Journal of Psychosomatic Research 52 (2002) 129 – 136

Dieting frequency among college females:

Association with disordered eating, body image, and
related psychological problems
Diann M. Ackarda,*, Jillian K. Crollb, Ann Kearney-Cookec
a
Westwood Lake Office Park II, 8421 Wayzata Boulevard, Suite 305 Golden Valley, MN 55426, USA
b
Division of Epidemiology, University of Minnesota, Minneapolis, MN, USA
c
Cincinnati Psychotherapy Institute, Cincinnati, OH, USA
Received 10 July 2000; accepted 26 June 2001

Abstract

Objective: To examine associations between dieting frequency
and eating disorder behaviors, body satisfaction, and related
factors. Method: Females (N = 345) whose average age and body
mass index (BMI) were 20.58 and 21.79, respectively, were
grouped into three categories of lifetime dieting frequency (never,
1 – 5 times, or 6 or more times) and matched on current BMI across
categories. Results: Positive associations were found between
dieting frequency and eating disorder symptoms and related
problems such as body dissatisfaction, current body size
perception, depression, exercise preoccupation, and feelings of
ineffectiveness and insecurity. Dieting frequency was inversely
associated with self-esteem, ideal body size, emotional regulation,
and impulse control. Discussion: Independent of current BMI,
frequency of dieting behaviors is strongly associated with negative
emotions and problematic behaviors. As this study is correlational
in nature, future longitudinal studies should ascertain the sequence
of onset of these experiences. D 2002 Elsevier Science Inc. All
rights reserved.

Keywords: Body image; Depression; Dieting; Eating disorders; Self-esteem

Introduction There are issues of concern over the practice of

While the definition of ‘‘dieting’’ includes weight-
reduction efforts generally considered to be healthy (e.g.,
increased fruit and vegetable intake and decreased fat and
sugar intake), many individuals also consider ‘‘dieting’’ to
include unhealthy weight-control behaviors such as fasting,
skipping meals, and eliminating food groups [1]. Regard-
less of how one defines dieting, the lifetime prevalence of
these weight-control behaviors in females is alarming.
Results from a nationally representative population-based
survey of high schools girls indicate that 58% had dieted
[2], and in a study of over 4000 adults, 75% of the women
indicated that they had been on a diet [3].
* Corresponding author. Tel.: +1-763-595-7294; fax: +1-763-595-
7293.
E-mail address: diann_ackard@mindspring.com (D.M. Ackard).
dieting. First, many of the individuals who diet are of
normal weight for their height. In 1985, over 34.1 million
men and women dieters were found to be of normal
weight, as compared to 22.6 million dieters who were
overweight [4]. Studies have also indicated that approx-
imately 47% of normal-weight women and 32% of
normal-weight girls diet to lose weight [4– 6].
Second, many of the individuals who diet use
unhealthy weight-control behaviors such as fasting and
use of appetite suppressants, rather than healthier weight-
loss practices such as reducing intake of fat and sweets
and increasing physical activity. For example, in a com-
munity-based weight-gain prevention program, 22% of
women and 17% of men reported the use of at least
one unhealthy weight reduction behavior over the past
year [7]. Adolescents are also using unhealthy weight-
control measures. In a state-wide survey of 133,794 male
and female adolescent students in Minnesota, 43% of girls
and over 13% of boys in the 9th and 12th grades reported

