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

Rebecka Peebles,Iris F Litt,Julia R Mann,Jenny L Wilson,Dina Lg Borzekowski,Kristina K Hardy,James D Lock

doi:10.2196/jmir.2023

Abstract

BackgroundMuch 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.ObjectiveTo examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life.MethodsWe 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.ResultsWe 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/m2; 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.ConclusionsPro-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.

Highlights

Have you read the consent form, do you understand the study, and are you willing to participate by answering this questionnaire?* Yes No
If you have not been diagnosed with an eating disorder, do you feel you have had an eating disorder? No Yes, in the past Yes, currently
If you have been medically hospitalized for an eating disorder, how many times were you hospitalized?

Summary

Marital Status

Never married Married (first marriage) Divorced or widowed and presently remarried monogamous relationship, living with partner (but not married) Monogamous relationship, not living with partner Divorced and not presently married Widowed and not presently married Other (Please Specify)

What is your primary role?

56. On how many of the past 28 days have you had a strong desire to lose weight?

70. Over the past 28 days how dissatisfied have you been with your SHAPE?

77. Are you currently in treatment for an eating disorder?

80. In the past 30 days were you medically hospitalized for an eating disorder?

93. How old were you when you first started dieting?