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      Disordered Eating in a Digital Age: Eating Behaviors, Health, and Quality of Life in Users of Websites With Pro-Eating Disorder Content

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          Abstract

          Background

          Much concern has been raised over pro-eating disorder (pro-ED) website communities, but little quantitative research has been conducted on these websites and their users.

          Objective

          To examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life.

          Methods

          We conducted a cross-sectional, Internet-based survey of adult pro-ED website users. Main outcomes were Eating Disorder Examination Questionnaire (EDE-Q) and Eating Disorder Quality of Life (EDQOL) scores.

          Results

          We included responses from 1291 participants; 1254 (97.13%) participants were female. Participants had an average age of 22.0 years and a mean body mass index of 22.1 kg/m 2; 24.83% (296/1192) were underweight; 20.89% (249/1192) were overweight or obese. Over 70% of participants had purged, binged, or used laxatives to control their weight; only 12.91% (163/1263) were in treatment. Mean EDE-Q scores were above the 90th percentile and mean EDQOL scores were in the severely impaired range. When compared with moderate and light usage, heavy pro-ED website usage was associated with higher EDE-Q global (4.89 vs 4.56 for medium and 4.0 for light usage, P < .001) and EDQOL total scores (1.64 vs 1.45 for medium and 1.25 for light usage, P < .001), and more extreme weight loss behaviors and harmful post-website usage activities. In a multivariate model, the level of pro-ED website usage remained a significant predictor of EDE-Q scores.

          Conclusions

          Pro-ED website visitors reported many disordered eating behaviors, although few had been treated. Heavy users reported poorer quality of life and more disordered eating behaviors.

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          Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples.

          J. Mond, P. Hay, B. Rodgers … (2004)
          In order to examine the concurrent and criterion validity of the questionnaire version of the Eating Disorders Examination (EDE-Q), self-report and interview formats were administered to a community sample of women aged 18-45 (n = 208). Correlations between EDE-Q and EDE subscales ranged from 0.68 for Eating Concern to 0.78 for Shape Concern. Scores on the EDE-Q were significantly higher than those of the EDE for all subscales, with the mean difference ranging from 0.25 for Restraint to 0.85 for Shape Concern. Frequency of both objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) was significantly correlated between measures. Chance-corrected agreement between EDE-Q and EDE ratings of the presence of OBEs was fair, while that for SBEs was poor. Receiver operating characteristic (ROC) analysis, based on a sample of 13 cases, indicated that a score of 2.3 on the global scale of the EDE-Q in conjunction with the occurrence of any OBEs and/or use of exercise as a means of weight control, yielded optimal validity coefficients (sensitivity = 0.83, specificity = 0.96, positive predictive value = 0.56). A stepwise discriminant function analysis yielded eight EDE-Q items which best distinguished cases from non-cases, including frequency of OBEs, use of exercise as a means of weight control, use of self-induced vomiting, use of laxatives and guilt about eating. The EDE-Q has good concurrent validity and acceptable criterion validity. The measure appears well-suited to use in prospective epidemiological studies.
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            Development and psychometric validation of an eating disorder-specific health-related quality of life instrument.

            Laurel Crosby, D A Wittrock, Stephen A. Wonderlich … (2005)
            Health-related quality of life (HRQOL) has been used increasingly as an outcome measure in clinical research. Although the generic quality of life instruments has been used in previous research, disease-specific instruments offer greater sensitivity and responsiveness to change than generic instruments. No such disease-specific instrument is currently available that applies to eating-disordered samples. The current article reports on the development and validation of the Eating Disorders Quality of Life (EDQOL) instrument, a disease-specific HRQOL self-report questionnaire designed for disordered eating patients. The EDQOL demonstrates excellent psychometric properties. The application of the EDQOL as an outcome measure in eating disorder research is considered. 2005 by Wiley Periodicals, Inc.
            Article 0 comments Cited 68 times – based on 0 reviews     Review now
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              e-Ana and e-Mia: A content analysis of pro-eating disorder Web sites.

              Mandy L. Wilson, Rebecka Peebles, S Schenk … (2010)
              The Internet offers Web sites that describe, endorse, and support eating disorders. We examined the features of pro-eating disorder Web sites and the messages to which users may be exposed. We conducted a systematic content analysis of 180 active Web sites, noting site logistics, site accessories, "thinspiration" material (images and prose intended to inspire weight loss), tips and tricks, recovery, themes, and perceived harm. Practically all (91%) of the Web sites were open to the public, and most (79%) had interactive features. A large majority (84%) offered pro-anorexia content, and 64% provided pro-bulimia content. Few sites focused on eating disorders as a lifestyle choice. Thinspiration material appeared on 85% of the sites, and 83% provided overt suggestions on how to engage in eating-disordered behaviors. Thirty-eight percent of the sites included recovery-oriented information or links. Common themes were success, control, perfection, and solidarity. Pro-eating disorder Web sites present graphic material to encourage, support, and motivate site users to continue their efforts with anorexia and bulimia. Continued monitoring will offer a valuable foundation to build a better understanding of the effects of these sites on their users.
              Article 0 comments Cited 68 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Rebecka Peebles:
                The Craig Dalsimer Division of Adolescent MedicineDepartment of PediatricsThe Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania3401 Civic Center Blvd11NW Room 19Philadelphia, PA, 19104United States1 215 590 68641 215 590 4708peeblesr@email.chop.edu
                Journal
                Journal ID (nlm-ta): J Med Internet Res
                Journal ID (iso-abbrev): J. Med. Internet Res
                Journal ID (publisher-id): JMIR
                Title: Journal of Medical Internet Research
                Publisher: Gunther Eysenbach (JMIR Publications Inc., Toronto, Canada )
                ISSN (Print): 1439-4456
                ISSN (Electronic): 1438-8871
                Publication date Collection: Sep-Oct 2012
                Publication date (Electronic): 25 October 2012
                Volume: 14
                Issue: 5
                Electronic Location Identifier: e148
                Affiliations
                [1] 1The Craig Dalsimer Division of Adolescent Medicine Department of Pediatrics The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania Philadelphia, PAUnited States
                [2] 2Division of Pediatric Neurology Department of Pediatrics The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania Philadelphia, PAUnited States
                [3] 3Department of Pediatrics Stanford University Stanford, CAUnited States
                [4] 4Department of Neurology Children's National Medical Center Washington, DCUnited States
                [5] 5Division of Child and Adolescent Psychiatry Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Palo Alto, CAUnited States
                [6] 6Rice University Houston, TXUnited States
                [7] 7Department of Health, Behavior and Society Johns Hopkins Bloomberg School of Public Health Baltimore, MDUnited States
                Article
                Publisher ID: v14i5e148
                DOI: 10.2196/jmir.2023
                PMC ID: 3510745
                PubMed ID: 23099628
                SO-VID: 445b3060-7456-4980-b60b-3689c0191d07
                Copyright © ©Rebecka Peebles, Jenny L Wilson, Iris F Litt, Kristina K Hardy, James D Lock, Julia R Mann, Dina LG Borzekowski. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.10.2012.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                Date received : 16 June 2012
                Date revision requested : 11 July 2012
                Date revision received : 13 July 2012
                Date accepted : 13 July 2012
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Medicine
                Keywords: eating disorder,social network,anorexia nervosa,bulimia nervosa,pro-eating disorder website,pro-anorexia website,pro-bulimia website,pro-ed,pro-ana,pro-mia
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: eating disorder, social network, anorexia nervosa, bulimia nervosa, pro-eating disorder website, pro-anorexia website, pro-bulimia website, pro-ed, pro-ana, pro-mia

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