0022-3999/02/$ – see front matter D 2002 Elsevier Science Inc. All rights reserved.
PII: S 0 0 2 2 - 3 9 9 9 ( 0 1 ) 0 0 2 6 9 - 0
130 D.M. Ackard et al. / Journal of Psychosomatic Research 52 (2002) 129–136
fasting or skipping meals to control or lose weight [8].
Diet pills or speed were used by 2% of boys and over
8% of girls in the 9th and 12th grades, and 2% of all
youth surveyed reported using laxatives in an attempt to
control or lose weight.
Third, there is debate as to the accuracy of restraint
theory (the assumption that dietary restraint is etiolog-
ically significant for the development of eating disor-
ders). Supporting restraint theory, results from a
prospective study of 1010 adolescent girls indicate that
among the 34.6% of the overall study population who
indicated dieting at baseline, 21% of these girls
developed eating disorders by the time of the 12-month
follow-up [9]. In contrast, recent research by Lowe
[10,11] raises question as to the etiological relationship
between dieting and binge-eating. No significant rela-
tionship between dieting and binge-eating was found in
either study. Consequently, the authors conclude that
factors other than dieting maintain binge-eating in
bulimic individuals [11].
While dieting efforts among average weight or under-
weight individuals are most often considered negative [5],
dieting efforts among overweight individuals have been
viewed more positively [1]. For example, Wing and
Jeffery [12] found that among overweight individuals,
modest weight reductions (10 – 15% of initial body
weight) achieved by the combination of calorie reduction
and exercise implementation were associated with positive
changes in cardiovascular risk factors. Furthermore,
results from a study of over 14,000 respondents to a
popular magazine survey suggest that the frequency of
dieting is less important than the individual’s perception
of being a weight cycler in its association with psycho-
logical problems such as low self-esteem and body
satisfaction [13]. However, detrimental consequences of
dieting have also been documented, including later onset
of obesity among female adolescents [14], as well as
socioenvironmental, psychological, and other physical
effects [15].
Despite a large body of literature on emotional and
behavioral factors associated with dieting, we are
unaware of any studies that have looked at these
associations independent of body mass index (BMI). It
has been well established that BMI is strongly associated
with dieting frequency [16] as well as disordered eating
and body image dissatisfaction [13,17 – 19]. Conse-
quently, BMI has been statistically controlled in the
current study in order to obtain a more accurate under-
standing of the specific relationship between dieting and
disordered eating, body image dissatisfaction, and other
psychopathology. The purpose of the present study was
to evaluate the relationship between lifetime dieting
frequency and disordered eating behaviors and character-
istics, body image satisfaction, depression, self-esteem,
and other psychological variables, after controlling for
current BMI.
Method
Participants
Participants in the current study represent a subsample
of 560 female university students from a larger study [20].
Within this original sample, differences were seen by BMI
categories [c2 (df = 8) = 47.93, P < .00001]; approximately
43% of those who were underweight (BMI < 19), 68% of
those who were normal weight (BMI between 19 –24), and
87% of those who were overweight (BMI > 24) had dieted.
Because of these differences in dieting frequency across
BMI, 345 females were selected from the larger sample by
using frequency-matching procedures on BMI for each
dieting category. Participants were grouped into one of
three categories based upon their self-reported lifetime
dieting frequency [none, 1 –5 times, or 6 or more times]
and were matched across category groups on BMI within
one unit of kg/m2, resulting in 115 females per frequency
of dieting category.
The average age of participants who participated in the
current study was 20.58 years (S.D. = 3.01, range 18 to
48). Self-report height and weight means were 6500
(S.D. = 2.63 in.) and 132 lb (S.D. = 20.00), respectively,
corresponding to an average BMI of 21.79 (range 15.84 to
33.78, S.D. = 3.03). Most participants were single (56%) or
in a monogamous relationship (40%), Caucasian (78%) or
Black (14%), and either Catholic (43%) or Protestant (24%).
Procedure
Female students were recruited by ‘advertisements’ for
the study. Interested students were instructed to sign-up for
selected study dates and times on sheets posted in a hallway
outside of an introductory psychology classroom. They
signed up for the study to receive extra credit for introduct-
ory undergraduate courses, namely psychology and wom-
en’s studies courses. At their study date and time,
participants were seated in groups in a classroom with a
maximum of 25 seats at least 3 ft apart and were provided
with a brief overview of the study. Participants provided
their written consent and were told that they were free to
withdraw from the study at any time. Survey packets,
randomly coded without identifying participant’s name,
were distributed to each person. Participants were asked to
refrain from discussing the study with other university
students until the end of the school year to prevent selection
bias and avoid influencing others’ responses. Data were
collected in compliance with the Institutional Review Board
at the university where the study was conducted.
Instruments
Dieting frequency
Lifetime dieting frequency was assessed with the
question ‘‘Have you ever dieted to lose weight.’’ The
 D.M. Ackard et al. / Journal of Psychosomatic Research 52 (2002) 129–136
original response categories were: Never dieted; Yes, I
have dieted 1– 5 times; 6 – 10 times; 11– 15 times; and
more than 15 times. The original five categories were
collapsed into three categories (Never, 1– 5 times, and 6
or more times) for the current study in order to obtain a
more even distribution and allow for easier matching
across dieting categories.
Eating disorders
The Eating Disorders Inventory-2 (EDI-2) is a reliable
and valid 91-item multidimensional self-report instrument
that assesses characteristics of eating disorders and related
psychological concerns [21]. On a 6-point Likert scale
(‘untransformed scores’), individuals indicate how often
they engage in the queried characteristics. These scores
retain the integrity of the data and reduce skew [22]. EDI-2
scores are often weighted from 0– 3 (‘transformed scores’)
for ease of clinical interpretation when comparing to EDI
norms, with higher scores indicating worse symptomato-
logy. The Bulimia scale measures cognitive and behavioral
aspects of binge-eating. The Ineffectiveness scale includes
statements about inadequacy and lack of control over life,
and the Perfectionism scale includes items that convey the
need for superiority of personal achievements. The Inter-
personal Distrust scale measures feelings of distrust and
alienation concerning close relationships. Interoceptive
Awareness relates to one’s ability to recognize and respond
to emotions, and Maturity Fears assesses concerns about
growing older and the desire to remain in the security of
childhood. The Asceticism scale includes items about
spiritual ideals such as self-restraint and control of bodily
urges, while the Impulse Regulation scale measures the
tendency toward a range of impulsive behaviors such as
self-destructiveness and substance abuse. The Social Insec-
urity scale is designed to measure tension and disappoint-
ment in social relationships.
The Bulimia Test-Revised (BULIT-R) is a 28-item
instrument measuring symptoms of bulimia with estab-
lished reliability and validity [23]. Individuals indicate
which behaviors they engage in and to what extent on a
5-point Likert scale. Their overall score is a sum of their
responses for 28 of the items, with higher scores indicating
worse symptomatology.
Body image
Body image was assessed with several individual items
and two scales from the EDI-2. The EDI-2 Body Dissat-
isfaction scale assesses dissatisfaction with overall shape
and size, and the Drive for Thinness scale captures
information about the individual’s pursuit of thinness.
The Body Image Assessment instrument assesses per-
ception of current and ideal body shape with established
reliability and validity [24]. Participants select one female
body silhouette perceived to represent her current figure or
body shape, and one silhouette for the preferred figure or
body shape; figures range from 1 (thinnest) to 9 (heaviest).
131
Body mass index
Current BMI was calculated by asking participants to
self-report their height and weight and using these values
in the standard BMI formula [weight in kilograms divided
by squared height in meters]. Ideal BMI values were
calculated using each participant’s response to the question
‘‘Indicate your ideal weight in pounds (what you would
like to weigh)’’ as the weight value within the formula.
Depression
The Center for Epidemiological Studies—Depression
scale (CES-D) is a reliable and valid 20-item self-report scale
measuring symptoms of depression in the general population
[25]. On a 4-point Likert scale (from 0 – 3), individuals
indicate how often they experience different symptoms of
depression. Higher scores indicate worse symptomatology.
Self-esteem
The Rosenberg Self-Esteem Scale [26] is a 10-item
5-point Likert scale questionnaire that assesses level of
self-esteem with established reliability and validity [27].
Higher scores represent higher self-esteem.
Affect regulation
The Trait Meta-Mood Scale [28] is a 30-item self-
report scale designed to assess relatively stable individual
differences in people’s tendency to attend to their moods
and emotions (Attention subscale), discriminate clearly
among them (Clarity subscale), and regulate them
(Repair subscale).
Exercise
The Obligatory Exercise Questionnaire [29] is a
20-item questionnaire with documented reliability and
validity that measures general physical activity. On a 4-
point Likert scale, individuals report how often they
experience each exercise-related situation. Higher scores
indicate more excessive physical activity. Three factors
have been identified from the Obligatory Exercise Ques-
tionnaire with sample statements from each factor noted in
parentheses: Emotional Element of Exercise (‘‘When I
don’t exercise, I feel guilty’’), Exercise Frequency and
Intensity (‘‘I engage in physical exercise on a daily basis’’),
and Exercise Preoccupation (‘‘When I miss an exercise
session, I feel concerned about my body possibly getting
out of shape’’) [30].
Statistical analyses
Data were analyzed using SPSS for Macintosh, Version
6.1 [31]. Categorical demographic variables were examined
with chi-square analyses while continuous demographic
variables were examined with ANOVAs across dieting
frequency groups. Continuous scores on dependent varia-
bles were examined with means and were compared using
ANOVA across lifetime dieting frequency categories. For all
132 D.M. Ackard et al. / Journal of Psychosomatic Research 52 (2002) 129–136

