Applied Research in Quality of Life (2007) 2:1731 DOI 10.

1007/s11482-007-9027-1

Life Satisfaction, Dieting Behavior, and Weight Perceptions among College Students
Keith J. Zullig & Scott M. Pun & E. Scott Huebner

Received: 15 December 2006 / Accepted: 14 May 2007 / Published online: 29 June 2007 # Springer Science + Business Media B.V. / The International Society for Quality-of-Life Studies (ISQOLS) 2007

Abstract This study examined the relationships among perceived life satisfaction, perceptions of body weight, and dieting behaviors among 522 college students. Adjusted multiple logistic regression analyses and multivariate models constructed separately were utilized for this study. Perceptions of underweight and extreme worry over weight were significantly associated with dissatisfaction with life for both males and females (p<0.01). However, vomiting; perceptions of overweight; binge eating behavior; extreme worry over binge eating behavior; and engaging in binge eating behavior for more than one year were significantly related to dissatisfaction with life for only females (p<0.01). In addition, both males and females were less likely to self-identify problematic disordered eating, with males being particularly less likely to report concern over extreme dieting behaviors. Results suggest that carefully designed educational and intervention efforts for college students with eating disorders must take gender differences into account. Programs for males may need to differ from those for females in terms of recruitment, intervention integrity, and evaluation considerations. Keywords Life satisfaction . Dieting behavior . College students A variety of eating disorders is prevalent among college students. Some estimate the number of young adult women with eating disorders at 5% (Kreipe and Mou 2000).
K. J. Zullig (*) : S. M. Pun Center for Health Enhancement, Miami University, 106 Phillips Hall, Oxford, OH 45056, USA e-mail: [email protected] S. M. Pun e-mail: [email protected] E. S. Huebner Department of Psychology, University of South Carolina, Columbia, SC 29208, USA e-mail: [email protected]

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Although the majority of those with eating disorders are young women, males comprise between 915% of cases (Andersen 1995; ODea and Abraham 2002). The social norm toward thinness may lead to a number of eating disorder symptoms, especially in college women. For example, increased pressures for social dating during the college years likely contribute to the relative importance of physical attractiveness among students of this age group (Sanderson and Darley 2002). Women may be more likely to exhibit behavior indicative of eating disorders because thinness is normally considered attractive (Grogan 1999). As a result, college environments may indirectly contribute to the development and maintenance of eating disorders by accentuating attractiveness, motivation and perfection (Kashubeck et al. 1994). Negative body image has been shown to be an element involved in a number of health problems found in females such as poor self-esteem, depression, obesity, and other disordered eating (Cash and Pruzinsky 2002; Powell and Hendricks 1999). In addition, literature suggests that body dissatisfaction elevates risk for dieting, negative affect, and initiation and maintenance of bulimic pathology (Stice 2002). This finding supports a definition of body image that goes beyond being dissatisfied with body appearance and physical characteristics to include the characteristic of spending disproportionate amounts of cognitive and behavioral energy concerning physical appearance for the purpose of defining ones self (Cash and Pruzinsky 2002; Cash 2002). Furthermore, it appears this preoccupation with body image affects both sexes. Dissatisfaction with body shape appears to be particularly prevalent among college age Caucasian women (Demarest 2000), but college men adhere to sociocultural ideals as well (Pope et al. 1999). Although women tend to desire a thinner, more waif-like look (Grogan 1999), college men appear to be split between wanting to become thinner or larger and more muscular (Drewnowski and Yee 1987; Silberstein et al. 1988). Although statistically normal, discontent with ones body and dieting for weight loss may not be benign. Undue anxiety about ones body size and dieting for weight loss have been identified as primary risk factors for debilitating eating disorders (Conners 1996). For example, those with anorexia have been shown to have an approximately fourfold risk of mortality compared to healthy people the same age and sex (Nielsen 2001). Similarly, those diagnosed with bulimia may see an increased mortality rate of up to seven times within 10 years of detection (Nielsen 2001). Therefore, what may prove most insightful in disordered eating assessment are the perceptions of those affected. Enhancing quality of life (QOL) if often referred to as the cornerstone of health promotion (Diener 2000). QOL is commonly measured through a number of objective and subjective methods. Objective measures include socioeconomic indicators (e.g., unemployment rates, gross domestic product, access to health care, and housing quality) and environmental indicators (e.g., air quality and recreational services). Subjective measures, on the other hand, refer to individuals internal judgments of the quality of their overall lives and/or specific life domains (e.g., satisfaction with friends, family, living environment, etc.; Diener and Suh 1997). This study considers one important aspect of subjective QOL: life satisfaction. General life satisfaction has been defined as an overall cognitive evaluation by a person of his or her life (Diener et al. 2004). According to Diener et al. (2004), satisfaction judgments are based on individuals comparisons between self-generated standards and their perceived life circumstances. According to Frisch (2006), life satisfaction refers to our subjective evaluation of the degree to which our most

