The return of students to university this year has been one of the most unusual in living memory, but that doesn’t prevent a number of time-honored problems from existing.  Foremost among these is the risk of eating disorders among the student body.

New research from Washington University in St. Louis suggests it’s a problem that affects 13% of women and 3.6% of men, with less than 20% of these people receiving any kind of treatment.  The researchers developed an app that was tested on around 700 women across 27 college campuses, with the app aiming to provide a form of cognitive behavioral therapy to the women.

The users reported a decline in their symptoms over time, including less binge eating and concerns around their weight or body shape, as well as general improvements in depression and anxiety levels.

“College students are busy and often don’t have spare time to seek the help they need, and many college counseling centers aren’t equipped with clinicians who are trained in treating eating disorders, so we believe digital interventions like this one can dramatically increase access to care,” the researchers say.  “In our study, this digital phone app was associated with dramatic increases in access to treatment. And in cognitive behavioral therapy, we know the app is providing a therapy that’s proven to help.”

Motivating change

The study began by distributing a questionnaire to women to explore their risk of developing an eating disorder.  Once they had identified a woman with or at risk of getting an eating disorder, they randomly assigned her a referral to a commonly prescribed care plan via their university’s counseling services, or to receive the cognitive behavioral therapy via the app.

The app provided users with content that aimed to help them challenge the unhelpful ways of thinking and behaving around food.  They also had access to a coach who would send regular support via SMS.

“One striking finding was that so many women assigned to the digital intervention actually used the phone app, and it helped to reduce their symptoms, such as marked concerns about their shape and weight, body esteem issues, and binge eating or purging,” the researchers explain.

The researchers believe that the app was effective because it allowed the users to engage with it on their own time and according to their own schedule.  This translated into much higher adherence, with 83% of those in the app group completing at least some of the program, versus just 28% in the usual care group receiving any treatment at all.

With COVID-19 creating a peculiar atmosphere on many university campuses, the researchers were also pleased that the app helped to reduce depression and anxiety that so often accompany eating disorders.

“Students with eating disorders tend to isolate themselves socially, but now all students are charged with keeping themselves socially distant,” the researchers conclude. “There are data showing increases in symptoms of binge eating disorder and bulimia nervosa now that people are more isolated, with easier access to food and, obviously, unprecedented stress.  We think these problems could increase in the coming months, so it’s important that there be ways to reach students who are having difficulty. We believe delivering therapy with a phone-based app may be truly effective.”