Table of Contents
Rationale and purpose of the study
Eating disorder continues to be a major health and lifestyle problem that confronts a lot of people. There are numerous studies including those of LeMoult et al. (2015) and Kotler et al. (2001) that suggest that when it comes to eating disorder, one of the worse affected groups of people are children and adolescents. Among this group of people, eating disorder may be experienced in many different forms including bulimia nervosa and anorexia nervosa. People with anorexia nervosa tend to starve themselves by staying away from food due to the thought that they are overweight when in actual they are dangerously underweight (Haedt-Matt & Keel, 2011). Those with bulimia nervosa on the other hand experience lack of control over what they eat, as they eat too much than their body requires (Lavender et al., 2016). People involved in eating disorder are likely to confront a number of health risks including obesity and being underweight (Wilfley, Wilson & Agras, 2003). Once obesity sets in, it also comes with its own attendant problems such as heart disease, hypertension, diabetes, and stroke (Svaldi et al., 2012). People suffering the eating disorder of bulimia nervosa have also been found to have frequent episodes of tooth decay and damage to their esophagus (Engel et al., 2013). Because of the health risks associated with eating disorder, the need to control the issue among affected people has increased in both the professional and academic world.
As much as it is good to look for ways to control eating disorder among affected people, it is particularly effective to look at the issue from a preventive perspective. The basis for this claim is the old healthcare adage that prevention is better than cure. Even though the complications associated with eating disorders may be generally reversible, Smyth et al. (2007) lamented that achieving absolute reversal is extremely difficult and some patients never achieve it throughout their life time. Meanwhile, Lamerz et al. (2005) was excited to report that with the right mechanisms and approaches, it is easier to prevent the onset of eating disorder and its associated health implications. Ogden et al. (2006) stressed that even for people with high risk of experiencing eating disorder, there could be therapeutic approaches that can be used to ensure that eating disorder do not set off entirely. On the issue of using therapeutic approaches, Wilfley, Wilson and Agras (2003) emphasized that such methods of preventing eating orders are more effective when used among people mature enough to take independent decisions for themselves. This is the motivation that influenced the current study to address ways of preventing eating order among college female students.
Population of the study
Most existing studies have looked at the issue of eating disorder among children and adolescents. There are also new emerging academic and professional discoveries that are suggesting that the issue of work or career responsibility is making a lot of young people who have just started working at high risk of experiencing eating disorders (Engel et al., 2013; Lavender et al., 2016). Most of people like this are in the age group of 18 to 25. Interestingly, within this age group, it is not only those experiencing pressure from work that suffer eating disorder but also those who go through the experience and hassle of unemployment or job search. Another demographic indication among people aged 18 to 25 that increases their chances with suffering eating disorder is the fact that within these years, most of these people still find themselves in school; at the higher levels of education like the college or university, where the stress associated with learning is highest (Cannon et al., 2008).
The indications given above help to justify the selection of the age population of people aged 18 to 25. Within this population, a sub-population of college female students will be used. As will be expanded latter, females were selected because they have higher risk of being exposed to the problem of eating disorder. The high chances of eating disorder associated with females are most biological, having to do with the hormonal function of their bodies (Haedt-Matt & Keel, 2011). A preventive approach to eating disorder is thus needed among this group to ensure that they take the right steps to preventing the onset of possible eating disorders. The study was also conducted among students due to the proven impact relationship between learning and eating disorder (Svaldi et al., 2012). The period of being in college could be associated with adopting new social behaviors and lifestyle that increases the risk of adopting bad eating habits that could lead to eating disorders in students (Johnson, Rohan & Kirk, 2002).
Risk factors
Ongoing studies that have sought to compare key biological, genetic, behavioral, psychological, and social trends among people with eating disorders and those without the disorder have helped to uncover numerous risk factors that present possible onset of the problem in people. Researching about the risk factors associated with eating disorders is an important academic and professional practice because it helps in identifying people with higher risks so that a preventive approach can be taken against the onset of the disorder. Based on the review of literature in this area of study, the commonest risk factor that emerged was age. Age has been reported in several studies including those of Smyth et al. (2007), Lamerz et al. (2005) and Kotler et al. (2001). In almost all these studies, it is admitted that frequency of eating disorders is higher during the teen and young adulthood ages. This means within the age range of 13 to 25, people have higher chances of experiencing eating disorder. The second most ranking risk factor identified in literature had to do with gender and race. On gender, it was said that the chances of experiencing the onset of eating disorders is 2½ times greater for women as against men (Wilfley, Wilson & Agras, 2003; Johnson, Rohan & Kirk, 2002).