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important needs, goals, and wishes have been fulfilled (p. 22). Thus, life satisfaction assessments provide a view of the concerns and conditions of community residents themselves, revealing what is most important to them (Huebner et al. 2004). Such evaluations, when they are positive, are thought to influence the probability of subsequent behavioral responses, enhancing resilience (Diener et al. 2004; Lazarus 1991). For example, high global life satisfaction has been shown to serve as a protective factor against the development of behavior problems in the face of adverse life experiences in adolescence (Suldo and Huebner 2004). By providing insight to the psychological factors to individuals health status and functioning, measures of life satisfaction are crucial to overall health assessments providing related, but separable information from other traditional mental health indicators (Diener et al. 1999; Huebner et al. 2007). Life satisfaction measures are consistent with the positive mental health orientation that defines psychological wellbeing as more than the absence of psychopathological symptoms (Peterson 2006; Seligman and Csikszentmihalyi 2000). For instance, one can be dissatisfied with life because of experiencing some undesirable conditions, but simultaneously not display symptoms of psychopathology. Alternatively, one can experience psychological symptoms, but be satisfied with life. Hence, measures of life satisfaction can provide increased incremental validity in the assessment of health outcomes (Haranin et al. 2007; Huebner et al. 2004). Life satisfaction reports are constructed as ongoing judgments that reflect the influence of changing life circumstances (Diener et al. 1999). As such, changes in satisfaction with life could elicit changes in individuals coping strategies. For instance, someone may respond to declines in life satisfaction and associated emotions by engaging health-related risk behaviors (e.g., disordered eating) in an attempt to increase their life satisfaction. On the other hand, engaging in healthrelated risk behaviors may alter a persons satisfaction with life. Recently, low levels of life satisfaction have been shown to be related to a variety of maladaptive health-related outcomes among adolescents, including higher rates of suicidal behavior, lower physical activity levels, substance use, and violent behavior (Valois et al. 2001, 2004a, b; Zullig et al. 2001). In addition, emerging literature among college students indicates low life satisfaction is related to alcohol misuse (Zullig et al. 2005). Fewer studies have explored the relationship among life satisfaction and disordered eating and poor body image. Among adults, a Finnish study of twin pairs aged 1854 at baseline found low levels of life satisfaction were predictors of weight gain in older women (Korkeila et al. 1998). Utilizing a sample of 1,069 women and 963 men, Greeno et al. (1998) found that a lack of perceived eating control and a higher BMI in women were associated with lower life satisfaction and lack of control over eating. In men, these same researchers found that only the lack of perceived control over eating was an important predictor of lower life satisfaction. Among a large, randomly selected sample of adolescents, Valois et al. (2003) established that perceptions of overweight, perceptions of underweight, having dieted to lose weight, having vomited or used laxatives to lose weight, and taking diet pills were significantly related to reduced life satisfaction and that results varied by both gender and ethnicity. However, among college students, only one somewhat related qualitative study was located in a review of literature. Kitsantas et al. (2003) interviewed 56

