. Men (n = 285) and women (n = 610) completed assessments of weight history, weight-bias internalization, and ED symptoms. Absolute (difference in highest and current BMI) and relative WS (%BMI change) were calculated. Hierarchical linear and count regression models examined whether WS contributed to ED symptoms (restraint, objective binge episodes [OBEs], loss-of-control [LOC] eating, and compensatory exercise) above and beyond weight-bias internalization. Analyses were conducted by gender. After accounting for weight-bias internalization, WS demonstrated unique associations with restraint in men (p = .01) and women (p < .001), and LOC eating frequency in men (p = .02), though effects were weaker relative to weight-bias internalization. Although WS was positively correlated with frequency of OBEs in men and LOC eating in women, these associations were no longer significant when accounting for weight-bias internalization. Weight-bias internalization was positively associated with all measured ED symptoms. Consistent with previous work, gender differences in the relations of WS and ED symptoms emerged. Results suggest weight-bias internalization might contribute to links between WS and ED symptoms, particularly binge behaviors, in non-clinical samples. Future research should explore whether decreasing weight-bias internalization could weaken the association between WS and ED symptoms.

Pilot study of a personality-based approach to assessing eating disorder and Obsessive Compulsive Disorder symptom risk in college men and women

Objective: To conduct a pilot test of the validity of using empirically derived personality types to characterize eating disorder (ED) risk in college students and resolve discrepancies regarding the role of perfectionism and obsessive-compulsive disorder (OCD) symptoms.Participants: Man and woman undergraduate students (N = 169) at a small, private university. Data were collected from February to May 2016 and 2018. Methods: Participants completed self-report measures of personality (perfectionism, impulsivity, and effortful control) and psychopathology (EDs, OCD). Results: Our analyses replicated three validated personality types: overcontrolled, undercontrolled, and resilient. Analysis of variances demonstrated perfectionism, ED, and OCD symptoms were significantly elevated in the overcontrolled subtype. There was no interaction by sex. Conclusions: These findings suggest that personality types may be useful for classifying ED risk and OCD symptoms in college students across sexes. Further study and relevance to prevention and intervention efforts to reduce the burden of EDs on college campuses will be discussed.

Compensatory behaviors among racial and ethnic minority undergraduate women

Limited research has examined prevalence rates of disordered eating across racial and ethnic groups. The current study aimed to assess the prevalence of compensatory behaviors across minority undergraduate women. Self-report responses (N = 3,430) on the Eating Disorder Examination Questionnaire were analyzed from 2,094 White (55.9%), 684 Hispanic/Latina (18.3%), 508 Asian (13.6%), 235 Black (6.3%), and 65 Native American/Alaskan Native (1.7%) women attending college within the United States. Racial and ethnic differences were significant across all compensatory behaviors. Most notably, Asian and Native American women engage in compensatory behaviors comparable to or more than their White peers, and Black women consistently reported the lowest prevalence rate of any behavior. Findings were compared to the existing literature, noting general trends across studies that may help inform screening, assessment, and treatment of eating pathology as well as suggest future directions for intervention science.

Disordered Eating Among a Diverse Sample of First-Year College Students

OBJECTIVE

A cross-sectional study of first-year college students was conducted to identify the prevalence and predictors of disordered eating (DE).

METHODS

College freshmen students, aged 18 years, (n = 106) completed the Eating Disorder Examination Questionnaire (EDE-Q) and a supplemental survey. A subset of the sample (n = 77) underwent measurements of height, weight, and body composition. DE was defined as an elevated (3) weight, shape, eating concern, or dietary restraint EDE-Q subscale score.

RESULTS

The sample, consisting of 56.6%, 15.1%, 11.3%, and 11.3% Latino/a, Asian, African American, and Caucasian students, respectively (37% male), reported a 31.1% prevalence of DE. The current desire to lose weight was the strongest predictor of DE (odds ratio = 15.3; 95% confidence interval = 2.8, 82.5). Other variables linked to DE or elevated EDE-Q subscale scores included body mass index (BMI) 25.0 kg/m², vegetarianism, weight loss in the past year, female gender, and eating breakfast < 5 d/wk. Participants with BMI 25.0 kg/m² and the current desire to lose weight (n = 23) or following a vegetarian diet (n = 5) exhibited the highest prevalence of DE (78.3% and 80.0%, respectively). A higher proportion of Latinas reported binge episodes compared to female Caucasian, Asian, and African American students (36.4% vs. 0.0%, 6.7%, and 28.6%, respectively, p = 0.056, χ² = 7.6). Males, versus females, were more likely to report excessive exercise (56.4% vs. 37.3%, p = 0.056, χ² = 3.6).

CONCLUSIONS

This study adds to the current body of literature on DE by providing a diverse sample and potentially novel predictors and risk factors for DE.

