Bodies of Evidence
Tuesday, October 31, 2006
The programs have catchy names like "Food, Mood and Attitude" and "Full of Ourselves" as well as an ambitious goal: to prevent adolescent eating disorders, which tend to be chronic, difficult to treat and sometimes fatal.
But do they work?
In the case of one such program -- "Student Bodies," developed by researchers at Stanford University -- a recently published study suggests that the answer is yes. Stanford researchers, who followed 480 female California college students for up to two years, report that the eight-week Internet-based program reduced the development of eating disorders in women at high risk.
"This study shows that innovative intervention can work," said Thomas Insel, director of the National Insitute of Mental Health, which funded the study; its findings appeared in the August issue of the Archives of General Psychiatry.
Prevention programs for eating disorders have proliferated in the past decade, in part because of the high cost and low success rate of treatment programs. The disorders include a constellation of problems, including anorexia, a pathological fear of gaining weight marked by self-starvation. Anorexia has the highest mortality rate of any psychiatric illness: About 10 percent of patients hospitalized for treatment ultimately die of the disorder.
An estimated 4 percent of teenage girls and young women suffer from anorexia or bulimia, which is marked by recurrent binging and purging, or binge-eating disorder, in which sufferers gorge themselves until they become sick. Another 4 percent are believed to suffer from less severe subclinical forms of these disorders, which can last a lifetime and wreak physical and emotional havoc. The incidence of the disorders has doubled in the past 40 years, according to statistics compiled by the Eating Disorders Coalition, a Washington advocacy group.
"This study is a very significant piece of research because it demonstrates that one can transfer what's known about risk factors into a program that can be applied at very low cost," said Michael Levine, an eating disorders expert who is a professor of psychology at Kenyon College in Ohio. "And it gives every indication of being able to reduce important risk factors" for eating disorders such as excessive concern about body image and weight.
"I can't think of a single computer-based eating disorders program that can hold a candle to these results," said University of Texas psychologist Eric Stice, who two years ago conducted a meta-analysis and found that about 20 percent of eating disorders programs have a statistically significant benefit. Few programs, he said, have involved as many subjects or long-term follow-up as the Stanford approach. Programs achieving the best results, Stice said, are targeted at high-risk subjects rather than the general population of teenagers, involve girls 15 or over, and are interactive rather than didactic.
Clinicians say that effective prevention programs are badly needed. "These are very difficult problems to treat," said Sherry Goldman, a child psychiatrist and pediatrician who practices in Rockville. Many teenage eating disorder patients, she said, "don't recognize the seriousness of their symptoms" and don't think they have a problem.
It's not clear what causes eating disorders, which seem to run in families for reasons that may be biological or environmental -- or both. The vast majority of sufferers are female, which experts say is partly a reflection of cultural norms such as the current popular fascination with skeletal-looking celebrities.
But few experts think culture alone is responsible. Goldman and others who treat teenage girls say that underlying depression is common in eating disorder patients, as are certain personality traits including competitiveness, conformity, rigidity and perfectionism. Many patients have difficulty expressing emotion; some have been sexually or physically abused as children. For them, eating -- or not eating -- becomes something they can control and a way of dissipating feelings that would otherwise be overwhelming.
Psychiatrist C. Barr Taylor, lead author of the Stanford study and a developer of "Student Bodies," said his team focused on young women known to be especially susceptible to eating problems: the 35 to 50 percent of teenage girls with high levels of concern about their weight and body shape, some of whom were overweight. Among the questions used to screen study participants was "How afraid are you of gaining three pounds?" Possible answers included "moderately" and "very."