Table 1
Means, standard deviations, and ANOVA results for dieting frequency with eating disorder behaviors and characteristics (N = 345)
Dieting frequency
Eating disorder behaviors and characteristics Never, M (S.D.) 1 – 5 times, M (S.D.) > 6 times, M (S.D.) df F value P value
EDI-2
Asceticism 3.22 (1.91) 3.77 (2.33) 5.70 (4.02) (2,340) 22.96 .0000a
Bulimia 0.36 (0.87) 1.17 (2.27) 2.90 (3.48) (2,342) 32.48 .0000a,b
Interpersonal distrust 2.32 (2.63) 2.23 (3.23) 3.40 (3.72) (2,340) 4.67 .0100a,*
Impulse regulation 1.62 (2.95) 2.84 (3.67) 5.41 (5.91) (2,342) 22.63 .0000a
Ineffectiveness 1.61 (3.58) 2.03 (3.02) 5.41 (6.32) (2,342) 24.17 .0000a
Interoceptive awareness 1.23 (2.32) 2.68 (3.92) 5.88 (5.81) (2,341) 35.85 .0000a,b
Maturity fears 2.67 (3.10) 3.19 (3.42) 4.20 (4.20) (2,342) 5.37 .0051c,*
Perfectionism 5.80 (4.04) 6.69 (4.04) 7.31 (4.63) (2,340) 3.67 .0265c,*
Social insecurity 2.75 (3.52) 2.70 (2.82) 4.92 (4.06) (2,342) 15.12 .0000a
BULIT-R 39.31 (9.18) 47.85 (13.68) 72.27 (21.13) (2,342) 140.57 .0000a,b
Means and standard deviations reported for the EDI-2 are based upon transformed scores.
a
Post hoc (Turkey’s test) analyses indicate frequent (  6 times) dieting group significantly different ( P .01) from never dieted and moderate dieting
(1 – 5 times) groups.
b
Post hoc (Tukey’s test) analyses indicate never dieted group significantly different ( P .01) from moderate (1 – 5 times) and frequent dieting (  6 times)
groups.
c
Post hoc (Turkey’s test) and analyses indicate never dieted group significantly different ( P .01) from frequent dieting (  6 times) group.
* Analyses using untransformed scores for the EDI-2 resulted in the following significance levels different from those listed above: Interpersonal Distrust
( P = .0175), Maturity Fears ( P = .0142), and the Perfectionism ( P = .0048).

