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Am Fam Physician. 2006;74(11):1943-1944

Anorexia nervosa, bulimia, and binge eating occur in about 2 to 4 percent of adolescent and young adult women. The incidence of these disorders peaks at 16 to 20 years of age, which corresponds with the time young women enter college. High school and college students commonly use unhealthy weight regulation and have body image concerns that predispose them to eating disorders. In addition, 35 to 45 percent of adolescent girls state that they are too fat, have difficulties with weight control, and want to lose weight. Persons with eating disorders tend to have low self-esteem, shame, and other psychological problems. Laxative abuse and self-induced vomiting can cause significant adverse physical conditions. Identifiable risk factors for eating disorders include excessive weight and body shape concerns. Using this information, prevention programs are being developed to reduce the incidence of eating disorders. Taylor and associates evaluated an Internet-based psychological intervention program aimed at preventing eating disorders in at-risk young women.

The randomized controlled trial included women 18 to 30 years of age from two metropolitan areas who were at high risk of developing eating disorders. Participants had to have a body mass index (BMI) of 18 kg per m2 or higher and less than 32 kg per m2 and could not have an eating disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Those who met the inclusion criteria were randomly selected to receive an Internet-based cognitive behavior intervention (Student Bodies) or were placed on a waiting list with no intervention until after the conclusion of the study. Student Bodies is an eight-week program to reduce body dissatisfaction and excessive weight concerns that includes Internet-based information and a weekly online discussion group moderated by a clinical psychologist or psychology graduate student. At nine months, the intervention group was offered a two-week review course. The participants were studied for up to three years. The main outcome was time to onset of subclinical or clinical eating disorders. Other outcomes included score changes on the Weight Concern Scale, Global Eating Disorder Examination Questionnaire, and Eating Disorder Inventory.

There were 480 participants. The intervention group had significantly lower scores on the Weight Control Scale for years 1 and 2 compared with the control group. In addition, the intervention group had greater reduction in the slope on the Weight Concerns Scale compared with the control group. Eating disorders were reduced in two subgroups: those with BMIs of 25 kg per m2 or greater and those with baseline compensatory behaviors such as self-induced vomiting; laxative, diuretic, or diet pill use; and driven exercise. There were no participants with an elevated BMI at baseline who developed eating disorders; however, in the control group, 4.7 percent at year 1 and 11.9 percent at year 2 developed eating disorders.

The authors conclude that an Internet-based cognitive behavior program can significantly reduce weight and body shape concerns among college-age women at risk of eating disorders. They note that these programs also may reduce the onset of eating disorders in some high-risk groups.

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