title: Disordered eating in a digital age: eating behaviors, health, and quality of life in users of websites with pro-eating disorder content.
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.
authors.affiliation: The 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, PA 19104, United States. peeblesr@email.chop.edu
authors.forename: Rebecka
authors.initials: R
authors.lastname: Peebles
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Wilson
authors.forename: Iris F
authors.initials: IF
authors.lastname: Litt
authors.forename: Kristina K
authors.initials: KK
authors.lastname: Hardy
authors.forename: James D
authors.initials: JD
authors.lastname: Lock
authors.forename: Julia R
authors.initials: JR
authors.lastname: Mann
authors.forename: Dina L G
authors.initials: DL
authors.lastname: Borzekowski
mesh_terms: D000293:Adolescent; D000328:Adult; D001068:Feeding and Eating Disorders / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult