Potential Triggers for Risking the Development of Eating Disorders in Non-Clinical Higher-Education Students in Emerging Adulthood

Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9-4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2-1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6-2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1-1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.

Prevalence of Eating Disorders and Its Associated Risk Factors in Students of a Medical College Hospital in South India

Background and objectives Eating disorders are some of the most under-researched and difficult to diagnose psychiatric conditions, with a high mortality rate, especially among the adolescent age group. The aim of this study is to determine the prevalence and risk factors for eating disorders among students of a medical college hospital in South India. Materials and methods An observational, cross-sectional study was conducted among 332 students of four constituent colleges of a tertiary-care hospital selected by simple random sampling. Their height and weight were recorded. Four major questionnaires were distributed among the students - Demographic details, Eating Attitudes Test (EAT26), Body Shape Questionnaire (BSQ34), and Perceived Stress Scale (PSS). The results were tabulated and analyzed using SPSS software version 16.0 (IBM Corporation, Somers, New York, USA). Results The proportion of students who had a high risk for eating disorders was 13%. It was prevalent almost equally in both males and females. High risk for eating disorders was associated with high stress and severe body shape concerns (p<0.001). Other influencing factors were history of counselling, peer pressure, excessive exercise as well as the history of any behavioral symptoms like the use of laxatives and diet pills (p<0.001). Conclusions Eating disorder risk is prevalent in a high percentage of medical and paramedical students. High stress and body shape concerns are associated with eating disorders. Only if diagnosed early, with screening programs using questionnaires and further psychiatric evaluation, we can hope to mitigate the complications they incur.

Prevention of eating disorders: A systematic review of randomized, controlled trials

OBJECTIVE

This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention.

METHOD

A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted.

RESULTS

Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up.

DISCUSSION

The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required. © 2016 Wiley Periodicals, Inc.

The European Initiative ProYouth for the promotion of mental health and the prevention of eating disorders screening results in Hungary

OBJECTIVE

The ProYouth programme focuses on the promotion of mental health and the prevention of eating disorders (EDs) among young people. The aim of our study was to explore whether the programme can address individuals who are at risk for developing 2EDs.

METHOD

This study is designed as an online cross-sectional survey (n = 664, 12.2% men, 87.8% women, mean age: 24.9 years, SD = 5.4 years, range: 18-40 years). Measures included demographic data, self-reported weight and height, the Patient Health Questionnaire for Depression and Anxiety, Short Evaluation of Eating Disorders, Weight Concerns Scale and previous/current treatment for EDs.

RESULTS

In terms of severity of EDs, 22.9% (n = 152) of the screened participants were symptom free, 48.8% (n = 324) had considerable concerns about their weight, 11.1% (n = 74) were slightly impaired, 15.1% (n = 100) had severe impairment and 2.1% (n = 14) of participants are currently under treatment for EDs. In total, 56.3% of users (n = 374) registered in the programme. According to our results, those who had considerable concerns about their weight and individuals who were severely impaired registered with a greater odds to the programme than those who were symptom free [odds ratio (OR) = 1.64, p = .021 and OR = 1.90, p = .023, respectively]. Furthermore, those who previously received treatment for their ED registered to the programme with greater odds than those who did not (OR = 2.40, p = .017).

CONCLUSION

ProYouth successfully addressed those who have elevated concerns about their weight and who also registered with greater odds to the programme than those who were symptom free regarding EDs. The screening results show that there is a greater need for specialized care targeting EDs in Hungary than what is currently available.

International school mental health: global approaches, global challenges, and global opportunities

School mental health programs from developed countries demonstrate that both the practice and research are becoming more important to policy makers, educators, health providers, parents, and other stakeholders. Some United Nations agencies and other international organizations have begun work to advance school mental health internationally. School-based mental health programming needs to be considered as part of usual child and youth mental health policies and plans, whether those are national or other jurisdictional in nature. Currently, a paucity of evidence-based and cost effective child and youth global mental health policies/programs exist, limiting school-based mental health programs being developed, implemented, or sustained.