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college students for self-regulatory strategies to lose and maintain their weight. Students with eating disorders reported more self-regulatory strategies for managing their weight, lower life satisfaction, and higher levels of negative affect than individuals of normal weight (Kitsantas et al. 2003). Life satisfaction was assessed in this study using the Extended Life Satisfaction Scale (ELSC; Alfonzo et al. 1996), which is a 50-item self report scale that assesses nine domains of life satisfaction: general life, sexual life, social life, intimate relationships, self-satisfaction, physical appearance, family life, school life, and job satisfaction. Although Kitsantas et al. (2003) suggest a link between eating disorders and lower life satisfaction, no research has attempted to explore the association among life satisfaction and poor weight perceptions and dieting practices among college students, particularly in reference to weight perceptions and dieting behaviors. Therefore, the purpose of this study was to explore the relationships among weight perceptions, dieting behaviors, and perceived life satisfaction among a randomly selected population of college students. It was hypothesized that those students with poor body image perceptions and dieting behaviors would report significantly reduced satisfaction with life.

Materials and Methods Sampling Method During February 2003, 1,000 students aged 18 years of age or older were randomly selected from the referent universitys e-mail database to participate in the webdelivered health survey in this mid-western state. Equal numbers of students were randomly selected from each class using the uniform distribution number generator function in SAS, giving each student an equal probability of being selected for the sample. This function assigns each student a random number resulting in a representative sample of university students. The sample database included student names, current mailing addresses, and current e-mail addresses. Using web-survey methods (Pealer et al. 2001) and methods approved by the referent universitys institutional review board, selected students (N=1,000) were sent, via electronic mail and US mail, a solicitation regarding the purpose of the study. Students were informed that if they chose to participate, they would receive a coupon redeemable at a local caf for a medium drink of their choice. Seven days after the initial solicitation was sent to each selected participant, a second solicitation was sent via electronic mail with an attached link to the survey. If selected participants chose to participate, they were directed first to an informed consent statement describing the research procedures and steps taken to protect participants privacy. Students who chose to participate were then referred to the survey by clicking the referent link. Once each participant submitted their completed survey, any identifying information was separated from their responses and stored in a separate data storage facility, making their responses anonymous. A follow-up e-mail was sent to each participant 1 week after the survey was originally distributed, followed by one additional US mail and e-mail reminder 1 week thereafter. A total of 522 questionnaires were returned for a 52% response rate.

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Participants Sixty-six percent (n=344) of the respondents were female and 34% (n=178) were male. Approximately 91% (n=471) of the respondents were white, most reported living either in a residence hall (45%, n=236), or off-campus (48%, n=249), which is where most participants completed the questionnaire (44%, n=233) and (42%, n= 222). Most respondents reported growing up in suburban settings (77%, n=403). The mean age of the sample was 20.32 (SD=1.78). These and other demographic data are presented in Table 1. Instrumentation Brief Multidimensional Students Life Satisfaction Scale (BMSLSS) The BMSLSS consisted of one item for each of the five life satisfaction domains identified on the 40-item Multidimensional Students Life Satisfaction Scale (Huebner 1994) and an additional sixth item, I would describe my satisfaction with my overall life as. The domains, which include family, friends, school, self, and living environment, were chosen on the basis of a literature review, pilot studies, and previous research (Huebner 1991). One item was I would describe my satisfaction with my family life as while another was I would describe my satisfaction with my friends as and so forth. Response options were derived from the widely utilized Delighted-Terrible Scale (Andrews and Withey 1976). They included: terrible, unhappy, mostly dissatisfied, mixed (about equally satisfied and dissatisfied), mostly satisfied, and delighted. The BMSLSS was recently found to display adequate validity and
Table 1 Sample demographics Characteristic Age group (years) 18 19 20 21 22 23+ Year First year Sophomore Junior Senior Other Gender Male Female Race White Non-white Receive Financial Aid Yes No Unsure Number of respondents (N=522) 15 119 169 135 71 13 40 180 157 139 5 (2.9%) (22.8%) (32.4%) (25.9%) (13.6%) (2.5%) (7.7%) (34.6%) (30.1%) (26.7%) (1.0%)

178 (34.1%) 344 (65.9%) 471 (90.6%) 51(9.8%) 238 (45.6%) 262 (50.2%) 22 (4.2%)

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reliability among public school adolescents and college students (Seligison et al. 2003; Zullig et al. 2005). The independent variables explored in this study were self-described weight (response options were very underweight, slightly underweight, about the right weight, slightly overweight, very overweight); degree of worry over weight (response options were not at all worried, a little worried, somewhat worried, very worried, extremely worried); binge eating behavior, defined for the respondent as eating an unusually large amount of food in a 2-hour period (response options were never, monthly, weekly, every other day); degree of worry over binge eating behavior (response options were I do not binge, not worried at all, a little worried, somewhat worried, very worried, extremely worried); duration of binge eating behavior (response options were I do not binge eat; 1 year or more; less than 1 year, but more than 6 months; less than 6 months); vomiting to get rid of food in the past year (response options were never, once, more than once); and whether students described themselves as having an eating disorder (response options were yes, definitely; yes, I think so; not sure; no, I dont think so; no, definitely not). Students were classified as holding healthy or unhealthy perceptions of weight or engaging in risky dieting behavior or not. The referent group was designated for those who held healthy perceptions of weight or who had not reported extreme dieting behavior. Both measures were ordered in the survey to that respondents completed the independent variables before the dependent, life satisfaction variables. Frequencies and percentages for the selected behaviors are presented in Table 2 by gender.
Table 2 Gender breakdown of dieting behavior variables n and % Risk variable Self-described weight Just right Slightly/very overweight Slightly/very underweight Degree of worry over weight Not worried Little/somewhat worried Very/extremely worried Binge eating behavior Never binged Binge at least monthly Degree of worry over binge eating Never binged Little/somewhat worried Very/extremely worried Duration of binge eating Never binged Less than 1 year 1+ years Vomited to get rid of food (past year) Never vomited Vomited at least once Self-described eating disorder No Not sure Yes Female-n (%) (n=343) 168 (49.0) 109 (31.8) 66 (19.2) 62 (18.1) 220 (64.1) 61 (17.8) 256 (74.6) 93 (27.1) 247 (72.0) 77 (22.5) 19 (5.5) 263 (76.7) 27 (7.8) 53 (15.5) 318 (92.7) 25 (7.3) 313 (91.3) 19 (5.5) 11 (3.2) Male-n (%) (n=178) 87 (48.9) 51 (28.7) 40 (22.5) 71 (39.9) 94 (52.8) 13 (7.3) 131 (73.6) 47 (26.4) 134 (75.3) 40 (22.4) 4 (2.3) 142 (79.8) 17 (9.6) 19 (10.6) 172 (96.6) 6 (3.4) 173 (97.2) 2 (1.1) 3 (1.7)

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Data Analysis All six discrete variables from the BMSLSS were pooled together to form a pseudocontinuous dependent variable ranging in score from 6 (16) to 42 (76). The overall item was included in these analyses because prior research has shown it to be highly correlated with the five pooled BMSLSS items in the college population (r=0.75, p< 0.0001; Zullig et al. 2005). The total life satisfaction score was expressed as a Mean Satisfaction Score (MSS) with lower scores indicative of reduced satisfaction with life. A coefficient alpha of 0.83 was obtained for the six-item scale in this study. The pooled dependent variable was collapsed into three outcome levels: dissatisfied, mid-range, and satisfied students. Because students falling into the mid-range category were measured with one response option (i.e., feeling equally satisfied and dissatisfied with life), whereas the other two categories comprised three response options, a numeric collapse of the MSS determined subject categorization. Consistent with prior BMSLSS research, MSS scores ranging from 6 to 27 were categorized as dissatisfied, scores ranging from 2834 comprised the mid-range group, and scores of 35 or greater defined the satisfied group (Valois et al. 2003; Zullig et al. 2001). To account for the three-level outcome variable, adjusted multiple logistic regression was conducted at =.05 for this analysis. Adjusted odds ratios (OR) and confidence intervals (CI) were calculated to determine which risk behaviors were associated with reduced life satisfaction for each gender group for both the mid-range and dissatisfied levels. Satisfied students served as the referent group. Variables not meeting the 0.05 significance level were not retained in the model.

Results Perceived Life Satisfaction Consistent with prior research (Valois et al. 2003; Zullig et al. 2001), the majority of students reported at least mid-range satisfaction with life or greater (76.2% of females, and 73% of males), while approximately 24% of females and 27% of males reported being dissatisfied with life (Table 3). As one might expect, there was also a linear increase in the numbers of students in each category when one examines the dissatisfied, mid-range, and satisfied categories, respectively. These results appear to be quite consistent for multiple populations of public high school and college students, providing additional evidence regarding the short-term and long-term stability of life satisfaction judgments (Funk et al. 2006; Valle et al. 2006).

Table 3 Frequency and percentage of perceived life satisfaction level by gender Gender Females Males Lower life satisfaction 82 (23.8%) 48 (27.0%) Midrange 117 (34.0%) 59 (33.1%) Higher life satisfaction 145 (42.2%) 71 (39.9%)

N=522; chi-square 2df=0.6235, p=0.73

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A chi-square analysis was performed testing the hypothesis of equal proportions (percentages) across the gender groups for levels of life satisfaction. An overall chisquare value of 0.6235 with 2 degrees of freedom with a p value of 0.73 was obtained, indicating that percentages of life satisfaction across the levels of life satisfaction were about the same for females and males. Mid-range Level of Life Satisfaction and Weight Perceptions and Dieting Behavior Results here identified no significant associations regarding any of the examined weight perception or dieting behavior variables and perceived life satisfaction. Owing to this lack of association at the mid-range level, these data are neither tabled nor discussed. Life Dissatisfaction and Weight Perceptions and Dieting Behavior Females Significant associations were established between dissatisfaction with life and perceptions of slightly/very overweight (OR=2.37) or slightly/very underweight (OR=12.90), being little/somewhat worried about weight (OR=3.97) or very/ extremely worried about weight (OR=12.61), binge eating at least monthly (OR= 2.62), being very/extremely worried about binge eating (OR=2.86), having binge ate for 1+ years (OR=3.32), and having vomited at least once to get rid of food (past year; OR=3.21; Table 4). Females who reported poor dieting behaviors and

Table 4 The relationship between reported dissatisfaction with life and dieting behavior by gender Risk variable Odds ratio and 95% confidence interval Female Self-described weight Slightly/very overweight Slightly/very underweight Degree of worry over weight Little/somewhat worried Very/extremely worried Binge eating behavior Binge at least monthly Degree of worry over binge eating Little/slightly worried Very/extremely worried Duration of binge eating Less than 1 year 1+ years Vomited to get rid of food (past year) Vomited at least once Self-described eating disorder Not sure Yes *p<0.01 **p<0.0001 ***p<0.001 2.37* (1.224.61) 12.90** (6.4425.85) 3.97* (1.928.19) 12.61** (2.7258.50) 2.62*** (1.365.06) 1.08 (0.641.82) 2.86*** (1.415.52) 1.12 (0.363.46) 3.32*** (1.636.29) 3.21* (1.238.43) 0.17 (0.021.64) 0.33 (0.042.58) Male 1.78 (0.764.18) 5.76** (2.4813.40) 1.26 (0.236.96) 3.19* (1.278.34) 0.86 (0.342.18) 0.77 (0.292.07) Inadequate cell size 0.57 (0.122.65) 0.86 (0.107.04) 3.14 (0.5019.68) Inadequate cell size

