Unhealthy weight control methods and body image concerns, which may predispose to clinical and subclinical eating disorders, are widespread among college students. The primary aim of this application is to determine if reducing eating disorders risk-factors (excessive weight/shape concerns and/or bingeing) in female college students reduces the incidence of these disorders. Secondary aims are to evaluate the long-term effects, of a moderated, interactive, multimedia intervention to: reduce potential risk factors for eating disorders, determine the importance of weight gain, evaluate the role of upsetting events, detect new onset of other psychiatric disorders or alcohol and drug abuse on precipitating subclinical/clinical eating disorders. Six hundred sixty students at high risk of developing eating disorders from 3 different colleges/universities will be selected for the project. Students will be selected as being at risk based on high scores on the weight concerns scale. High-risk students will then be randomized into a multimedia risk-reduction program or to no-intervention and followed for up to two-and-a-half years. We expect that 10 percent of the students in the high-risk untreated group will develop eating disorders in one year and that the intervention will reduce this rate by 50 percent (a 5 percent difference). The multimedia risk-reduction program was chosen for the intervention because it was proven effective in a series of pilot studies and can be provided to students at relatively low cost. The intervention is a structured 9-week program which includes sections on reducing body image and weight/shape concerns, the risks of eating disorders, and increasing healthy weight regulation practices. The program also includes weekly readings and writing assignments and participation in a moderated electronic discussion group. The program automatically monitors adherence. Quarterly booster sessions will be provided to help ensure maintenance of risk factor reduction. The primary outcome measure will be one-year incidence of eating disorders determined by a diagnostic interview. Secondary outcome measures will include weight concerns, eating disorder symptoms, body shape and eating disorder attitudes, distress and treatment seeking. Changes in BMI, the occurrence of major stressors and psychiatric events will also be assessed to determine their impact on the incidence of eating disorders. Incidence rates will be compared using a chi-square statistic. Survival analyses and other multivariate statistics will be used to examine secondary hypotheses and exploratory analyses. The application focuses on issues relevant to recently described NIMH priorities in prevention. Developing and evaluating interventions to reduce eating disorders in this high-risk population is of extreme public health importance.
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