The Health Journey Of College Women With Eating Disorder Behaviors

College can be a stressful time for students. During this transitional phase, many young women face new challenges, including unique social and academic stressors, which increase the risk of developing eating disorders and eating disorder behaviors. In fact, it is estimated that 7% to 18% of college women screen positive for eating disorders. College women are also increasingly using mobile health applications for diet, physical activity, and weight loss (weight loss apps) even when weight loss may be unnecessary. These apps support dieting and promote the thin ideal, which are related to the development of eating disorders. Thus, the combination of the college environment and use of weight loss apps may further exacerbate eating disorder behaviors among this population. However, the usage and consequences of weight loss apps in the context of eating disorders is not well known. Some aspects of weight loss apps may be helpful for eating disorder recovery while others may inhibit recovery and even harm users. Significant research exists on weight loss apps and the quantification of health behaviors, known as the quantified self, in Human-Computer Interaction (HCI). However, most of these studies view weight loss apps as a positive influence on users and a way to combat the obesity epidemic in the United States. While the negative effects of social media and pro-eating disorder communities have been well studied, this research tends to ignore the potential negative implications of weight loss apps. In terms of positive use and impact, research tends to focus on online eating disorder support communities and treatment apps and often neglects potential positive aspects of non-eating disorder specific technologies, such as weight loss apps. In this dissertation study, I address these limitations in existing research by conducting a qualitative study, which includes think-aloud exercises and semi-structured interviews, with college women with eating disorder behaviors. The bulk of this research rests on the main study, which aims to understand the usage and unintended consequences of weight loss apps among this population. Through this research, I provide an understanding of why college women with eating disorder behaviors use weight loss apps, descriptions of how weight loss apps are used, and descriptions of unintended negative and positive consequences. This dissertation study is important because it is among the first research to consider the role of weight loss apps in the context of eating disorders. Findings from this research contribute to our understanding of eating disorders and app design. Specifically, I present a conceptual understanding of an individuals health journey, which includes the changing nature of app use and the mutual influence between an individual and technology. Then I provide an identification of problematic aspects of design, which challenges the current narrative about weight loss apps. Based on problematic aspects of design, I make design suggestions, which are important for designing future weight loss apps and other similar health technologies to focus more on promoting healthy behaviors. This research emphasizes the need for a fundamental shift in how we think about and design for health within apps.