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perceptions of their weight increased the odds of reporting dissatisfaction with their lives by 2.37 to 12.90 times, when compared to those females who did not report these poor dieting and weight perceptions. Males Significant associations were determined between dissatisfaction with life and perceptions of slightly/very underweight (OR=5.76) and very/extremely worried about weight (OR=3.19; Table 4). Males who reported poor perceptions of their weight increased the odds of reporting dissatisfaction with their lives by 3.19 to 5.76 times, in comparison to those males who did not report these poor weight perceptions.

Discussion This was a cross-sectional study of the association between self-reported overall life satisfaction and dieting behaviors and weight perceptions among a large (N=522), randomly selected sample of college students. Life satisfaction was measured with an easily administered and validated six-item scale (Zullig et al. 2005). The results of this study indicate that a substantial number of college students at this midwestern university are experiencing poor perceptions of their weight and engaging in poor dieting behavior. Although the research base connecting these two bodies of literature is growing (Valois et al. 2003), this is the first study to demonstrate significant relationships among self-reported satisfaction with life and poor dieting behavior and weight perceptions among college students. Moreover, this study highlighted that the nature and magnitude of poor dieting behavior and perceptions of weight were significantly influenced by gender. However, the noted similarities between genders warrant additional attention. For example, the association between dissatisfaction with life and being slightly/very underweight or very/extremely worried about their weight by both males and females may be explained very differently within the context of societal demands and expectations (McCabe and Ricciardelli 2004). Previous research among college students regarding life satisfaction and life demands revealed those with lower life satisfaction were characterized by more constrictive lifestyles (e.g. fewer responsibilities, roles, and obligations, and less satisfying relationships; Bailey and Miller 1998). Given the known psychological factors (e.g., stress, self esteem, and emotion; Treasure et al. 2003), perfectionist tendencies (Kiemle et al. 1987; Slade et al. 1991) and intense preoccupations with weight associated with disordered eating, females in this study who reported being slightly/very underweight may be inappropriately attempting to align their bodies with the perceived social norm of thinness (Sanderson and Darley 2002). In the process, these females may be alienating valuable social supports (Bennett and Cooper 1999), as weight concerns dominate much of their time, further fueling feelings of dissatisfaction. It should be noted here that life satisfaction is strongly associated with social support from family and friends (Dew and Huebner 1994; Gilman and Huebner 1997; Huebner 1991). In addition, sub-clinical levels of life dissatisfaction have been shown to relate to social rejection among normal college students (Furr and Funder 1998). Taken together,

