Universal prevention efforts should address eating disorder pathology across the weight spectrum: Implications for screening and intervention on college campuses

Abstract

Purpose Given shared risk and maintaining factors between eating disorders and obesity, it may be important to include both eating disorder intervention and healthy weight management within a universal eating disorder care delivery program. This study evaluated differential eating disorder screening responses by initial weight status among university students, to assess eating disorder risk and pathology among individuals with overweight/obesity versus normal weight or underweight. Methods 1529 individuals were screened and analyzed. Screening was conducted via pilot implementation of the Internet-based Healthy Body Image program on two university campuses. Results Fifteen percent of the sample had overweight/obesity. Over half (58%) of individuals with overweight/obesity screened as high risk for an eating disorder or warranting clinical referral, and 58% of individuals with overweight/obesity endorsed a ≥10-pound weight change over the past year. Compared to individuals with normal weight or underweight, individuals with overweight/obesity were more likely to identify as Black, endorse objective binge eating and fasting, endorse that eating disorder-related concerns impaired their relationships/social life and made them feel badly, and endorse higher weight/shape concerns. Conclusions Results suggest rates of eating disorder pathology and clinical impairment are highest among students with overweight/obesity, and targeted intervention across weight categories and diverse races/ethnicities is warranted within universal eating disorder intervention efforts. Integrating eating disorder intervention and healthy weight management into universal prevention programs could reduce the incidence and prevalence of eating disorders, unhealthy weight control practices, and obesity among university students.

Weight, reference points, and the onset of eating disorders

“…This is in line with the considerations of epidemiologists that purging is a symptom of a number of EDs (Steinhausen et al, 2005). In fact, individuals who endorse any purging behavior are given a clinical referral, they are not just identified as high risk (Keel et al, 2005;Kass et al, 2017).…”

A controlled study of an integrated prevention program for improving disordered eating and body image among Mexican university students: A 3‐month follow‐up

“…Similar results were also found in the previous mentioned integrated programs. Recent study by Kass et al (), 1,529 students were screening and after intervention using an Internet‐based Healthy Body Image program on two university campuses showed important results. Students with overweight/obesity endorsed higher ED pathology, clinical impairment, and weight changes compared with students with normal weight or underweight.…”

“…Regarding prevention implications, prevention programs that endorse an integrated approach to eating and weight‐related problems are still nascent in countries such as Mexico. Integrating ED intervention and healthy weight management into universal prevention programs could reduce the incidence and prevalence of EDs, unhealthy weight control practices, and obesity among university students (Kass et al, ; Wilksch et al, ). Unfortunately, apart from those involved in psychology and/or nutrition studies, there appears to be little interest in this issue despite the fact that overweight issues and obesity have become epidemically alarming and require urgent attention (Gutiérrez et al, ).…”

“…Only seven integrated prevention programs were found after our review (Haines, Neumark‐Sztainer, Perry, Hannan, & Levine, ; Kass et al, ; McVey, Tweed, & Blackmore, ; Neumark‐Sztainer et al, ; Sánchez‐Carracedo et al, ; Sánchez‐Carracedo et al, ; Stice, Rohde, Shaw, & Marti, ; Wilksch et al, ). These programs were, however, designed and implemented mainly for younger ages (10–15 year olds), except Stice, Rohde, Shaw, et al () or Kass et al () aimed to university students. Although all of these programs reported promising results, the fact that most of them have been implemented in North American English‐speaking contexts, this may severely limit their wider application to other countries or implemented in young adult sample.…”

Eating disorder symptoms across the weight spectrum in Australian adolescents

“…In one of the only population-based studies to examine disordered eating across the weight spectrum, the third wave of the U.S. National Longitudinal Study of Adolescent to Adult Health conducted in 2001Health conducted in to 2002, symptoms such as fasting, selfinduced vomiting, and binge eating were found to be more common in young adults with overweight or obesity (18-24 years) than in young adults who were underweight or normal weight (Nagata, Garber, Tabler, Murray, & Bibbins-Domingo, 2018). Studies of adults and university students report similar findings (Duncan, Ziobrowski, & Nicol, 2017;Kass et al, 2017;Lipson & Sonneville, 2017). Such largescale studies broaden our understanding of eating disorder symptoms across the weight spectrum, but the focus on adults and older adolescents limits extrapolation to earlier adolescence when the onset of eating disorders is at its peak.…”