Exploring weight control as motivation for illicit stimulant use

OBJECTIVE

Research has highlighted a growing trend among young, adult women to initiate drug use for weight loss. With known suppressive effects on appetite, illicit stimulants (i.e., cocaine, amphetamine, methamphetamine, and ecstasy) may be particularly attractive to college women, who are at elevated risk for increased body dissatisfaction and experimenting with extreme weight loss techniques. The current study examines the association between risk factors and symptomatology of eating disorders and illicit stimulant use (ISU).

METHODS

A preliminary study was conducted on a nonclinical sample of 131 drug-using, college women (16- to 24-years old). Participants reported internalization of the thin ideal, body dissatisfaction, disordered eating behavior, and current drug use as well as corresponding weight-related motivation.

RESULTS

There were 15.3% of women who reported drug use for weight-control purposes. Results showed women who reported drug use for weight control predominantly used illicit stimulants (70%), such as cocaine, amphetamine, methamphetamine, and ecstasy. Moreover, the odds of ISU were increased among women who engaged in laxative misuse.

CONCLUSIONS

These results suggest that a desire for weight control may be associated with ISU among college women. Women engaging in more extreme weight loss behaviors are at high risk for initiating and maintaining ISU for weight-related reasons.

Driven exercise in the absence of binge eating: Implications for purging disorder

OBJECTIVE

Purging disorder (PD) is characterized by recurrent purging without objectively large binge-eating episodes. PD has received relatively little attention, and questions remain about the clinical significance of "purging" by exercise that is driven or compulsive (i.e., as extreme compensatory or weight-control behavior). The little available research suggests that individuals who use exercise as a compensatory behavior might have less eating-disorder psychopathology than those who purge by vomiting or laxatives, but those studies have had smaller sample sizes, defined PD using low-frequency thresholds, and defined exercise without weight-compensatory or driven elements.

METHOD

Participants (N = 2,017) completed a web-based survey with established measures of eating-disorder psychopathology, depression, and physical activity. Participants were categorized (regular compensatory driven exercise, PD-E, n = 297; regular compensatory vomiting/laxatives, PD-VL, n = 59; broadly defined anorexia nervosa, AN, n = 20; and no eating-disordered behaviors, NED, n = 1,658) and compared.

RESULTS

PD-E, PD-VL, and AN had higher eating-disorder psychopathology and physical activity than NED but did not significantly differ from each other on most domains. PD-VL and AN had higher depression than PD-E, which was higher than NED.

DISCUSSION

Findings suggest that among participants with regularly compensatory behaviors without binge eating, those who use exercise alone have similar levels of associated eating-disorder psychopathology as those who use vomiting/laxatives, although they have lower depression levels and overall frequency of purging. Findings provide further support for the clinical significance of PD. Clinicians and researchers should recognize the severity of driven exercise as a compensatory behavior, and the need for further epidemiological and treatment research.

Alcohol use and strenuous physical activity in college students: A longitudinal test of 2 explanatory models of health behavior

OBJECTIVE

To help clarify the effect of gender on the bidirectional relationship between alcohol use and strenuous physical activity in college students.

PARTICIPANTS

Five hundred twenty-four (52% female) college students recruited in August 2008 and 2009 and followed up in April 2009 and April 2011, respectively.

METHODS

Participants reported their alcohol use and strenuous physical activity on 2 occasions (baseline and follow-up) spaced approximately 1 or 2 years apart.

RESULTS

For females, alcohol use quantity at baseline was associated with increased strenuous physical activity at 1- and 2-year follow-ups, and alcohol use frequency at baseline was associated with decreased strenuous physical activity at 2-year follow-up. For males, alcohol use frequency at baseline predicted decreased strenuous physical activity at 1-year follow-up.

CONCLUSIONS

Gender differences may be explained from an eating disorders perspective such that women use physical activity as a compensatory strategy to combat potential weight gain from calories consumed during alcohol use.

Does short-term fasting promote pathological eating patterns?

Fasting, or going a significant amount of time without eating, has been identified as a risk factor for the development of pathological eating patterns. Findings from several studies examining the impact of fasting on subsequent eating behaviors have been mixed. The current study recruited college students to record food intake, episodes of binge eating, and use of compensatory behaviors before, throughout, and following a 24-hour fast. Participants attended an initial appointment in which they completed measures of dietary restraint and disinhibition and received instructions on self-monitoring and fasting. Participants (N=122) self-monitored their eating behaviors for 96 h, including a 24-hour fasting period. Participants did not demonstrate significant increases in disordered eating behaviors following the fast (e.g., objective binge episodes, self-defined excessive eating or compensatory behavior use). Baseline disinhibition predicted excessive eating as well as objective binge episodes both before and after fasting. Altogether, findings have implications for research seeking to further understand how fasting may contribute to the development of pathological eating patterns; specifically, it seems that the ED risk associated with fasting is derived from the behavior's interaction with other individual difference variables.