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Internet Program Promising In Averting Eating Disorders

Can a cognitive-behavioral intervention delivered via the Internet prevent eating disorders? A new study says it can, highlighting the promise of harnessing new technology for therapeutic gains.

One of the newest trends in psychiatric science is investigating whether mental illnesses can be prevented. In fact, a few efforts to date have already produced positive results.

For example, an air Force suicide prevention program has been found effective (Psychiatric News, December 17, 2004). A brief intervention was recently found to prevent depression in high-risk patients in primary care settings (Psychiatric News, may 19).

And now a novel strategy for preventing eating disorders seems to be effective as well. "To our knowledge, this is the first study to show that eating disorders can be prevented in high-risk groups," the investigators asserted in their study report, which appeared in the august Archives of General Psychiatry. The lead researcher was C. Barr Taylor, M.D., a professor of psychiatry at stanford university.

Some 3 percent of young american women are estimated to have anorexia nervosa, bulimia, or binge-eating disorder. Moreover, a number of studies have found that excessive concerns about one's weight and shape often herald the onset of eating disorders. So Taylor and his group designed an internet-based cognitive-behavioral program called student Bodies to reduce such excessive concerns and then tested it, in small samples and over the short term, and found that it worked. Then they conducted a large longitudinal study not only to determine whether they could confirm the results they had obtained in their pilot inquiries, but also to determine whether student Bodies might be able to prevent eating disorders.

As subjects for the study, Taylor and his group sought college women who were excessively concerned about their weight and shape, but who were also within a normal weight range (with a body mass index between 18 and 32) and did not have an eating disorder. Recruitment occurred in three waves between november 13, 2000, and october 10, 2003. The women were screened for body mass index, image and weight concerns, and eating disorders.

For the eight-week study, half of the 480 women who qualified to participate were randomized to receive student Bodies, while the other half were placed on a wait list, meaning that they too could go through the program at the end of follow-up.

The subjects were followed up for one to three years. Participants recruited during wave one were assessed annually for up to three years, participants recruited during wave two were assessed annually for up to two years, and participants recruited during wave three were assessed at one year.

Regardless of whether subjects were in the intervention or control group, their body mass indexes remained remarkably stable during the years of follow-up. Nonetheless, the intervention group experienced a significantly greater reduction in concerns about body image and weight than the control group did. This finding confirmed what the researchers had found in their pilot inquiries—that the student Bodies program can indeed temper young women's obsessive concerns about their body image and weight.

Regarding the development of eating disorders, there was no significant difference between the control group and the entire intervention group. However, there was one between the control group and two subgroups of the intervention group. One subgroup was women with a body mass index of 25 or more. The other was women who engaged in behaviors that often lead to an eating disorder, such as diet-pill use, obsessive exercise, laxative use, or self-induced vomiting. Thus, the student Bodies program seems to have prevented the onset of eating disorders in some of the participants in these two subgroups.

Taylor commented to Psychiatric News on why he thought exposure to student Bodies had led to significantly reduced onset of eating disorders in these two subgroups, but not in the others who had received it. The women in the two subgroups, he said, were "probably more motivated and at higher risk."

"This is a carefully conducted and important study that indicates that progress is being made toward the development of programs to prevent eating disorders, one of the most important, but most difficult, problems in the field," B. Timothy Walsh, M.D., director of the eating Disorders Research unit at new york state Psychiatric institute, told Psychiatric News. "There were a number of critical facets to the study. For example, the intervention was not provided to all students, but only to those who showed evidence of being at increased risk for developing an eating disorder. It is also notable that the intervention was successfully delivered over the internet, highlighting the promise of harnessing new technologies for therapeutic gains."

The study was funded by the national institute of mental Health.

"Prevention of Eating Disorders in At-Risk College-Age Women" is posted at <http://archpsyc.ama-assn.org/cgi/content/full/63/8/881>.

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