image: Kelsie Forbush, who leads the BEST-U intervention, has been conducting research and treatment in the field of eating disorders since 2000.
Credit: University of Kansas
LAWRENCE — Eating disorders are the most common mental health concern on college campuses, yet there is a serious shortage of treatment providers on campuses. A new program leveraging the phone to increase treatment access for college students experiencing eating disorders is expanding after a pilot program’s positive results at the University of Kansas where most participants saw recovery.
The timing couldn’t be better. In the few years since the COVID-19 pandemic, eating disorder prevalence has increased by 62% in university women and 140% in university men, according to the KU researchers, citing a Journal of Psychosocial Nursing and Mental Health Services study. But with a shortage of practical and affordable treatments for many of these students, the team behind BEST-U hopes to fill gaps in eating disorder treatment accessibility for universities across the country.
The BEST-U program, an 11-week treatment underpinned by guided self-help cognitive behavioral therapy (CBT), has shown “most participants were fully recovered from their eating disorder” at KU, according to researcher Kelsie Forbush, professor of clinical child psychology at KU and co-principal investigator of a new $715,516 grant from the National Institutes of Health to expand the program to train non-mental health care professionals within student health settings to deliver the treatment.
Her co-principal investigator is Kara Christensen-Pacella, an assistant professor from the University of Nevada Las Vegas, who was previously a researcher and therapist on the pilot trial. The expanded study will take place at both KU and UNLV.
“We were inspired to create BEST-U because we saw a high demand for eating disorder treatment but very few resources in our community,” said Forbush, who also serves as a senior scientist with KU’s Life Span Institute and director of its newly founded Center for the Advancement of Research on Eating Behaviors (CARE). “In many cases, KU students had to drive to Kansas City for treatment, but some didn’t have a car. It was also very cost-prohibitive because most area providers did not take insurance.”
Forbush and her colleagues wanted to address the problem after seeing the obvious effect on students. First, they looked at the scope of the issue and found “incredibly” high rates of eating disorders on KU’s campus, matching national data. Then, they explored models that could expand access to intervention while remaining effective.
Forbush’s main collaborator was Sara Gould of Children's Mercy Hospital-Kansas City, where she directs the eating disorder center and is a full-time clinician. Other key collaborators include KU faculty member Alesha Doan, who will lead qualitative aims and analyses to determine how to best scale the program to other colleges across the United States, and Angeline Bottera, who is the associate director of CARE.
“Together, we created an 11-week intervention using a mobile health app,” Forbush said. “Students spend about 10 minutes per week on the app, which is highly interactive, and they also receive 25 to 30 minutes of telehealth coaching from a trained graduate student. By the end of the 11 weeks, most participants were recovered from their eating disorder.”
Besides pairing participants with a trained BEST-U coach, the BEST-U interface includes videos, interactive quizzes, short questions and surveys to track progress each week.
Forbush will partner closely with Watkins Health Services by training their providers to serve as coaches, which will help expand the reach of the intervention to colleges that do not have trained mental health eating-disorder providers. Forbush is also conducting an additional clinical trial of BEST-U to identify if some clients can recover without receiving coaching sessions and who may need additional support.
“We were very excited about the results of our pilot trials and received great feedback,” Forbush said. “One of my favorite stories is about a new coordinator I hired to help run the study. She and her mom were shopping, and the cashier overheard their conversation. When the cashier realized our coordinator was working on the BEST-U study, the cashier said, ‘I participated in that study, and it changed my life.’”
Forbush’s other projects have included addressing eating disorders in the military and developing digital health tools for teens suffering from anorexia nervosa.
The CARE Center, formerly a lab, was established in recent months as a fully fledged research center under the Life Span Institute. CARE conducts research to better identify people with eating disorders for early screening, intervention and treatment-progress monitoring. The center’s mission is “to improve the way eating disorders are assessed, diagnosed and treated through cutting-edge methods and research.” CARE then applies findings to clinical settings with university students.
“The peak age of onset for eating disorders is usually late adolescence to early adulthood,” Forbush said. “So, we're reaching people right in that peak window — when an eating disorder often starts or when they may have already had it for a few years before coming to college. That can be a good time to seek treatment. Sometimes people notice their eating disorder symptoms getting worse as they transition to college.”
It's this work with university students Forbush cited as the most rewarding part of her research and clinical studies. Forbush said expanding the BEST-U program that has succeeded so well at KU makes her “very excited” because it means changing more lives for the better.
“It feels so rewarding to have identified a need — there's a gap, and students need this service — and then to be able to help start filling that gap has felt amazing,” she said. “When you have an eating disorder in college, you really do miss out on a lot of the developmental experiences of becoming an adult — things like making friends and fully engaging in your classes — and you don't get those years back. If we can help a student overcome an eating disorder and get back on track with the developmental trajectory of early adulthood, that’s extremely important. And that's very rewarding.”