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these findings suggest that levels of social support may mediate the relationship between life dissatisfaction and poor weight perceptions and dieting behavior. Of course, future research is needed to test this hypothesis. For males in this study, the findings that life dissatisfaction is associated with being slightly/very underweight and very/extremely worried about their weight may begin as early as Grade 4. For instance, Parkinson et al. (1998) found boys in Grades 45 desired a larger body, whereas boys in Grades 78 desired a leaner body. These results suggest that boys at a very young age are aware of the sociocultural ideal for males. In adult men, these goals for a larger, more muscular body are common across a range of cultures. Prior research indicates men from France, Austria, and America indicated, on average, that their ideal stature was 13 kg greater in muscle mass than their current body and that those who displayed the greatest propensity for increased muscle mass also displayed the highest levels of body dissatisfaction (Pope et al. 2000). One study of underweight college males (body mass index <25) demonstrated that these males experienced an exceptionally negative body image that impeded their social adjustment (Harmatz et al. 1985). Therefore, it is not surprising that life satisfaction is related to males perceptions of their bodies. More interesting is that males in this study do not seem to be distressed or dissatisfied by some of the eating behaviors that most would consider dangerous (e.g., binge eating behavior). This effect occurs despite approximately 26% of males reporting binge eating at least monthly and about 11% engaging in binge eating for more than one year. These males may be different than males who are dissatisfied with their lives because they perceive themselves as slightly/very underweight. More significantly, evidence suggests that males who engage in unhealthy dieting behaviors are actually at greater risk for becoming overweight in longitudinal analyses 5 years later (Neumark-Sztainer et al. 2006) when compared to those not engaging in extreme dieting behaviors. There is a relative dearth of knowledge regarding male disordered eating, yet what is known is that among the strongest predictors of male college student unhealthy dieting behaviors are depression, obsessivecompulsive disorders, and exercise disorders (Erol et al. 2006; ODea and Abraham 2002). Screenings and subsequent probing for these symptoms may increase the possibility of recognition and self-disclosure of disordered eating among these males. Collectively, body image literature suggests that women attach greater importance to the appearance of their bodies than men. Females also appear to attach greater important to body weight as BMI increases (Rozin and Fallon 1988). Thus, the finding that life dissatisfaction was significantly associated with self-described perceptions of being overweight by females is not surprising. Nor are the findings that females who engaged in binge eating behavior, particularly for 1 or more years, and vomiting to rid themselves of food were significantly more likely to report dissatisfaction with life. Previous research has demonstrated correlations between body dissatisfaction and a drive for thinness among females, in addition to a belief that weight loss is associated with a youthful appearance (Gupta and Schork 1993). Interestingly, there was a lack of association between life dissatisfaction and those females who described themselves as having an eating disorder or were not sure if they had an eating disorder in this study (there were too few males in these categories to calculate risk). Although speculative, one explanation may be that those who are not sure or self-describe themselves as having an eating disorder are

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likely in denial or see their symptoms as unproblematic. Anorexics may defend and identify with their symptoms early on in the disorder (Macleod 1982). Often, early symptoms of an eating disorder may be seen as positive. For example, anorexics may perceive their ability to manage eating habits as a form of self-control. They may also see the attention that is being given to their thinness as affirmative (Bliss 1982). In fact, a common approach to addressing the treatment of addictive behaviors and eating disorders is first attending to patient ambivalence (Vitousek et al. 1998). Although the numbers in these categories are low and must be interpreted cautiously, these findings suggest that these students may not recognize the signs and symptoms of an eating disorder. The general findings support the contention that both males and females may not recognize or disclose the signs and symptoms of eating disorders, although in very different ways. For females, any deviations from what they believe to be the ideal body type and drastic methods to obtain that ideal body type may result in dissatisfaction with life. Males engaged in disordered eating, although less prevalent than females, appear to be significantly less concerned about extreme dieting behavior. Nonetheless, both males and females appear to be very much at risk for eating disorders (e.g., 27% of females and 26% of males reported binge eating at least monthly), which suggest further intervention by others may be warranted to connect these students with needed services and treatment and educational efforts. Evidence suggests that among individuals who have not disclosed or recognized disordered eating symptoms, those who are questioned are more likely than not to volunteer information (Becker et al. 2005). Therefore, one promising educational intervention appears to be a carefully planned Student Assistance Program (SAP) in colleges and universities. SAP models consist of several basic components: formal student identification, staff training and identification of problem behaviors (e.g., disordered eating), faculty and staff identification of behaviors, intensive training for SAP team members, referral for assessment for treatment and follow-up posintervention support, parental involvement, and community agency support and collaboration (Herberg et al. 1990; Moore and Forster 1993). Evaluations of SAP programs in Pennsylvania public high schools indicate SAPs to be effective (Fertman et al. 2001) and a similar education and screening program conducted and evaluated on more than 400 college campuses revealed that two years after the program, more than 80% of program participants were aware of the dangers posed by disordered eating and the availability of treatments (Becker et al. 2004). Under an SAP model, faculty and staff could be trained to recognize common eating disorder signs and symptoms (e.g., perfectionism, obsessivecompulsive behavior, social withdrawal from friends, etc.) or academic signs and symptoms of problematic students (e.g., attendance, grades) and be empowered to make a referral to proper SAP team members for further evaluation, and if warranted, further intervention. The basic tenet of an SAP is to prevent students from hitting the bottom because if left unchecked, eating disorders may cause serious mental and emotional complications and possible mortality (Keel et al. 2003). In addition, emerging research suggests that individuals engaged in unhealthful eating behaviors may be quite agreeable to disclosing symptoms in structured settings (Becker et al. 2005), which may increase satisfaction with life. This holistic approach enables a shared language and a shared way of working and understanding among all stakeholders.