group comparisons, Tukey’s multiple-comparison tests were
conducted post hoc to assess differences between pairs of
groups at P .01. Results using the transformed scores of
the EDI-2 scales are reported in the tables, and any different
results using untransformed scores for the EDI-2 are
reported as notes in the table. Post hoc ANCOVAs, control-
ling for current body image figure or age in separate
analyses, were conducted to assess if the associations would
remain significant.
Results
Demographic differences among dieting frequency
groups were assessed with chi-square analyses. Although
analyzed with small subsample sizes, results indicated
differences between dieting frequency groups on marital
status, race, and religion. Individuals who were married or
separated/divorced were more likely than single or partnered
individuals to diet: 100% (n = 10) of married or separated/
divorced (n = 3) individuals reported dieting, compared to
67% (n = 93) of partnered and 64% (n = 124) of single
individuals [c2(6) = 17.35, P < .01]. African American
(34.7%, n = 17) and Hispanic (50%, n = 1) individuals were
least likely to report dieting when compared to Caucasian
(71.1%, n = 192) and Asian (76.5%, n = 13) individuals
[c2(8) = 33.89, P < .00005]. All individuals who identified
themselves as Jewish (100%, n = 5) reported dieting 6 or
more times, compared to 36.5% (n = 54) of Catholic, 26.5%
(n = 22) of Protestant, 35.0% (n = 21) of other religions, and
26.5% (n = 13) of individuals with no religious affiliation
[c2 (8) = 26.64, P < .001]. No differences were found
between frequency of dieting categories and current age or
age at onset of puberty.

