Abstract
Previous research on eating disorders, disordered eating behaviours, and whether their prevalence varies across schools, has produced inconsistent results. Our previous work using Swedish record-linkage data found that rates of diagnosed eating disorders vary between schools, with higher proportions of girls and higher proportions of highly educated parents within a school being associated with greater numbers of diagnosed eating disorders. We aimed to extend these findings to a UK population-based sample and hypothesised that a similar association would be evident when studying disordered eating behaviours. We used data from the Avon Longitudinal Study of Parents and Children to test the hypothesis that prevalence of self- and parent-reported disordered eating behaviours (binge eating, purging, fasting, restrictive eating, and fear of weight gain), and body dissatisfaction cluster by school. We had complete data on body dissatisfaction, school attended, and other possible risk factors for 2146 girls in 263 schools at age 14 and on disordered eating behaviours for 1769 girls in 273 schools at age 16. We used multilevel logistic regression modelling to assess whether prevalence varied between and within schools, and logistic regression to investigate the association between specific school characteristics and prevalence of disordered eating behaviours and body dissatisfaction. At age 14, there was no evidence for body dissatisfaction clustering by school, or for specific school characteristics being associated with body dissatisfaction. At age 16, there was no evidence for clustering, but higher rates of disordered eating behaviours were associated with attending all-girl schools and lower levels with attending schools with higher academic results. We found no evidence for clustering of disordered eating behaviours in individual schools, possibly because of the small cluster sizes. However, we found evidence for higher levels of disordered eating behaviours in 16 years in all-girl schools, and in schools with lower academic performance.
Highlights
Understanding the aetiology of eating disorders is important given their high prevalence [1,2,3], prospective associations with adverse outcomes [1, 4], high mortality [5], and healthcare costs
We found no evidence that disordered eating behaviours or body dissatisfaction at either age 14 or age 16 clustered by school
These results are consistent with our previous study using Swedish record-linkage data [8]; in that we found that girls at schools with a greater proportion of girls have higher rates of self-reported disordered eating behaviours, as well as diagnosed eating disorders
Summary
Understanding the aetiology of eating disorders is important given their high prevalence [1,2,3], prospective associations with adverse outcomes [1, 4], high mortality [5], and healthcare costs. One possible modifiable risk factor is the school environment, since the peak of onset for eating disorders is during adolescence [6, 7]. It is, important to understand whether and how schools might be associated with risk of developing an eating disorder. Population studies in the US have found that disordered weight control behaviours vary between schools, but that differences do not persist following adjustment for individual risk factors [11], and that the likelihood that an individual female student is trying to lose weight increases with the proportion of underweight girls in her school [12]
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