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Limitations These findings, however, must be considered within the context of limitations from this preliminary study. First, this study was cross-sectional in nature, which precludes any conclusions regarding the temporal sequence of life dissatisfaction as a precursor or poor dieting behavior and perceptions of weight or vice versa. What is currently known is that findings reported here appear to be fairly consistent with what has been reported on public high school adolescent dieting behavior and satisfaction with life (Valois et al. 2003). Hence, relationships identified within this study may develop before college and could potentially be exacerbated during the college years. Second, results reported here represent one, largely Caucasian university in the Midwestern United States that may not be nationally or internationally representative. Finally, data were collected electronically through the Internet and yielded a response rate of 52%, which although is becoming more commonplace, is still experimental technology. Students who do not have ready access to a computer in a private setting may be less apt to complete the questionnaire, or answer the questions candidly. Results indicate that 46 (8%) of respondents completed the survey in a computer lab.

Conclusion This studys cross-sectional design precludes any determination of a temporal sequence of whether these emerging adults reported dissatisfaction with life as a result of inappropriate dieting behaviors and negative perceptions of weight, or whether they reported inappropriate dieting behaviors and negative perceptions of weight owing to dissatisfaction with life. Current life satisfaction and dieting behavior/body image literature suggests that this relationship may establish itself before the college years (Valois et al. 2003). Thus, college-level intervention programs should be structured to provide health professionals with guidelines and protocols for dealing with this issue, yet be flexible enough to allow for proper handling of unique situations. Perhaps the most intriguing possibility raised by the findings is that college age males may perceive various maladaptive eating behaviors as non-problematic, despite the fact that the behaviors represent risk factors for students of both genders. Specifically, 26% of the males reported monthly binge eating, but only 4% reported being very worried about their binge eating. Furthermore, 40% of the males were not worried about their weight even though 51% described themselves as overweight or underweight. Given the relative lack of dissatisfaction associated with some behaviors as well, it is possible that college age males may be more refractory to treatment efforts, that is, they may be less likely to acknowledge, monitor, or seek assistance for their maladaptive eating behaviors. As a result, prevention and intervention programs may need to be tailored differentially for college age males and females, with special efforts to motivate male students to enroll, participate, and comply with treatment strategies. It is further possible that males may need to have special attention devoted to changing their definitions of healthy eating behavior to ensure the collection of meaningful and valid program evaluation data among this population. Nevertheless, these possibilities are speculative and await further research.

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Keith J. Zullig M.S.P.H., Ph.D. (University of South Carolina, Arnold School of Public Health) is Assistant Professor of Health Education at Miami University. His primary research interests include adolescent and young adult health risk behavior, quality of life research, and intervention/evaluation research. He is a member of the American Public Health Association; American School Health Association; and the American Association for Health Education.

Scott M. Pun M.S. (Miami University) is a Research Associate in the Program in Health Promotion at Miami University. He is a member of the American Public Health Association and American Association for Health Education.

Scott Huebner Ph.D., NCSP is Professor in the Department of Psychology at the University of South Carolina. He received his Ph.D. from Indiana University. His research interests involve the conceptualization, measurement, and implications of positive psychological well-being constructs. He is a fellow of the American Psychological Association (Div. 16) and the International Society for Quality of Life Studies.