Table 2
Means, standard deviations, and ANOVA results for dieting frequency with body image (N = 345)
Dieting frequency
Body image measures Never, M (S.D.) 1 – 5 times, M (S.D.) >6 times, M (S.D.) df F value P value
EDI-2
Body dissatisfaction 5.65 (6.53) 10.87 (7.01) 16.88 (7.95) (2,341) 70.18 .0000a,b
Drive for thinness 1.12 (1.93) 4.65 (4.86) 10.83 (5.99) (2,342) 131.63 .0000a,b
Ideal BMI 20.66 (2.14) 19.96 (1.74) 19.31 (1.51) (2,342) 15.93 .0000a,b
Body image assessment: current figure 3.38 (1.09) 3.56 (0.95) 3.90 (0.99) (2,342) 7.94 .0004a
Body image assessment: preferred figure 2.93 (0.75) 2.54 (0.76) 2.37 (0.75) (2,342) 16.93 .0000b
Means and standard deviations reported for the EDI-2 are based upon transformed scores.
a
Post hoc (Tukey’s test) analyses indicate frequent (  6 times) dieting group significantly different ( P .01) from never dieted and moderate dieting
(1 – 5 times) groups.
b
Post hoc (Tukey’s test) analyses indicate never dieted group significantly different ( P .01) from moderate (1 – 5 times) and frequent dieting
(  6 times) groups.
 D.M. Ackard et al. / Journal of Psychosomatic Research 52 (2002) 129–136 133

Table 3
Means, standard deviations, and ANOVA results for dieting frequency with depression, self-esteem, and affect regulation (N = 345)
Dieting frequency
Psychological measures Never, M (S.D.) 1 – 5 times, M (S.D.) > 6 times, M (S.D.) df F value P value
CES-depression scale 12.35 (9.86) 15.19 (9.32) 22.46 (13.07) (2,328) 25.52 .0000a
Rosenberg self-esteem scale 32.02 (5.11) 31.21 (4.58) 27.63 (5.43) (2,342) 24.50 .0000a
Trait Meta-Mood Scale
Full scale 65.31 (12.94) 67.12 (15.28) 74.30 (17.18) (2,342) 11.19 .0000a
Attention Index 26.33 (5.21) 27.32 (6.91) 28.14 (7.50) (2,342) 2.16 n.s.
Clarity Index 26.02 (7.64) 26.77 (8.02) 30.60 (9.49) (2,342) 9.79 .0001a
Repair Index 12.97 (4.43) 13.03 (4.59) 15.56 (4.91) (2,342) 11.64 .0000a
a
Post hoc (Tukey’s test) analyses indicate frequent (  6 times) dieting group significantly different ( P .01) from never dieted and moderate dieting
(1 – 5 times) groups.

