The programs have catchy names like “Food, Mood and Attitude” and “Full of Ourselves” as well as an ambitious goal: to prevent adolescent eating disorders, which tend to be chronic, difficult to treat and sometimes fatal.
But do they work? In the case of one such program – “Student Bodies,” developed by researchers at Stanford University – a recently published study suggests that the answer is yes. Stanford researchers, who followed 480 female California college students for up to two years, report that the eight-week Internet-based program reduced the development of eating disorders in women at high risk.
“This study shows that innovative intervention can work,” said Thomas Insel, director of the National Insitute of Mental Health, which funded the study; its findings appeared in the August issue of the Archives of General Psychiatry.
Prevention programs for eating disorders have proliferated in the past decade, in part because of the high cost and low success rate of treatment programs. The disorders include a constellation of problems, including anorexia, a pathological fear of gaining weight marked by self-starvation. Anorexia has the highest mortality rate of any psychiatric illness: About 10 percent of patients hospitalized for treatment ultimately die of the disorder.
An estimated 4 percent of teenage girls and young women suffer from anorexia or bulimia, which is marked by recurrent bingeing and purging, or binge-eating disorder, in which sufferers gorge themselves until they become sick. Another 4 percent are believed to suffer from less severe subclinical forms of these disorders, which can last a lifetime and wreak physical and emotional havoc. The incidence of the disorders has doubled in the past 40 years, according to statistics compiled by the Eating Disorders Coalition, a Washington advocacy group.
“This study is a very significant piece of research because it demonstrates that one can transfer what’s known about risk factors into a program that can be applied at very low cost,” said Michael Levine, an eating disorders expert who is a professor of psychology at Kenyon College in Ohio. “And it gives every indication of being able to reduce important risk factors” for eating disorders such as excessive concern about body image and weight.
“I can’t think of a single computer-based eating disorders program that can hold a candle to these results,” said University of Texas psychologist Eric Stice, who two years ago conducted a meta-analysis and found that about 20 percent of eating-disorders programs have a statistically significant benefit. Few programs, he said, have involved as many subjects or long-term follow-up as the Stanford approach.
Programs achieving the best results, Stice said, are targeted at high-risk subjects rather than the general population of teenagers, involve girls 15 or over, and are interactive rather than didactic.
Clinicians say prevention programs are badly needed.
“These are very difficult problems to treat,” said Sherry Goldman, a child psychiatrist and pediatrician who practices in Rockville, Md.
Many teenage eating-disorder patients, she said, “don’t recognize the seriousness of their symptoms” and don’t think they have a problem.
It’s not clear what causes eating disorders, which seem to run in families for reasons that may be biological or environmental – or both.
The vast majority of sufferers are female, which experts say is partly a reflection of cultural norms such as the current popular fascination with skeletal-looking celebrities.
But few experts think culture alone is responsible. Goldman and others who treat teenage girls say that underlying depression is common in eating-disorder patients, as are certain personality traits including competitiveness, conformity, rigidity and perfectionism.
Many patients have difficulty expressing emotion; some have been sexually or physically abused as children. For them, eating – or not eating – becomes something they can control and a way of dissipating feelings that would otherwise be overwhelming.
Psychiatrist C. Barr Taylor, lead author of the Stanford study and a developer of “Student Bodies,” said his team focused on young women known to be especially susceptible to eating problems: the 35 to 50 percent of teenage girls with high levels of concern about their weight and body shape, some of whom were overweight. Among the questions used to screen study participants was “How afraid are you of gaining 3 pounds?” Possible answers included “moderately” and “very.” Through fliers posted at colleges in San Francisco and San Diego, the team recruited 480 women whose average age was nearly 21 and whose average body mass index (BMI) was 23.7 – in the normal range, equivalent to a 5-foot-4 woman who weighs 138 pounds.
Half were randomly assigned to “Student Bodies,” which included weekly online sessions about healthy eating, journal keeping and an interactive discussion monitored by a psychologist, as well as information about body image. The other half were assigned to a control group and permitted to go through the program once the evaluation was complete.
A two-year follow-up revealed no overall difference in the development of eating disorders between the control group and Student Bodies participants, Taylor said. But it did find significant differences in two high-risk subgroups: students who were overweight and those who were already engaged in behaviors that can presage a full-blown disorder, such as excessive exercise, self-induced vomiting and use of diet pills or laxatives.
Among “Student Bodies” participants with a BMI over 25, which is considered overweight, none had developed an eating disorder at the two-
year follow-up, while 12 percent in the control group had.
And among the women from San Francisco (but not San Diego) who reported problem behaviors such as self-induced vomiting at the start of the study, 14 percent had developed an eating disorder at the two-year mark, compared with 30 percent of the control group.
“We’re the first study to show it’s possible to prevent eating disorders among a high-risk group,” Taylor said.
Eating-quotient quiz
Do your thoughts and feelings about weight and your body put you at risk for an eating disorder? The following quiz developed by Stanford University researchers as part of the “Student Bodies” prevention program may help you find out. It is not intended as a diagnostic test. Answer the questions truthfully, then consult the key at the bottom to learn how to interpret your score.
A day rarely passes in which I don’t worry about how much I eat.
( ) True ( ) False
I am embarrassed to be seen in a bathing suit.
( ) True ( ) False
There are many foods I always feel guilty about eating.
( ) True ( ) False
Most attractive people I see are thinner than I am.
( ) True ( ) False
I usually begin the day with a vow to diet.
( ) True ( ) False
My thighs are too fat.
( ) True ( ) False
I feel uncomfortable eating anything fattening in front of people.
( ) True ( ) False
It makes me nervous if I know people can watch me from behind.
( ) True ( ) False
After I eat a lot, I think about ways of getting rid of or burning up calories.
( ) True ( ) False
I hate seeing myself in a mirror.
( ) True ( ) False
I feel terrible about myself if I don’t exercise a lot every day.
( ) True ( ) False
I find my naked body repulsive.
( ) True ( ) False
If I eat too much, I sometimes vomit or take laxatives.
( ) True ( ) False
My worst problem is how my body looks.
( ) True ( ) False
Scoring 0-4 True responses; laxative/vomiting question marked False: Low Risk
5-8 True responses; laxative/vomiting question marked False: Moderate Risk
9-13 True responses; laxative/vomiting question marked False: High Risk
Any number of True responses with laxative/vomiting question marked True: Very High Risk Seek help promptly.
-The Washington Post
