Eating disorders (EDs) are serious health problems affecting college students. This paper aimed to estimate the costs, in United States (US) dollars, of a stepped care model for online prevention and treatment among US college students to inform meaningful decisions regarding resource allocation and adoption of efficient care delivery models for EDs on college campuses. Methods Using a payer perspective, we estimated the costs of (1) delivering an online guided self-help (GSH) intervention to individuals with EDs, including the costs of “stepping up” the proportion expected to “fail”; (2) delivering an online preventive intervention compared to a “wait and treat” approach to individuals at ED risk; and (3) applying the stepped care model across a population of 1,000 students, compared to standard care. Results Combining results for online GSH and preventive interventions, we estimated a stepped care model would cost less and result in fewer individuals needing in-person psychotherapy (after receiving less-intensive intervention) compared to standard care, assuming everyone in need received intervention. Conclusions A stepped care model was estimated to achieve modest cost savings compared to standard care, but these estimates need to be tested with sensitivity analyses. Model assumptions highlight the complexities of cost calculations to inform resource allocation, and considerations for a disseminable delivery model are presented. Efforts are needed to systematically measure the costs and benefits of a stepped care model for EDs on college campuses, improve the precision and efficacy of ED interventions, and apply these calculations to non-US care systems with different cost structures.

Objective The objectives were to identify and predict patterns of weight control behavior in 15 year old (yo) girls and to examine weight control group differences in energy intake. Method Subjects included 166 girls assessed every 2 years (ys) from age 5 to 15. Latent class analysis was used to identify patterns of weight control behaviors. Antecedent variables (e.g. inhibitory control at 7ys), and concurrent variables (e.g. BMI and dietary intake at 15ys) were included as predictors. Assessments were a combination of survey, interview, and laboratory measures. Results LCA identified four classes of weight control behaviors, Non-dieters (26%), and three dieting groups: Lifestyle (16%), Dieters (43%), and Extreme Dieters (17%). Levels of restraint, weight concerns, and dieting frequency increased across groups, from Non-dieters to Extreme Dieters. BMI at 5ys and inhibitory control at 7ys predicted weight control group at 15ys; e.g. with every one-point decrease in inhibitory control, girls were twice as likely to be Extreme Dieters than Non-dieters. Girls in the Extreme Dieters group were mostly classified as under-reporters, and had the lowest self-reported intake, but ate significantly more in the laboratory. Discussion Among 15yo girls, “dieting” includes a range of both healthy and unhealthy behaviors. Risk factors for membership in a weight control groups are present as early as 5ys. Patterns of intake in the laboratory support the view that lower reported energy intake by Extreme Dieters is likely due under-reporting as an intent to decrease intake, not actual decreased intake.