Elsevier

Journal of Nutrition Education and Behavior

Volume 47, Issue 5, September–October 2015, Pages 412-420.e1
Journal of Nutrition Education and Behavior

Research Article
Eating Disorders and Associated Health Risks Among University Students

https://doi.org/10.1016/j.jneb.2015.06.009Get rights and content

Abstract

Objective

To determine the prevalence of eating disorders among university students and its relationship to behavioral characteristics and substance use.

Design

Cross-sectional study collected socioeconomic characteristics and behavioral risk.

Setting

University of Upper Normandy, France.

Participants

University student volunteers.

Phenomenon of Interest

The Sick, Control, One stone, Fat, Food (SCOFF) screening test was used to identify subjects with eating disorders by a confidential questionnaire self-administered either online or on paper.

Analysis

Multivariate logistic regression models with P < .05 considered significant.

Results

A total of 3,457 students were included with a male-to-female ratio of 0.57. The prevalence of positive SCOFF screening was 20.5% among students. A positive relation between the positive SCOFF was observed with female gender (adjusted odds ratio [AOR], 2.98; 95% confidence interval [CI], 2.28–3.89; P < .001), stress (AOR, 1.10; 95% CI, 1.09–1.12; P < .001), depression (AOR, 8.62; 95% CI, 3.37–22.10; P < .001) alcohol abuse problems (AOR, 1.52; 95% CI, 1.20–1.95; P = .006), and risk of cyber-addiction (AOR, 5.09; 95% CI, 2.69–9.62; P < .001).

Conclusions and Implications

Eating disorders are highly prevalent among university students in France and associated with other behavior risks, stress, and depression. It might prove necessary in the future to screen students with the SCOFF questionnaire upon entry to the university to inform student about the risk of eating disorders and advise them to consult with their general practitioner.

Introduction

Eating disorders (ED) are characterized by behaviors aiming to achieve or maintain a slim body shape; great importance is given to thinness as a requisite for self-esteem. The absence of prodromic signs and lack of diagnostic criteria during the early stages of ED often result in late diagnosis. Screening scales may allow earlier diagnosis and nutritional intervention. One such scale is the Sick, Control, One stone, Fat, Food (SCOFF), a screening and diagnostic facilitating test for eating disorders in university students.1, 2, 3 Eating disorders are particularly frequent in young adults,4 college students included. There is evidence from a variety of sources that symptoms of ED are pervasive in university populations, with a prevalence ranging from 8% to 17%5, 6, 7 and peaking around 30% in students with war stress in Lebanon.8 To the authors' knowledge, the prevalence of ED described in the literature is variable and no study has been conducted in France among college students. Indeed, there is only 1 European study on ED in an adult population, which involved 6 countries including France.9 This prevalence was based on clinical diagnosis; people who did not consult a doctor or who had subclinical symptoms and eating disorders not otherwise specified were not included.

Many surveys have shown that dissatisfaction with body weight among university students and young adults is most frequent in highly industrialized countries.10, 11, 12, 13 Inaccurate perception of body weight can trigger abnormal eating behaviors and ED in those predisposed, especially in stressful situations.14, 15 In their study of a nonclinical female population, Sassaroli and Ruggiero15 found that stress might bring out a previously absent association between some psychological predisposing factors for ED. A strong positive relation between risk of ED and stress has also been reported recently.16 Eating disorder symptoms in university students may be positively correlated with other mental health problems such as depression and anxiety17 and with behavioral coping mechanisms for psychological distress such as binge drinking, cigarette smoking, and frequent exercise.5, 18 Even if university students appear to be in good health, there is a frequent onset of risky behaviors during time at a university. Moreover, the risk of substance use (alcohol, tobacco, and cannabis) and related problems is heightened during the university period19 and some studies have shown that substance use and overestimations of norms vary according to the curriculum.6, 20 In young adults, ED are also often associated with substance-free addictions (also called behavioral addictions) such as cyber-addiction. Indeed, studies have shown that female Internet addicts are at higher risk of ED,21 especially bulimia nervosa.22

Emerging adulthood (18–25 years) has been identified as an important developmental period for exploring and establishing eating and weight-related conditions, health habits, and beliefs.23 Because many body- and weight-related conditions and behaviors established during adolescence persist across the lifespan, adolescence and young adulthood offer potent developmental windows for assessing predictors and risk factors for eating pathology. Such behaviors need to be addressed owing to their adverse consequences as metabolic risks later in adult life. This kind of research becomes especially necessary at the university level, because students make up a homogeneous and accessible population that can generally be considered to be in relatively good health. Understanding populations that do not receive clinical care, such as those at risk of ED, is particularly important for early detection and treatment.24

The aims of this study were to assess the prevalence of ED and to identify its relationship to associated risks including socioeconomic factors, substance use, behavioral addictions, stress, and depression across a large sample of university students in France.

Section snippets

Setting and Participants

This study was conducted on university campuses located in Upper Normandy, France, where a health education program was provided to higher education students aged 18 to 25 years. The program included a regional multidisciplinary group, Ta Santé en 1 Clic (“Your Health in 1 Click”), consisting of several partners from the health, higher education, and voluntary sectors (mainly members of associations for cancer prevention) as well as other students, all actively involved in the project design

Population Description

A total of 3,457 students with whole data were included between March, 2009 and December, 2012. Mean age of students was 20.5 years (SD, 2.2 years) with a male-to-female ratio of 0.57. Body mass index calculated from self-report was normal in 78.5% of students and mean BMI was 21.4 kg/m2 (SD, 2.98). Table 1 describes baseline characteristics of students.

Prevalence of ED, Eating Habits, and Physical Activity

Overall, 26.3% of students had been on a diet at least once (52.8% of students with positive SCOFF scores vs 19.1% of those with a negative

Discussion

To the authors’ knowledge, this is the first study conducted in a large population of university students in France, focusing on the relationship between the risk of ED and socioeconomic factors, substance use, behavioral addictions, stress, and depression.

Screening male and female university students with the SCOFF questionnaire may quickly identify students with eating disorders.

In this study, 1 in 5 university students had a positive SCOFF score, a prevalence similar to that reported in

Implications for Research and Practice

There are clinical implications regarding components that should be included in programs for preventing ED in both female and male university students. Eating disorders are highly prevalent among university students in France and are associated with other behavior risks (alcohol abuse and cyber-addiction) and health-related factors such as stress and depression. The absence of prodromal signs and lack of diagnostic criteria in the early stages of ED often result in delayed diagnosis. It might

Acknowledgments

Grants for this study were provided by Institut National du Cancer (INCA), Paris, France; Agence régionale de Santé de Haute Normandie; Ligue Contre le Cancer de Seine Maritime; Département de Seine Maritime; and Sanofi-Aventis. The authors are grateful to Nikki Sabourin-Gibbs, Rouen University Hospital, for reviewing the manuscript in English. The authors declare that they have no competing interests.

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    Conflict of Interest Disclosure: The authors' conflict of interest disclosures can be found online with this article on www.jneb.org.

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