Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students

Background Binge eating and purging behaviors (BPB) are common among college students, but evidence is scant on prevalence and associations of BPB with mental health problems and objective academic performance. This study aims to investigate: (a) 12‐month prevalence of BPB among college first‐year students, (b) comorbidity patterns of BPB with various mental health problems, and (c) the association of BPB with objective academic functioning. Methods Using data from the Leuven College Surveys (Belgium), as part of the World Mental Health Surveys International College Student initiative, we cross‐sectionally assessed 12‐month BPB and mental health problems among college first‐year students (n = 4,889; response rate = 73.2%) at the beginning of the academic year. Objective measures of academic functioning (final grades, expressed in academic year percentage “AYP” [0–100%] and academic failure) were obtained from administrative records at the end of the academic year. Results Twelve‐month prevalence of BPB was 7.6% (7.3%binge eating and 1.0%purging), with higher rates among females than males. Bivariate models showed an association between BPB and numerous mental health problems (ORs = 3.4–18.4). Multivariate models showed associations with non‐suicidal self‐injury, post‐traumatic stress, internalizing/externalizing problems and suicidal ideation. After controlling for sociodemographic characteristics and comorbid mental health problems, BPB were still associated with lower AYP (−4.1 to −11.2% range) and elevated odds of academic year failure (ORs = 1.4–4.2). Conclusions BPB (especially binge eating) are relatively common and associated with mental health problems, comparatively low academic performance, and higher risk of academic failure among college first‐year students. Further study is needed to examine the causal dynamics underlying these associations.

Section: Discussionmentioning

confidence: 99%

“…Relatedly, it is unclear what proportion of students with 12-month BPB of our sample would also meet full threshold disorder criteria. Emerging evidence shows that 10.5% of college students engaging in disordered eating behaviors also fulfill the diagnostic criteria for an eating disorder (Sonneville & Lipson, 2018).…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Binge eating and purging in first‐year college students: Prevalence, psychiatric comorbidity, and academic performance

Serra

Kiekens

Vanderlinden

et al. 2019

“…Furthermore, although in this study eating disorder symptoms tended to be more prevalent among girls, boys with obesity tended to have higher prevalence of binge eating and excessive exercise than their female counterparts. Clinicians' biases regarding who is vulnerable to eating disorder symptoms combined with the current diagnostic criteria (e.g., underweight criterion for AN) may lead to underdiagnosis and delayed treatment (Sim, Lebow, & Billings, 2013;Sonneville & Lipson, 2018). This study reinforces that clinicians need to be aware of such biases and the limitations of current diagnostic criteria and ensure they consider and enquire about eating disorder symptoms regardless of weight and sex.…”

Section: Prevalence By Weight Statusmentioning

confidence: 59%

“…The second BN symptom, overvaluation of weight and shape for self-worth, was particularly prevalent, with 17% of all adolescents and 33% of girls with obesity endorsing this symptom. An additional limitation was that the total prevalence of eating disorders inclusive of all diagnostic groups was not able to be estimated as the BET did not assess DSM-5 (Sim, Lebow, & Billings, 2013;Sonneville & Lipson, 2018). Despite this, the measure used in the current study also has limitations.…”

Section: Prevalence By Weight Statusmentioning

confidence: 95%

Eating disorder symptoms across the weight spectrum in Australian adolescents

Hughes

Kerr

Patton

et al. 2019

Objective: Despite known associations between eating disorders and obesity, little is known about the current prevalence of symptoms of eating disorders across the weight spectrum. This study therefore aimed to estimate the population prevalence of eating disorder symptoms in relation to weight status in adolescents.Method: The sample comprised 3,270 participants (14-15 years; 52% boys) drawn from Wave 6 of the Longitudinal Study of Australian Children. Symptoms of anorexia nervosa (AN) and bulimia nervosa (BN) were assessed using self-report on the Branched Eating Disorder Test. This measure identifies clinically significant symptoms in the past 3 months according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Using study-derived cross-sectional population weights, the prevalence of each symptom was estimated for the total population and by sex and weight status.Results: The estimated population prevalence was high (14.3-25.7%) for body image symptoms such as fear of weight gain and overvaluation of body weight but lower (0.5-3.7%) for behavioral symptoms such as binge eating and compensatory behaviors. Symptoms were more prevalent among adolescents with overweight or obesity.Although most symptoms tended to have higher prevalence among girls than boys, boys with obesity had higher prevalence of binge eating and excessive exercise than girls with obesity. The overall estimated population prevalence for AN and BN was 0.20% and 0.10%, respectively. Discussion:The study highlights a need for clinicians to be cognizant of disordered eating behaviors regardless of weight status and has implications for both eating disorder and obesity prevention and intervention. K E Y W O R D Sadolescents, anorexia nervosa, bulimia nervosa, eating disorders, obesity, overweight, prevalence

“…Lastly, there exist outdated presumptions that EDs predominately affect young, white females, which have likely contributed to discrepancy in diagnosis and treatment rates across socio-demographic groups (Becker, Franko, Speck, & Herzog, 2003;Sonneville & Lipson, 2018;Strother, Lemberg, Stanford, & Turberville, 2012). For example, stigma associated with ED in men likely increases treatment-seeking barriers (Griffiths et al, 2015;Murray et al, 2017;Thapliyal & Hay, 2014).…”

mentioning

confidence: 99%

Willingness of individuals with eating disorders to participate in health research

Nutley

Varma

Chen

et al. 2019

Background/Aims: This study examines the association between eating disorders (EDs) and willingness to participate in health research studies among community members. Materials & Method: Data were collected from Health Street, a University of Florida community engagement initiative which aims to reduce disparities in healthcare and health research by direct engagement of community members. Results: Among 8,226 community members, 3.9% (n = 324) reported a lifetime ED. For all six types of health research studies queried, individuals with a lifetime ED reported a higher willingness to participate in health research compared to individuals without a history. After adjusting for selected covariates, individuals with ED were significantly more likely than individuals without ED to say they would be willing to volunteer for research studies that: ask questions about health (OR: 7.601, 95% CI: [1.874, 30.839]); require an overnight stay in a hospital (OR: 2.041, 95% CI: [1.442, 2.889]); and provide no remuneration (OR: 1.415, 95% CI: [1.022, 1.958]). Furthermore, when compared to individuals with anxiety or depression, individuals with ED reported increased interest in research participation and increased willingness to participate in most types of research studies assessed. After stratifying by gender and race, we observed few differences in willingness to participate in research among individuals with ED. Discussion: These findings contribute to our current understanding of participant recruitment and enrollment in ED health research. Underrepresented populations who often do not seek treatment for EDs endorsed a high willingness to participate.Conclusion: Future studies will likely benefit from including community members in ED research. K E Y W O R D Scommunity-based participatory research, epidemiology, feeding and eating disorders, mental disorders, sampling bias, treatment seeking