Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

Abstract

Background Fasting is an unhealthy behavior that has been frequently used as part of weight loss attempts. To date, little research has been conducted to determine the prevalence and substance use and mental health correlates of fasting among college students. Therefore, the aim of this study was to estimate the prevalence and associations between any (≥ 1 time) and regular (≥ 13 times) occurrences of fasting in the past 4 weeks and substance use and mental health correlates among a large sample of college students from 2016 to 2020. Methods Data from four academic survey years (2016–2020; N = 8255) of the national (USA) Healthy Minds Study were analyzed. Unadjusted prevalence of any and regular fasting by survey year and gender was estimated. Multiple logistic regression analyses were conducted to estimate the associations between any and regular fasting and the demographic (age, body mass index, race/ethnicity, sexual orientation, highest parental education), substance use (cigarette use, marijuana use, other illicit drug use, alcohol use), and mental health (depression, anxiety, eating disorder symptoms, suicidal ideation, non-suicidal self-injury) correlates. Results Any fasting in the past 4 weeks was common among both men (14.77%) and women (18.12%) and significantly increased from 2016 (10.30%) to 2020 (19.81%) only among men. Regular fasting significantly increased among both men and women from 2016 (men: 1.46%; women: 1.79%) to 2020 (men: 3.53%; women: 6.19%). Among men and women, both any and regular fasting in the past 4 weeks were associated with higher odds of all mental health symptoms, including a positive depression, anxiety, and eating disorder screen, suicidal ideation, and non-suicidal self-injury. Among women, but not men, any and regular fasting in the past 4 weeks were associated with higher odds of marijuana use and other illicit drug use (e.g., cocaine, ecstasy). Conclusions The results from this study underscore both the high and increasing prevalence of fasting among a national sample of college students, as well as the substance use and mental health symptoms associated with this behavior. Healthcare professionals both on and off campus should consider screening for fasting behaviors among college students and provide appropriate intervention when needed.

Changes in the prevalence and sociodemographic correlates of eating disorder symptoms from 2013 to 2020 among a large national sample of U.S. young adults: A repeated cross‐sectional study

“…T A B L E 3 (Continued) Mitchison et al, 2012Mitchison et al, , 2017 and point-prevalence estimates from separate national U.S. samples in recent decades (Ganson et al, 2021;Hart et al, 2020;Hudson et al, 2007;Liechty & Lee, 2013;Lipson & Sonneville, 2017). Notably, although both ED symptoms and mental healthcare prevalence estimates increased over time, very few participants with current probable EDs received mental healthcare from 2013 (25.20%) to 2020 (38.03%).…”

“…To our knowledge, only one study has examined recent changes in specific ED symptoms within a national U.S. sample and these data suggest that the magnitude of increases in certain ED symptoms may differ from those identified for national samples in Australia. Specifically, comparably larger increases in fasting prevalence were identified between 2016 (men = 10%, women = 17%) and 2020 (men = 20%, women = 27%) among college students throughout the United States (Ganson et al, 2021) when compared to population‐based prevalence estimates for fasting/strict dieting between 1995 (1%) and 2015 (5%) among Australian adolescents and adults (Da Luz et al, 2017).…”

“…In addition to changes in ED symptoms that have may have emerged in the United States in general, the direction and magnitude of these time‐trends have likely varied for different sociodemographic groups. Younger age groups, girls and women, transgender and gender diverse populations, sexual minority populations, and individuals living in larger bodies have historically experienced a disproportionate risk of exhibiting elevated ED symptoms and receiving clinical ED diagnoses relative to older populations, boys and men, cisgender populations, heterosexual populations, and individuals living in smaller bodies, respectively (Ganson et al, 2021; Kessler et al, 2013; Lipson & Sonneville, 2017; Qian et al, 2021; Romano & Lipson, 2021; Udo & Grilo, 2018). In contrast, findings of ED prevalence across diverse racial and ethnic groups have been more variable, with some studies suggesting that prevalence estimates for ED symptoms are comparable across racial and ethnic groups (Marques et al, 2011; Perez et al, 2016) whereas others have identified notable yet inconsistent disparities (Ganson et al, 2021; Lipson & Sonneville, 2017; Solmi et al, 2014; Udo & Grilo, 2018).…”

“…Younger age groups, girls and women, transgender and gender diverse populations, sexual minority populations, and individuals living in larger bodies have historically experienced a disproportionate risk of exhibiting elevated ED symptoms and receiving clinical ED diagnoses relative to older populations, boys and men, cisgender populations, heterosexual populations, and individuals living in smaller bodies, respectively (Ganson et al, 2021; Kessler et al, 2013; Lipson & Sonneville, 2017; Qian et al, 2021; Romano & Lipson, 2021; Udo & Grilo, 2018). In contrast, findings of ED prevalence across diverse racial and ethnic groups have been more variable, with some studies suggesting that prevalence estimates for ED symptoms are comparable across racial and ethnic groups (Marques et al, 2011; Perez et al, 2016) whereas others have identified notable yet inconsistent disparities (Ganson et al, 2021; Lipson & Sonneville, 2017; Solmi et al, 2014; Udo & Grilo, 2018). Although it is unknown whether these documented disparities in ED symptom prevalence have widened or narrowed over the past decade among large national samples in the United States, earlier repeated cross‐sectional data from representative samples of Australian adolescents and adults indicated that the magnitudes of increases in fasting/strict dieting and purging behaviors (but not binge eating) from 1998 to 2008 were larger among males versus females (Mitchison et al, 2014).…”

Using Illicit Drugs to Lose Weight among Recovering Female Drug Users in China: An Exploratory Qualitative Study

“…Prior research has shown that there is a significant positive relationship between female adolescents’ substance use behaviors (including the use of alcohol, cigarettes, and illicit drugs such as marijuana and cocaine) and weight control attitudes and activities [ 14 , 15 ]. Body perception and weight loss expectations have been found to impact heavily on women’s illicit drug use [ 16 , 17 , 18 , 19 ].…”