# Prevalence and Factors Associated With Eating Disorder Risk Among College Students in Kerala, India: A Cross-Sectional Study

## TL;DR

This study found that nearly one-third of college students in Kerala, India, are at risk for eating disorders, with higher risk among those from high-income groups, underweight or overweight individuals, and those with social media disorder.

## Contribution

The study provides the first empirical data on eating disorder risk among college students in Kerala, India, and identifies specific sociodemographic and behavioral risk factors.

## Key findings

- 29.4% of students in Kerala were at risk for eating disorders.
- High-income students had significantly higher risk compared to lower-income groups.
- Social media disorder and weight status (underweight/overweight) were strongly associated with increased ED risk.

## Abstract

Introduction

Unhealthy diets are a major contributor to the global burden of disease, with eating disorders (EDs) being among the most prevalent psychological disorders affecting youth worldwide. Despite their increasing recognition, there is limited research quantifying ED risk in India. Therefore, we aimed to estimate the risk of ED in the Indian state of Kerala and to find the sociodemographic factors associated with it.

Methods

We conducted this study among 823 students (females: 60%) aged 18-22 years in randomly selected colleges in two of the 14 districts in Kerala. Data were collected using the self-administered Eating Attitudes Test-26 (EAT-26). Information on social media disorder was collected using the Bergen Social Media Addiction Scale (BSMAS). Log binomial regression analysis was done to find the factors associated with ED risk, and adjusted prevalence ratios (APR) with a 95% confidence interval (CI) were calculated.

Results

ED risk was reported by 242 students (29.4%, 95% CI: 26.3-32.6). Home-staying students are more likely to report a higher risk of ED compared to hostel or paying guest students (APR = 1.40; 95% CI: 1.08-1.80). Similarly, students belonging to high-income groups of social class I (APR = 9.60; 95% CI: 5.11-18.04), social class II (APR = 5.51; 95% CI: 2.89-10.47), and social class III (APR = 3.18; 95% CI: 1.54-6.56) were more likely to report ED risk compared to their counterparts. Additionally, students who were underweight (APR = 1.60; 95% CI: 1.24-2.05), overweight/obese (APR = 2.42; 95% CI: 1.96-3.01), and those with social media disorder (APR = 1.69; 95% CI: 1.27-2.24) had a higher likelihood of reporting ED risk.

Conclusion

Nearly one-third of college students were at risk of ED. Measures to reduce ED risk are required among students prioritizing those belonging to high-income groups, overweight/obese, underweight, and those having social media disorder.