Healthy eating attitudes and behaviours group program: A randomised controlled feasibility study

Eating disorders (ED) are serious mental health illnesses interfering psychological, physical and social well-being. Besides the severity of ED, most of the individuals presenting symptoms are either not detected or treated. Among ones undergoing treatment, full recovery and remission are also not very likely. Given subclinical and clinical ED symptoms commonly occur among university students and negatively influence their well-being, screening ED related symptoms among university students, identifying students with a high risk of developing ED, and providing psychological intervention to them would be an important step for psychological health improvement. In this regard, in the first part of this thesis (Study 1), it is aimed to investigate levels of ED symptoms and related psychological problems among Turkish university students. Furthermore, since there is no ED prevention program available for university students in Turkey, in the second part of this thesis (Study 2), it is aimed to develop a Cognitive Behaviour Therapy oriented ED prevention program for female university students presenting a high risk for ED. A further aim was to examine feasibility, acceptability and efficacy of this program. 1584 university students (1195 females, 385 males, and 4 others) from Istanbul participated in Study 1. The mean age of the participants was 21.55 (SD = 3.37), and their mean BMI was 22.06 (SD=3.62). Participants were asked to fill out Demographic Information Form, Eating Disorders Examination Questionnaire (EDEQ), Eating Attitudes Test – 40 (EAT-40), Body Image Satisfaction Questionnaire (BISQ), and Sociocultural Attitudes towards Appearance Questionnaire-4-Revised (SATAQ-4R) in either paper-pencil or online format. The analysis showed that 22.3% of the students are not satisfied with their weight. 10.9% of the students met clinical severity criteria of EAT-40 and 6.6% of the students met the clinical severity criteria of EDEQ-Total score. Analyses for comparing female and male students revealed that female students had statistically significantly higher scores in EAT-40, subscales and total EDEQ, Thin/Low Body Fat Internalization, General Attractiveness Internalization, Family Pressure subscales of SATAQ-4R than their male peers. Male students had significantly higher scores in Muscular Internalization and Peer / Significant Other Pressures subscales of SATAQ-4R. Percentage of female students meeting clinical severity criteria of EAT-40 and EDEQ-Total were higher than male students meeting clinical severity criteria for these instruments. Analyses further showed that students who approved participating in Study 2 presented higher levels of ED and related psychopathology compared to students who did not approve. Participants of Study 2 consisted of 38 female university students, and they were randomly assigned to 6 session - Healthy Eating Attitudes and Behaviours Group Program (experimental group), single session - Eating Disorders and Body Dissatisfaction: A Group Work (active control group) or wait-list control condition. EDEQ, SATAQ-4R, Body Shape Questionnaire (BSQ), Difficulties in Emotion Regulation Scale-16 (DERS-16) and Group Feedback Form were administered as outcome measures. Analyses revealed that experimental group resulted in significantly higher improvement in subscales and total EDEQ, BSQ, DERS, and Thin/Low Body Fat Internalization subscales of SATAQ-4R from baseline to post assessment and baseline to 1-month follow up assessment compared to active and wait-list control conditions. The effect size for improvement in these outcome measures reflected large effect. Experimental group condition also presented high levels of feasibility and acceptability. Informativeness, being fun, and offering good rapport and communication with group friends were found to be the most favourable aspects of this program. Overall, the findings of the current study highlight the importance of targeting ED symptoms and related problems their given significance among university students in Istanbul, Turkey. With its good level feasibility, acceptability and preliminary efficacy, Healthy Eating Attitudes and Behaviours Group Program would be beneficial for reducing ED related psychopathology, body dissatisfaction, emotion regulation difficulties and internalization of thin/low body fat ideal among Turkish female university students.