Evaluating the effects of a peer-support model: reducing negative body esteem and disordered eating attitudes and behaviours in grade eight girls

During adolescence girls become increasingly preoccupied with unrealistic ideals about body weight, often leading to dieting and unhealthy compensatory behaviours. These practices have been linked to adverse psychological, social, and health consequences. Peer-support groups offer promise in addressing risk factors for disordered eating. This study explored the effects of peer-support on measures of body satisfaction, weight loss/weight gain behaviour, internalization of media ideals, weight based teasing, and communication, for a cohort of grade 8 girls. High-risk participants demonstrated trends toward decreased internalization of media ideals and increased body satisfaction at post-test. Implications and future research direction are discussed.

The feasibility and acceptability of an approach to emotional wellbeing support for high school students

BACKGROUND

  Emotional wellbeing of young people has high global and national priority. UK high schools are under pressure to address this but lack evidence-based guidelines.

METHOD

  Students (N=23) (aged 11-16 years) and staff (N=27) from three urban UK high schools participated in qualitative interviews to explore the feasibility and acceptability of an approach to emotional wellbeing support. Key components were: self-referral, guided self-help, and delivery by school pastoral and support staff.

FINDINGS

  Confidentiality, emotional support, effectiveness and delivery modes were important to students. Organisational values influenced feasibility.

CONCLUSIONS

  Understanding a school's moral and operational framework can enhance the development of suitable emotional wellbeing support.

School counselors' knowledge of eating disorders

BACKGROUND

Twenty years ago, Price published a survey identifying knowledge deficits of school counselors regarding eating disorders. Our study surveys current school counselors to determine whether knowledge has increased and determine the availability of school-based prevention programming.

METHODS

School counselors from a single metropolitan area were surveyed prior to a mandatory in-service on eating disorders.

RESULTS

Of the 109 respondents, 55% felt eating disorders were a problem in their school. Very few felt "very competent" identifying (6%) or helping (2%) students with eating disorders. Today's school counselors were more likely to know a symptom of anorexia nervosa (AN) is missing at least three consecutive menstrual cycles and malnutrition is not a common cause of death for bulimia nervosa (BN).

CONCLUSIONS

While knowledge of AN and BN appear to have increased, school counselors still lack some basic understanding and report very low confidence in identifying and helping students with eating disorders.

Reduction of shape and weight concern in young adolescents: a 30-month controlled evaluation of a media literacy program

OBJECTIVE

Recent eating disorder prevention efforts have targeted high-risk females in late adolescence (>15 years). Methodologically rigorous evaluations of prevention programs directed to younger, mixed-sex, universal audiences are largely absent. The primary objective was to evaluate a theoretically informed media literacy program delivered to a mixed-sex, universal, young adolescent audience.

METHOD

Five hundred forty Grade 8 students (mean age 13.62 years, SD 0.37 years) from 4 schools participated with a total of 11 classes receiving the 8-lesson media literacy program (126 girls and 107 boys) and 13 comparison classes receiving their normal school lessons (147 girls and 160 boys). Shape and weight concern (primary outcome variable) and seven additional eating disorder risk factors (e.g., dieting, media internalization) were measured with validated questionnaires at baseline, postprogram, and 6- and 30-month follow-up.

RESULTS

Linear mixed model analyses were conducted using a 2 (group: media literacy program, control) x 3 (time: postprogram, 6-month follow-up, 30-month follow-up) x 2 (sex: girls, boys) mixed within-between design, with baseline entered as a covariate. Main effects for group, favoring the media literacy program, were found for shape and weight concern (effect size [ES] = 0.29), dieting (ES = 0.26), body dissatisfaction (ES = 0.20), ineffectiveness (ES = 0.23), and depression (ES = 0.26).

