App helps reduce eating disorder symptoms in college-aged women

A digital, coached cognitive behavioral therapy intervention accessible online or through a phone app may help college-aged women with eating disorders, according to a study published in JAMA Network Open.

“It is critically important to provide eating disorder interventions to college-age patients because this group is at elevated risk for eating disorders,” Denise E. Wilfley, PhD, the Scott Rudolph University Professor in the departments of psychiatry, medicine, pediatrics and psychological & brain sciences at the Washington University School of Medicine, told Healio Primary Care. “About 13.5% of U.S. college women and 3.6% of U.S. college men are affected by eating disorders. Also, 95% of first-time cases of eating disorders occur by the age of 25, highlighting the importance of intervention with this group.”

Wilfley and colleagues conducted a cluster randomized control trial of 690 women with binge-purge eating disorders who were recruited from 27 universities in the United States from 2014 to 2018.

Participants were randomly assigned to usual care — which involved written feedback encouraging the women to seek evaluation or treatment at the school’s counseling center — or the intervention. They were followed for up to 2 years.

The online and phone-based intervention covers the core factors of cognitive behavioral therapy for eating disorders, according to the researchers. It aims to reduce eating disorder behaviors, improve body image, regulate emotions, address shape checking and avoidance, combat negative thoughts and prevent relapse. It also included psychoeducation content, meal planning tools and logs for self-monitoring.

Coaches underwent extensive training and used a clinical management dashboard to monitor users. They provided timely messages to users, supported them through making changes and offered feedback on their progress.

After post-intervention assessments, researchers found a significantly greater reduction in eating disorder psychopathology among women in the intervention group compared with the control group. There was no significant difference in abstinence from any eating disorder behavior between post-intervention assessment (OR = 1.48; 95% CI, 0.48-4.62) or during follow up (OR = 1.51; 95% CI, 0.63-3.58).

At post-intervention assessment, participants in the intervention groups experienced significantly greater reductions in binge eating (rate ratio = 0.82; 95% CI, 0.70-0.96), compensatory behaviors (rate ratio = 0.68; 95% CI, 0.54-0.86), depression and clinical impairment compared with the control group.

The researchers noted that these reductions were sustained in all outcomes, except binge-eating, throughout the follow-up period.

While 83% of participants in the intervention group used the intervention tool, just 28% of control participants sought out treatment for their eating disorder (OR = 12.36; 95% CI, 8.73-17.51).

“PCPs play such an important role in the identification of eating disorders, which should be regularly screened for,” Wilfley said. “If identified, PCPs should certainly consider recommending evidence-based digital interventions to individuals with eating disorders, at least as one option for engaging with care.”

She said the app is not widely available for people to purchase yet, but she hopes this will change in the future.

In an editorial accompanying the study, Jess P. Shatkin, MD, MPH, vice chair of education and professor of child & adolescent psychiatry and pediatrics at the NYU School of Medicine, highlighted the increasing need for mental health services.

He wrote that the researchers “have presented us with not only a specific tool for the treatment of eating disorders, but also more evidence that online, manualized, and easily accessible therapeutic tools can help stem the rising tide of mental illness among college students.”

“Now is the time for all good mental health practitioners to embrace these and similar therapeutic tools and come to the aid of our college students,” Shatkin wrote.

References:

• Fitzsimmons-Craft EE, et al. JAMA Netw Open. 2020;doi:10.1001/jamanetworkopen.2020.15633.
• Shatkin J. JAMA Netw Open. 2020;doi:10.1001/jamanetworkopen.2020.16117.