While reporting on the outlook of eating disorder in women and men, LeMoult et al. (2015) noted that both men and women experience distorted sense of body image ones they have the onset of eating disorder. From a social perspective, peer dieting, negative affectivity, social support deficits, alcohol use, perfectionism, and fear of maturity have all been found as risk factors (Engel et al., 2013). The issue of genetics is another important area of recent research when it comes to risk factors associated with eating disorders. New studies have showed emerging trend of DNA variations that may be associated with higher risk of having eating disorder (Lavender et al., 2016). Weight concerns also pose risk of developing eating disorder. In a study by Stice et al. (2017), the researchers found that weight concerns lead to a number of behavioral and psychological reactions including pressure for thinness, thin-ideal internalization and thinness expectations. Meanwhile, each of these reactions are likely to cause people to develop bad eating habits. Body dissatisfaction is another risk factor reported in literature by Kotler et al. (2001).
The kind of daily exercise undertaken by a person has also been found to be a possible risk factor. Exercising is justified in literature because of the relationship between exercising and burning of fats (Cannon et al., 2008). On the issue of burning of fats, Ogden et al. (2006) mentioned that the type of job or career is also a risk factor. Instead of limiting the risk factor to job or career, Smyth et al. (2007) used the term of mental activity to include students. Ineffectiveness is another associated risk factor, where it is explained that people are inactive or less mobile increase their chances of developing eating disorder. Some health risk factors are also noted in literature with Stice et al. (2017) identifying functional impairment, depressive symptoms, mental health and psychiatric problems as risk factors associated with eating disorder. Last but not least, BMI and weight concerns have been noted as possible risk factors of eating disorder.
Prevention efforts associated with eating disorder
To achieve the prevention of eating disorders, a number of mechanisms have been used in the body of literature, including therapies. In this study, two therapeutic approaches that will be measured for their effectiveness on the prevention of eating disorders are e-therapy and cognitive behavior therapy (CBT). LeMoult et al. (2015) noted that prevention of eating disorder refers to a set of systematic attempts that are put in place to change the circumstances and factors that promote, initiate and also sustain the onset of eating disorder. By inference, in preventive approach, it is expected that those risk factors that are considered avoidable will be curtailed from setting off entirely in a person. For those risk factors such as age, gender and genetics which cannot be avoided, the preventive approaches are expected to give the right levels of education and advocacy to people on ways in which the said factors will not become a threat in initiating and sustaining eating disorder. Lamerz et al. (2005) was supportive of the claim that with body avoidable and unavoidable risk factors, it is possible to use both types of therapies, which are CBT and e-therapy as preventive efforts.
CBT has generally be noted to be effective as a preventive effort against eating disorder because its central goal is to cause a change in the pattern of thinking and behavior in people (Svaldi et al., 2012). From this, it would be understood that CBT can be an effective preventive effort for psychological and behavioral risk factors that are associated with eating disorder. This is because psychological risk factors are commonly associated with the pattern of thinking in people. The behavioral risk factors are also associated with the pattern of behavior of people. Consequently, while using the CBT sessions to shape the thoughts and behavior of people, it is possible to develop in these people, the right patterns of thinking and behavior that guard against the onset of eating disorder entirely (Johnson, Rohan & Kirk, 2002). E-therapy on the other hand may be explained as the use of online sessions to offer therapeutic sessions to people needing mental health and other forms of socio-behavioral counseling (Haedt-Matt & Keel, 2011). Indeed e-therapy is a very broad concept and could even include the delivery of CBT through an online session. Consequently, in this study, the actual definition of e-therapy is taken from the medium from which therapeutic sessions are delivered. CBT as used in this context refers to face-to-face hands-on and practical approach to problem solving. E-therapy on the other hand refers to the use of online medium for delivering therapy.
Like CBT, is also effective as a preventive effort associated with eating disorders. This is because the modality of designing these two programs are relatively same. For example both methods focus on thinking, social and behavioral patterns of people, all of which offer a means of adopting preventive lifestyle that curtails the onset of eating disorder. In most recent literature however, the line of debate among most researchers has been to consider which of the two methods offers more efficient and fast-tracked guarantee to preventive eating order (Cannon et al., 2008; Stice et al., 2016). The current study seeks to engage in the ongoing academic exercise by collecting empirical evidence from female college students on which of the two prevention efforts will work best for them. As explained under the hypothesis of the study, it is expected that students who undertake the e-therapy will report of social, behavioral and psychological changes that represent a more efficient way of reducing the tendency of having the onset of eating disorder as compared to those students who will be using the CBT. Among other things, certain benefits that the e-therapy offers which are absent in the CBT are expected to be the guiding principles for enhancing the efficiency of e-therapy. For example there is enhanced convenience with e-therapy, coupled with anonymity, which makes it possible for clients to open up with core behavioral and social issues that confront them. The more clients open up, the better the chances of giving them the right guidance and counsel on how to prevent the onset of eating disorders.
Questionnaire
In the course of measuring the effectiveness of the two preventive efforts delivered to students, a questionnaire will be used to undertake self assessment of their attitude towards eating. In order to have a standardized measure, other questionnaire that are known to be popular and frequently used for this same purpose will be reproduced. More specifically, the EDE-Q used in Fairburn and Beglin (2008) will be replicated in this study. The questionnaire is available from http://cedd.org.au/wordpress/wp-content/uploads/2014/09/Eating-Disorder-Examination-Questionnaire-EDE-Q.pdf.
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