CONCLUSION

Media literacy can be an effective intervention for reducing shape and weight concern and other eating disorder risk factors long-term in a universal mixed-sex, young adolescent population. More evaluations of methodologically sound prevention programs are required with this demographic.

A preliminary controlled comparison of programs designed to reduce risk of eating disorders targeting perfectionism and media literacy

OBJECTIVE

The primary objective was to compare the efficacy of two eight-lesson programs, targeting perfectionism and media literacy compared to control classes in reducing eating disorder risk.

METHOD

Students from six classes (N = 127, mean age 15.0 years, SD 0.4) and two schools participated. Linear mixed-model analyses were conducted by group (3: perfectionism, media literacy, control), time (2: postprogram, 3-month follow-up) and eating disorder risk status (2: high, low), with baseline observations included as a covariate.

RESULTS

An interaction effect favoring the perfectionism program at 3-month follow-up was found for concern over mistakes (effect size 0.45). A main effect for group, also favoring the perfectionism program, was found for personal standards (effect size 0.44). High-risk participants (i.e., those with high levels of shape and weight concern at baseline) benefited most from the perfectionism program with reliable change indices indicating favorable rates of improvement beyond chance on all of the variables, whereas the media literacy and control participants experienced a comparable rate of change during the course of the study.

CONCLUSIONS

Targeting perfectionism represents a promising prevention option that requires further investigation in children of mid-adolescence age, and further investigation is required to determine the demographic most likely to benefit from media literacy.

Is Self-Objectification Related to Interoceptive Awareness? An Examination of Potential Mediating Pathways to Disordered Eating Attitudes

Although there has been considerable empirical support for Objectification Theory ( Fredrickson & Roberts, 1997 ), findings have been mixed regarding self-objectification's relationship to interoceptive awareness, an awareness of one's internal physical and emotional states. We examined whether interoceptive awareness mediated the relationship between self-objectification and disordered eating attitudes, exploring more specifically the relative contributions of difficulties recognizing feelings of hunger and satiety versus emotions. College women ( N = 195) completed measures assessing self-objectification, interoceptive awareness, awareness of emotions, and disordered eating attitudes. Self-objectification correlated significantly more strongly with interoceptive awareness when internal cues about hunger and satiety were assessed. The relationship between self-objectification and disordered eating attitudes was partially mediated by interoceptive awareness. Results revealed that interoceptive awareness may best be captured by a measure that includes lack of awareness of both hunger and satiety and emotional states. Research and clinical implications of these findings are discussed.

School prevention program for eating disorders in Croatia: a controlled study with six months of follow-up

The main purpose of this pilot study was to evaluate the efficacy of a schoolbased program of eating disorder prevention on a sample of young adolescents in Croatia. The program was designed to reduce dietary restraint and preoccupation with shape and weight. One hundred and thirty-nine students (69 boys and 70 girls; mean age 12.8 years) were evaluated; 75 participated in the program (experimental group) and 64 formed the control group. Outcome measures included eating disorder attitudes, dieting behavior, selfesteem, and knowledge of the topics covered by the program. Outcome measures were evaluated one week before the intervention, one week afterwards, and during a follow-up of 6 months. The program significantly reduced eating disorder attitudes and dieting behavior, and improved knowledge in the female experimental group. A significant and positive effect on eating disorders attitude and knowledge, but not on dietary habits, was noticed in the male experimental group. No significant effects were observed in the control group. The findings of this prevention program give encouraging results and should be evaluated in further studies on larger samples.

Interventions for preventing eating disorders in children and adolescents

BACKGROUND

Eating disorders represent an extremely difficult condition to treat and patients consume an enormous amount of mental health energy and resources. Being young, female, and dieting are some of the few identified risk factors that have been reliably linked to the development of eating disorders, and several prevention eating disorder prevention programs have been developed and trialed with children and adolescents. The purpose of this systematic review is to evaluate the effectiveness of eating disorder prevention programs for children and adolescents both in the general population and those determined to be at risk.