Dieting frequency and eating disorder behaviors Dieting frequency and depression, self-esteem, and
and characteristics affect regulation

Associations between dieting frequency and eating dis-
order behaviors and characteristics are shown in Table 1.
Dieting frequency was associated with the BULIT-R and all
core EDI-2 subscales: dieting frequency was positively
associated with symptoms of bulimia, asceticism, interper-
sonal distrust, difficulties with impulse regulation, intero-
ceptive awareness, maturity fears, and feelings of
ineffectiveness, perfectionism, and social insecurity. The
higher the number of times that an individual had dieted,
the more the person appeared to struggle with eating
disorder behaviors and characteristics.
Dieting frequency and body image
Significant differences were found across categories on
all of the body image variables (see Table 2). Dieting
frequency was positively associated with the Body Dis-
satisfaction and Drive for Thinness scales of the EDI-2,
and inversely associated with ideal BMI values. Fre-
quency of dieting was also associated with current and
preferred body figure images as measured by the Body
Image Assessment instrument. Despite being matched on
current BMI, dieting frequency was positively associated
with perception of current body size, and inversely
associated with ideal body size.
Dieting frequency was positively associated with psy-
chological problems such as depression as measured by the
CES-D, and affect regulation problems such as more dif-
ficulty discriminating among moods, and less confidence in
ability to regulate moods and emotions as measured by the
Trait Meta-Mood Scale (see Table 3). Furthermore, fre-
quency of dieting was inversely associated with self-esteem
as assessed by the Rosenberg Self-Esteem Scale.
Dieting frequency and exercise
The full scale and three factors of the Obligatory Exer-
cise Questionnaire were associated with dieting frequency
(see Table 4). Higher frequencies of dieting behavior were
positively associated with greater emotional attachment to
and preoccupation with exercise, and frequency and intens-
ity of exercise.
Post hoc analyses
Despite accounting for current BMI in all analyses, there
were differences among dieting groups on current body
image figure, with those with a higher frequency of dieting
seeing themselves as significantly larger than those with less
frequent or no dieting. Consequently, post hoc analyses

