Findings offer insight into student attitudes about eating, body image
Preliminary findings from a campus survey on attitudes and behaviors around eating, dieting, weight control, exercise and body image, found U-M students diet regularly, dislike their bodies, fear gaining weight and seldom seek help for eating disorders.
Researchers also found that six out of 10 undergraduates had become more concerned about their bodies after starting school, and that 10 percent were purging in some way: vomiting, using laxatives, diuretics or diet pills.
The online survey — U-SHAPE: University Study of Habits, Attitudes and Perceptions around Eating — is the first comprehensive research of its kind.
A multidisciplinary team of faculty, researchers and counselors from the School of Public Health, School of Education, the Medical School, University Health Service, Counseling and Psychological Services and Ann Arbor's Center for Eating Disorders conducted the survey in October 2012.
Starting with a random sample of 10,000 undergraduates and graduate students, the findings from 3,088 participant responses can be generalized to the full student body and have important implications for policy and practice, the researchers said.
"Having a representative campuswide sample like that obtained through U-SHAPE means we can, for the first time, begin to understand what is going with the larger, more diverse student body on campus," said Sarah Ketchen Lipson, a dual-degree doctoral student at SPH and SOE.
Previous studies on eating disorders have focused on specific groups: athletes, sorority members, or students in courses such as psychology, nutrition and nursing.
"U-SHAPE findings allow for greater differentiation between individual students based on specific characteristics as well as greater generalization to other populations," said Dr. Suzanne Dooley-Hash, assistant professor of emergency medicine at the U-M Health System.
"In addition, U-SHAPE includes more aspects of eating and body image than have ever been included in a single study of college students in the past. This will allow for more in-depth analyses of the interactions between the different related factors."
Specific findings include:
• 27.8 percent of female undergraduates, 11.8 percent of male undergraduates, 21.5 percent of female graduate students, and 10.3 percent of male graduate students on campus screen positive for an eating disorder.
• 20 percent of U-M women feel that thoughts and fears about food and weight dominate their lives.
• 82 percent of women and 96 percent of men who screen positive for an eating disorder have not received treatment in the past year.
• Among women who screen positive for an eating disorder, a quarter also screen positive for depression, and almost half for anxiety.
• 40 percent of students have increased their restrictive eating since coming to college, with 30 percent reporting dieting for more than 180 days in the past year.
• 90 percent of first-year female undergraduates and more than half of first-year male undergraduates feared gaining the storied "freshman 15," which is the 15 pounds said to be a common amount of increase when someone goes to college.
• A higher proportion of males than females said it was "very like me" or "like me" to be "willing to sacrifice in order to influence my body shape or weight." Nearly 35 percent of males report this willingness to sacrifice.
• More than 50 percent of females and more than 30 percent of males report that they often talk about weight and/or dieting with their friends.
• More than half of all students reported knowing at least one U-M student struggling with an eating disorder or related issue.
• More than 60 percent of students believe peers would think less of someone with an eating disorder, while more than 30 percent said they would think less of a person with an eating disorder.
The latter finding surprised Dr. Diane Mickley, co-founder and chair of the grants committee for the Global Foundation for Eating Disorders (GFED) that funds U-SHAPE.
"Stigma was much higher than I expected. Increase in restrictive eating and preoccupation with weight after arrival at college was worse than I expected (I actually imagined it might improve for some compared to high school). The trivial number of eating disordered students getting treatment was far below what I hoped and imagined," said Mickley.
GFED is a nonprofit founded by Mickley, Rebecca Parekh and Leah Komar Harris. Its mission is to eliminate eating disorders by advancing the development and dissemination of effective treatments. U-SHAPE was the organization's inaugural grant.
The researchers say the stigma problem may have to do with perfectionism and student uncertainty about identity, social relationships or academic challenges.
"Stigma regarding mental health issues is another issue that we are working toward reducing on campus through social norm campaigns along with our 'Do Something' campaign regarding general mental health and help-seeking," said Andrea Lawson, clinical social worker for Counseling and Psychological Services.
"People tend not to share with others when they are struggling, especially in our perfectionistic, high-achieving university community where there may be greater stigma for mental health concerns, or they may worry that they are not naturally good enough to make it in the competitive environment.
"I think our campus may need to get better at communicating the signs of eating disorders so people can better identify themselves if they have concerning behaviors."
One result that also caught the researchers' attention was student attitude toward something that isn't always thought of as a disorder — binge eating.
"Binge eating has been regarded as a 'less serious' symptom, but it is as serious as any other eating disorder. When binge eating becomes a chronic behavior it is as deadly as anorexia nervosa and bulimia nervosa and shares the same degree of burden of illness. Unfortunately conventional wisdom points to dieting as the answer to binge eating or out-of-control eating," said Judith Banker, founder and executive director of the Center for Eating Disorders in Ann Arbor.
"Dieting is a key factor in the pathogenesis of all the eating disorders including Binge Eating Disorder, so you can see the vicious circle that quickly develops. There is scant research on the incidence of binge eating in community populations, including the campus population. So the data on binge eating gathered by U-SHAPE has great value."
Campus leaders say the information provided through the study will be valuable in helping further shape programming around disordered eating and body image.
"The Division of Student Affairs connects research findings such as this across the entire student career. Learning about what experiences students have before college and what interactions students have during college shapes our work to create student environments that affirm wellness," said Malinda Matney, senior research associate for the Division of Student Affairs.
"The programs and food in the University Unions, the nutritional information in University Housing, and the activities across Recreational Sports are all parts of this. We don't just consider wellness work for our UHS (University Health Service) and CAPS colleagues — all of us join them in promoting wellness."
Ketchen Lipson said that with continued support from GFED, the researchers plan to expand nationally and internationally.
The U-SHAPE research team includes: Dooley-Hash, Ketchen Lipson, Banker, Kellie Carbone, eating disorder prevention and body image health educator, UHS; Daniel Eisenberg, associate professor, SPH; and Lawson.