New smartphone app helps students with eating disorders at KU
Researchers at the University of Kansas are carrying out ongoing clinical trials of a promising new app that’s been shown already to help KU students living with an eating disorder, one of the deadliest mental illnesses. With these encouraging initial results, the Building Healthy Eating and Self-Esteem Together for University Students, or “BEST-U,” app soon could be expanded beyond KU’s campus to other universities.
Kelsie Forbush is leading the project. She’s a professor of psychology, a senior scientist at KU's Life Span Institute and director of the CARE and COPE labs, which focus on researching and treating eating disorders, respectively. Forbush and her colleagues hope to assess whether the BEST-U app is effective for college students who face barriers to accessing care.
“People have difficulty getting treatment for their eating disorder and difficulty affording it,” Forbush said. “There really aren't that many providers on college campuses who specialize in eating disorders, so often they refer students to the community. Here, for instance, there aren’t many providers in Lawrence, so they’ll refer to Kansas City. The issue is that waitlists are long and there are challenges with transportation.”
Forbush and her team wanted a scalable approach to address the high need that also was tailored to students.
“So, we did a long needs-based assessment, trying to figure out what would be a good fit for students and researching what's already been done,” she said.
The psychology researchers settled on an evidence-based approach, guided self-help cognitive behavior therapy, to underpin their app. But they cut some of the time-consuming workbook reading involved in traditional guided self-help CBT.
“I was very concerned students wouldn't do it if we gave them another book,” Forbush said. "There are already so many books that they're reading as students. I was influenced by research coming from the U.K. showing you could treat people with binge-spectrum eating disorders in as little as 12 weeks and get the same result as a full 20-week intervention. So the idea was to develop an intervention for college students that's fully mobile, health-based and takes lessons we give people in traditional CBT — but puts them in the app, makes them short, interactive, fun and engaging.”
The BEST-U interface includes videos, interactive quizzes, short questions and surveys to track progress each week. The app is paired with a trained BEST-U coach with whom participants meet for 25 to 30 minutes each week, either in-person or via telehealth.
“We were intent on creating a mobile, brief, powerful intervention,” Forbush said. “We wanted to meet college students where they are, reduce barriers to access — if they can't get to us because it's difficult to get across campus, they can do the telehealth.”
Students are randomized to partake in the BEST-U intervention or a waitlist control, where they’ll participate in the research as control subjects while awaiting the subsequent 12-week intervention (less time than it takes to be evaluated at many treatment centers).
So far, data from the BEST-U intervention show significant declines in eating-disorder behaviors, according to the KU researcher.
“We found large reductions in binge eating and behaviors like purging and compulsive exercise,” Forbush said. “We found reductions in body dissatisfaction — they were happier with their body. Then, we also found reduced impairment such that they're reporting better ability to engage with their family and friends and complete their academic responsibilities.”
What’s more, these positive changes from participation are still evident during the team’s three- and six-month follow-up sessions.
“I was so excited to see this short intervention is also a powerful one,” Forbush said. “At least for our six-month follow-up, it seems like they're maintaining those benefits.”
With successful results already from the KU-based trial, the team currently is submitting scholarly papers for peer review, hoping to share findings with the broader research community. They're also expanding the kinds of personnel who provide coaching by teaming up with medical providers at KU's Watkins Health Services. Next, the investigators will apply for a larger grant to bring the BEST-U intervention to the University of Nevada-Las Vegas, where collaborator and former KU postdoctoral researcher Kara Christensen serves as an assistant professor of psychology.
Past that, Forbush aims to see BEST-U available as widely as possible.
“My goal is really to scale up,” she said. “We could get this to many universities to address this gap in providers relative to need. A study recently showed the student-to-counselor ratio at many universities is 1,900-to-1. Eating disorders on college campuses have really increased since the pandemic, and people deserve to get care. It impacts their ability to function and achieve academically during college. Twelve weeks is not much time to help people get back on track. We think this is a scalable, impactful intervention.”