Table 4
Means, standard deviations, and ANOVA results for dieting frequency with exercise (N = 345)
Dieting frequency
Exercise measure Never, M (S.D.) 1 – 5 times, M (S.D.) >6 times, M (S.D.) df F value P value
Obligatory exercise questionnaire
Full scale 16.38 (6.74) 21.89 (7.13) 25.84 (8.72) (2,342) 45.18 .0000a,b
Emotional element of exercise 1.89 (1.92) 4.07 (2.64) 5.78 (2.96) (2,339) 66.69 .0000a,b
Exercise frequency and intensity 2.85 (2.58) 5.30 (2.54) 5.86 (2.86) (2,342) 17.46 .0000b
Exercise preoccupation 0.86 (1.15) 1.23 (1.11) 1.73 (1.20) (2,342) 16.44 .0000a,b
a
Post hoc (Tukey’s test) analyses indicate frequent (  6 times) dieting group significantly different ( P .01) from never dieted and moderate dieting
(1 – 5 times) groups.
b
Post hoc (Tukey’s test) analyses indicate never dieted group significantly different ( P .01) from moderate (1 – 5 times) and frequent dieting
(  6 times) groups.
134 D.M. Ackard et al. / Journal of Psychosomatic Research 52 (2002) 129–136
(ANCOVAs) were conducted for all associations, control-
ling for current body image figure. All previously reported
results remained significant.
Participants were not matched on age, but the age of
participants in the current study ranged from 18 to 48. To
evaluate if qualitative differences on the dependent variables
by dieting frequency were accounted for by age, ANCOVAs
with age as the covariate were completed on all associations.
Results indicate that all analyses remained significant even
after controlling for age.
Discussion
Results from the current study provide robust, consistent
evidence that regardless of BMI, dieting frequency among
young normal-weight college females is associated with
more symptoms of and greater severity of eating disorder
behaviors and emotional distress. Dieting frequency was
positively associated with number and severity of eating
disorder symptoms, and body dissatisfaction coupled with
an emphasis on outward appearance. Despite controlling for
current BMI, dieting frequency was positively associated
with perception of current body size and inversely associ-
ated with ideal body size. Post hoc analyses controlling for
current body perception or age remained significant; there-
fore associations are not related to age differences among
diet groups nor related to the higher body figures perceived
by the more frequent dieters. Frequency of dieting was also
related to affective disturbances such as depression, low
self-esteem, difficulty discriminating between and regulat-
ing moods, maturity fears, and feelings of ineffectiveness,
perfectionism, and insecurity. In addition, dieting frequency
was associated with relationship issues such as distrust in
interpersonal relationships, and behavioral problems such as
exercise ‘addiction’ and preoccupation, and a need for self-
control compounded by poor impulse control skills.
While the current study does control for current BMI by
matching subjects across dieting categories, it cannot
address the body composition (muscle weight, fat weight,
bone density, etc.) of the individual. Consequently, individ-
uals with the same BMI value are likely to be quite diverse
in terms of shape, bias regarding the accuracy of their self-
report weight, and body composition. This may account for
why, despite matching on BMI, the group of women who
reported more frequent dieting also reported perceiving their
current figure as larger.
Results from the current study are consistent with others
that have found many dieters to be of normal weight [4– 6].
Although our sample ranged in BMI from an underweight
15.84 to an overweight 33.78, the modal BMI was 20.67,
clearly within the range typically recognized as normal-
weight. The fact that a young group of women with a mean
BMI within the normal weight range diet is not as alarming
as understanding that many of the young women from this
sample have dieted as often as 6 times.
The results from the current study emphasize the strong
and potentially detrimental association between dieting
frequency and problematic behaviors and characteristics
and psychological distress among this group of young
females. Stice and Agras [32] in their investigation of
bulimic subtypes concluded that the combination of dieting
and negative affect seems to indicate a more severe variant
of bulimia. It is possible that those individuals who have
dieted more frequently and who report greater symptoms
of psychopathology are prone to the development of eating
disordered behaviors and characteristics. Alternatively, fre-
quent dieting in a young normal-weight group of females
may be part of a general pattern of eating disorder
symptomatology, perhaps more indicative of some under-
lying depressive qualities and problematic attitudes related
to eating.
The clinical implications of dieting behavior are com-
plicated. Dieting, if defined as eating healthfully and
engaging in moderate exercise, may be the best approach
to weight loss and/or weight maintenance in overweight
individuals, with positive effects on physical and mental
health [1,12]. Therefore, we cannot simplistically conclude
that all dieting is bad. However, individuals in the current
study were young lean women, and should be discouraged
from dieting. Furthermore, individuals of any weight and
age should be dissuaded from engaging in unhealthy
weight-control behaviors such as fasting, skipping meals,
using laxatives or diuretics, engaging in self-induced
vomiting, or using extreme intensities or frequencies of
exercise. More specific recommendations regarding the
healthfulness of dieting behaviors need to be evaluated
on an individual level.
Strengths and limitations
This study included a number of important factors that
add to the utility of the results. A major strength of this
study was the use of a weight-matched sample to control for
