photo by: Contributed

Members of the Unviersity of Kansas's Center for the Advancement of Research on Eating Behaviors. The team has helped develop the BEST-U treatment program.

When you study eating disorders like KU professor Kelsie Forbush does, you know that dangerous problems can often “fly under the radar.”

You know these conditions may be completely invisible to other people. You know that people can suffer from one even without being underweight.

“You may not know someone is struggling,” Forbush said.

But when she first came to KU, Forbush had to think about invisible problems in a new light. A student she interviewed had a disorder that was “totally treatable,” Forbush said, so she gave them a list of places they could get treatment.

And then the student came back and said none of those would work. They didn’t have a car to get to Kansas City; the places in Lawrence did not take insurance; and the KU counseling center was not able to provide eating disorder treatment at the time.

A new kind of invisible problem had suddenly become visible, one that particularly affects college students.

“We’re kind of living in a little bit of a ‘treatment desert,'” Forbush said. So she and her team investigated it further, and “we found a divide between the incredible demand for treatment and an absolute lack of resources.”

Now, Forbush and her team think they have a solution: a program called BEST-U that combines more traditional mental health coaching with a phone app that can guide students through self-help exercises in an easily accessible way.

The initial results from BEST-U have been so positive that they’ve surprised even Forbush herself, and her goal is to expand it beyond KU, to other colleges and universities where there are many students in need of help.

• • •

photo by: Contributed

Kelsie Forbush, a professor at the University of Kansas and the director of its Center for the Advancement of Research on Eating Behaviors (CARE).

Forbush, who is the director of KU’s Center for the Advancement of Research on Eating Behaviors (CARE), used to be a professional ballet dancer, and she saw up close and personal how body image issues in that field were a breeding ground for eating disorders.

She recalled the national news story of Heidi Guenther, a 22-year-old dancer with the Boston Ballet who suddenly died of a heart attack in 1997 a few years after her company told her to lose weight. Later, it was discovered that Guenther had been abusing laxatives and showed other extreme signs of eating disorders.

The popular depiction of eating disorders is similar to Guenther’s tragedy — rail-thin young women starving themselves to be skinnier. But, as it turns out, typical college students are also in a prime environment to develop eating disorders.

The Emily Program, a national organization that works with eating disorders in college students, has a whole list of reasons why. Students are often on their own, unsupervised, for the first time in their lives. They have new freedom to change their eating habits. There are all kinds of new stresses on them — academic performance, financial worries, the need to fit in. There’s even the fear of the “freshman 15” — the idea that new students often put on weight in their first year.

And KU researchers have found that eating disorders among college students have gotten even worse since the COVID-19 pandemic. In just the few years after the pandemic, eating disorder prevalence has increased by 62% in college women and 140% in college men, the researchers found.

When Forbush and her team launched their study at KU a few years ago, so many students took their survey that “it broke the survey,” Forbush said. That means there’s a lot of demand — and not nearly enough resources to treat those students.

The story is similar around the country, as Forbush said that for every 2,000 college students who have an eating disorder, there is just one mental health provider trained to treat eating disorders.

“The demand is so high,” Forbush said. “I wanted to understand a way to create a treatment to bridge that gap.”

• • •

photo by: Contributed

Kelsie Forbush (left), conducting a mock interview as part of the BEST-U treatment program. The program, which uses a mobile app and weekly meetings with a mental health specialist, has been successfully treating college students with eating disorders. She hopes the program can expand more nationally.

Not only do the unique pressures of college cause many students to develop eating disorders, but Forbush said that environment can also impact the treatment — if students are even able to access it.

While there are many self-help textbooks available for eating disorders, they may not be as relatable for college students as for other patients, or they may be too much of a burden for a student who is already having to do readings for multiple classes.

So, the BEST-U program tries instead to take those self-help concepts and make them more accessible and relatable through the app. The program lasts 11 weeks, with the students being expected to use the app for around 10 minutes a week and meet for in-person sessions with a trained graduate student for around 25 to 30 minutes once a week as well.

First, students interested in getting treatment go through an initial survey for eligibility. Forbush said that the method isn’t meant to be used to treat low-weight eating disorders like anorexia nervosa because that needs “a more intensive therapeutic approach.”

Then, the students start using the app. Forbush said the app was designed to be similar to the self-guided treatment textbooks, using the same kind of information but in a way that is less “boring.” The app includes videos and interactive quizzes and was tailored for students, taking core principles from those books and mixing them with other issues that may be more unique to students.

Forbush thinks having the program available all the time on their phones helps students spend more time on the treatment. She said she has worked with patients who have watched videos multiple times, or end up sending in multiple different responses to questions. When she asked the patients why, the answer was that they found the information helpful and thought about it more.

Additionally, the app format is “awesome” for therapists because information about what the students are doing is logged in real time, Forbush said. With a more traditional self-guided textbook or workbook, people might write down what they ate that week and list any questions they had on a piece of paper, and then hand that to the provider during that meeting, who would then skim through that and discuss those issues. But when the information is logged digitally, Forbush said, the therapist already has access to it before the appointment, so they can prepare in advance and then be able to spend more time talking with the patient.

“The sessions are much more tailored and effective,” Forbush said.

Forbush said she believes students end up “really engaged in the lesson and material,” which helps with the treatment outcomes. Initial results from BEST-U have found that the impact on patients has been better than traditional treatment methods, something Forbush said surprised her. She believes some of that impact is because the work comes in snippets. The repetition of using the app helps “empower” students to work on the problem, instead of having a feeling that problems will be “fixed in one hour” of talking with a therapist.

“The app is pretty short, but it reinforces the idea the work goes on outside the therapy room,” Forbush said.

• • •

Although the treatment is making strides and helping students, Forbush is continuing to work on the BEST-U app to be able to reach more people.

Forbush noted the most recent version of the treatment and app is kind of the “3.0 version,” which has been updated and tested to ensure people are getting the best version of treatment.

One way that Forbush hopes to expand the program further is to try to train people who are not mental health specialists, such as nurses or social workers, to serve as coaches. Previously, only highly trained specialists like post-doctorate fellows, Ph.D. students or faculty helped facilitate treatment. If patients still find success in treatment with coaches who aren’t specialists, that could lead to “a lot more flexibility in how care can be delivered,” Forbush said.

Forbush said that through each iteration, the team has been focused on ensuring each element of the treatment is scientifically supported, and BEST-U is continually improved “as the data comes out.”

Forbush’s goal is to hopefully make this a nationwide treatment program that other colleges can access. The next step would be a larger trial at more schools. If the program expands, Forbush hopes that the product can remain free or as cheap as possible, but the goal is just to get “this tool in the hands of more universities.”

In the end, Forbush hopes that the work done by the CARE team can lead to more students suffering with eating disorders to get access to treatment they need.

“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,” Forbush said.