OBJECTIVES

1. To determine if eating disorder prevention programs are effective in promoting healthy eating attitudes and behaviours in children and adolescents; 2. To determine if eating disorder prevention programs are effective in promoting psychological factors that protect children and adolescents from developing eating disorders; 3. To determine if eating disorder prevention programs are effective in promoting satisfactory physical health in children and adolescents; 4. To determine if eating disorder prevention programs have a long-term, sustainable, and positive impact on the mental and physical health of children and adolescents; and, 5. To determine the safety of eating disorder prevention programs in terms of possible harmful consequences on the mental or physical health of children and adolescents.

SEARCH STRATEGY

Relevant trials are identified through searching the Cochrane Controlled Trial Register (CCTR) and relevant biomedical and social science databases. All terms necessary to detect prevention programs and the participant groups are used. A strategy to locate randomised controlled trials is used. Other sources of information are the bibliographies of systematic and non-systematic reviews and reference lists from articles identified through the search strategy. In order to identify unpublished studies, experts in the field are contacted by letter and/or electronic mail.

SELECTION CRITERIA

Randomised controlled trials (RCT) with a major focus on eating disorder prevention programs for children and adolescents, where there is no known DSM-IV diagnosis of an eating disorder, are eligible for inclusion in the review. Trials must include a control group and at least one objective outcome measure (eg. BMI) or a standardised psychological measure used with the intervention and control group, pre- and post-intervention.

DATA COLLECTION AND ANALYSIS

A total of 1379 titles have been identified through the search to date. 13 studies were located that reported use of a randomised controlled trial methodology and were critically appraised by two independent reviewers. Five (5) studies were excluded as data were not reported in a useable form or useable data could not be obtained from the trial authors, one dissertation could not be obtained, one study had no "true" no-treatment or usual treatment control group, and one study did not use a pre-test outcome measure. Eight (8) studies met the selection criteria outlined above.

MAIN RESULTS

Only one of eight pooled comparisons of two or more studies using similar outcome measures and similar intervention types demonstrated the statistically significant effect of a particular type of eating disorder prevention program for children and adolescents. Combined data from two eating disorder prevention programs based on a media literacy and advocacy approach indicate a reduction in the internalisation or acceptance of societal ideals relating to appearance at a 3- to 6-month follow-up (Kusel, unpublished; Neumark-Sztainer2000) [SMD -0.28, -0.51 to -0.05, 95% CI]. However, there is insufficient evidence to conclude that this approach also demonstrated a significant impact on awareness of societal standards relating to appearance. There is insufficient evidence to support the effect of four programs designed to address eating attitudes and behaviours and other adolescent issues on body weight, eating disorder symptoms, associated eating disorder psychopathology or general psychological and physical well-being in the general sample or those classified as being at high risk for eating disorder (Buddeberg-F 1998; Killen 1993/1996; Santonastaso 1999; Zanetti 1999). Given only one program used a psychoeducation approach to prevent bulimia nervosa (Jerome, unpublished) and only one program adopted a focus on self-esteem (O'Dea 2000), the effect of these approaches could not be evaluated via meta-analyses. In relation to potential harmful effects, there is not sufficient evidence to suggest that harm resulted from any of the prevention programs included in the review.

REVIEWER'S CONCLUSIONS

The one significant pooled effect in the current review does not allow for any firm conclusions to be made about the impact of prevention programs for eating disorders in children and adolescents, although none of the pooled comparisons indicated evidence of harm. From a clinical perspective, the development and refinement of prevention programs is complicated by a lack of knowledge about risk factors associated with eating disorders and the need to strike a balance between delivering preventive interventions for eating disorders and considering the potential to cause harm. From a research perspective, the idea of "thresholds" for identifying young people at risk of developing eating disorders has been raised, and denial of concern or denial of illness represents a further issue complicating early identification in relation to eating disorder symptomatology. Longer-term effects of the intervention approaches will need to be monitored across development in order to demonstrate a decline in the incidence of eating disorders and associated risk factors.