Parental factors, mass media influences, and the onset of eating disorders in a prospective population-based cohort

Objective. To identify risk factors for eating disorders. Methods. A community cohort study was conducted in Navarra, Spain. A region-wide representative sample of 2862 girls who were 12 to 21 years of age completed the Eating Attitudes Test (40-item version) and other ques- tionnaires in 1997. Girls who scored high in the Eating Attitudes Test-40 were interviewed by a psychiatrist who applied Diagnostic and Statistical Manual of Mental Dis- orders, Fourth Edition criteria to diagnose prevalent cases of eating disorders. Girls who were free of any eating disorder in 1997 were reassessed after 18 months of fol- low-up using the same methods. Results. Ninety new cases of eating disorders accord- ing to Diagnostic and Statistical Manual of Mental Dis- orders, Fourth Edition criteria were identified during the follow-up. In the multivariate logistic analysis, a higher risk of incident eating disorder was found for several exposures assessed at the beginning of follow-up, such as younger age, usually eating alone (odds ratio (OR): 2.9; 95% confidence interval: 1.9 - 4.6), and frequently reading girls' magazines or listening to radio programs (OR: 2.1; 1.2-3.8 for those most frequently using both media). No independent association was found for television view- ing or socioeconomic status. A marital status of parents different from "being married" was associated with a significantly higher risk in the multivariate analysis (OR: 2.0; 1.1-3.5). Conclusions. Our results support the role of mass me- dia influences and parental marital status in the onset of eating disorders. The habit of eating alone should be considered as a warning sign of eating disorders. Pediatrics 2003;111:315-320; eating disorders, anorexia nervosa, bulimia nervosa, mass media, parental.