On-Line Program May Avert Eating Disorders in High-Risk Women

STANFORD, Calif., Aug. 7 -- Abnormal body-image concerns and the risk of a full-blown eating disorder in high-risk college-age women can be significantly reduced by an Internet-based behavioral intervention, researchers here reported.

In a randomized, controlled trial of 480 women (ages 16 to 20) at risk for an eating disorder, an eight-week psycho-social intervention, called "Student Bodies," was most successful among overweight women with a BMI of 25 or more, according to a report in the August issue of the Archives of General Psychiatry.

Of those in the intervention group with a BMI over 25, none developed an eating disorder after two years, whereas 11.9% of the equal-weight controls did, said C. Barr Taylor, M.D., of Stanford, and colleagues. The program was tested in the San Francisco area and in San Diego.

The program also appeared to help a subgroup of women in the San Francisco area with early symptoms of an eating disorder and low-level baseline compensatory behaviors, such as self-induced vomiting, laxative, diet-pill or diuretic use, or excessive exercise, the researchers reported. Of those in the intervention group, 14% developed an eating disorder within two years versus 30% of the controls, the researchers said.

Altogether, over the course of a three-year follow-up, 43 participants (9%) were classified as having a subclinical or clinical eating disorder, mainly bulimia nervosa or binge-eating disorder, the researchers said. Although the onset of an eating disorder between the groups was not significantly different, differences in the subgroups, constituting about half the sample, were significant, the researchers said.

The on-line program included a psychologist-moderated online discussion group. Each week, when a participant logged onto the program, she was directed to the updated weekly program content. Participants were expected to read the material and comply with the accompanying assignment, which included self-monitoring, writing entries in a journal, and participation in online discussion group.

The core goals of the program were to reduce weight and shape concerns, enhance body image, promote healthy weight regulation, avoid binge eating, and increase knowledge about the risk associated with an eating disorder.

Attitude measurements, in addition to the actual onset of an eating disorder, included change in scores on the Weight Concerns Scale, Global Eating Disorder Examination Questionnaire, and Eating Disorder Inventory drive for thinness, and bulimia subscales and depressed mood.

The most important finding was that the intervention led to sustained reductions in weight and shape concerns in two subgroups of college-age women at high risk. The peak age for the onset of an eating disorder appears to be around 16 to 20 years, about the time when young women begin leaving home and starting college, the researchers said.

Both groups continued to improve over time, the researchers said, suggesting that improvement may be the result of statistical regression or the normal development among college women. The changes in both groups occurred with no overall changes in BMI, suggesting that weight loss was not a factor in the participants' feelings about their weight and shape.

There are a number of research and delivery issues related to a stepped-care program, but this study provides an important step in that direction, Dr. Taylor said. "To our knowledge this is the first study to show that eating disorders can be prevented in a high-risk group."

An Internet-based intervention has the advantage of facilitating rapid dissemination, the researchers said, noting that its most significant cost was related to the highly trained discussion-group moderators. About one to two hours per week were required to moderate groups of 10 to 20 participants. Future studies might explore ways to provide less expensive moderators, they suggested.

They also wrote that the results cannot be widely generalized because there were differences in the baseline characteristics and treatment responses between the two sites in the study. Also, they said, the rate of compliance with the program was very high-nearly 80% of the Web pages were read-suggesting that the participants were unusually motivated.

In addition, they noted, the program required use of a computer, eliminating those with no such access. However, Dr. Taylor concluded, Internet-based programs may be a good first step in a program designed to screen women at potential risk for an eating disorder.