the effect of current BMI. Furthermore, the use of psycho-
metrically sound standardized instruments to assess these
constructs allows for comparison of this sample to others in
future research. Finally, a nonclinical sample of female
college students allows readers to understand a broader
spectrum of behaviors than if surveying only those students
who present at a weight-loss clinic or an eating disorder
treatment facility. In addition, this sample can provide a
glimpse of some of the experiences related to dieting and
psychological health that the college population of females
may be experiencing.
Nonetheless, certain limitations should be taken into
account. First, the authors acknowledge that results from
the current study are correlational in nature, and therefore
causation cannot be determined. It is possible that enga-
ging in the behavior of dieting may lead to the later onset
of problems. However, it is also possible that certain
characteristics (dissatisfaction with body shape and size,
 D.M. Ackard et al. / Journal of Psychosomatic Research 52 (2002) 129–136
depression, low self-esteem) place some individuals at
greater risk for engaging in dieting, and potentially for
developing an eating disorder. Second, dieting was not
objectively defined. Future research should allow partic-
ipants to specify the types, duration, and outcomes of
their dieting behaviors. Some participants may have
dieted by making moderate decreases in fat intake and
increases in fruit and vegetable intake, generally regarded
as health-promoting behaviors [33]. Others may have
engaged in more extreme weight-reduction efforts such
as fasting and meal skipping that can have a negative
impact on emotional and physical health [15]. One
previous study found significant differences in self-
reported dieting and energy intake depending on the
phrasing of the question [34]; for women, questions
asking about current dieting were associated with the
lowest caloric intake, followed by questions assessing
decreased calories over the past year, regular dieting
over past year, high restraint, ever dieted, and doing
anything to lose weight. It will be important in future
research to understand the qualitative differences of diet-
ing practices by using reliable and valid dieting assess-
ment tools. Finally, the use of a nonrepresentative sample
of young, predominantly normal-weight college women
from psychology and women’s studies courses limits the
generalizability of the findings.
Directions for future research
Future research should continue to control for the effects
of BMI while evaluating the qualitative aspects of dieting
(type of diet, duration of diet, success or failure of the
weight-reduction effort, etc.) on outcome variables. This
approach would address some of the limitations of the
current study and build upon extant literature. In addition,
researchers should evaluate the possibility that other expe-
riences such as weight-related teasing or rejection from
thinner peers add to the negative consequences of dieting
found in the current study.
In conclusion, results from the current study provide
strong evidence for the association between frequent diet-
ing and disordered eating concerns and behaviors, body
image dissatisfaction, and other psychological problems in
a sample of young, normal-weight college females. Diet-
ing behaviors among females may be descriptive of a
broader pattern of disordered eating behaviors not neces-
sarily meeting clinical criteria. Future research should
explore these relationships longitudinally and with more
qualitative measures.
Acknowledgments
Preparation of this article was supported in part by the
Training Program in Behavioral Aspects of Cardiovascular
Disease from the National Heart, Lung, and Blood
135
Institute (NHLBI) Grant No. T32HL07328 (DMA) and
by the Adolescent Health Training Program (Maternal and
Child Health Bureau, HRSA) Grant #5T71MC0000622
(JKC). The authors would like to thank Carol B.
Peterson, PhD, Michael D. Resnick, PhD, and several
anonymous reviewers for their excellent comments on
drafts of this manuscript.
References
[1] Brownell KD, Rodin J. The dieting maelstrom: is it possible and
advisable to lose weight? Am Psychol 1994;49:781 – 91.
[2] Schoen C, Davis K, Collins KS, Greenberg L, Des Roches C, Abrams
M. The commonwealth fund survey of the health of adolescent girls.
New York (NY): Commonwealth Fund, 1997.
[3] Jeffery RW, Adlis SA, Forster JL. Prevalence of dieting among work-
ing men and women: the healthy worker project. Health Psychol
1991;10:274 – 81.
[4] Stephenson MG, Levy AS, Sass NL, McGarvey WE. 1985 NHIS
findings: nutrition knowledge and baseline data for the weight loss
objectives. Public Health Rep 1987;102:61 – 7.
[5] Biener L, Heaton A. Women dieters of normal weight: their motives,
goals, and risks. Am J Public Health 1995;85:714 – 7.
[6] Moses N, Banilivy M, Lifshitz F. Fear of obesity among adolescent
girls. Pediatrics 1989;83:393 – 8.
[7] Neumark-Sztainer D, Sherwood NE, French SA, Jeffery RW. Weight
control behaviors among adult men and women: cause for concern?
Obes Res 1999;7:179 – 88.
[8] Minnesota Department of Children, Families and Learning. Minnesota
student survey: 1998 statewide tables. St. Paul, MN, 1998.
[9] Patton GC, Johnson-Sabine E, Wood K, Mann AH, Wakeling A.
Abnormal eating attitudes in London school girls—a prospective epi-
demiologic study: outcome at twelve month follow-up. Psychol Med
1990;20:383 – 94.
[10] Lowe MR, Gleaves DH, DiSimone-Weiss RT, Furgueson C,
Gayda CA, Kolsky PA, Neal-Walden T, Nelsen LA, McKinney
S. Restraint, dieting, and the continuum model of bulimia nervosa.
J Abnorm Psychol 1996;105:508 – 17.
[11] Lowe MR, Gleaves DH, Murphy-Eberenz KP. On the relation of
dieting and bingeing in bulimia nervosa. J Abnorm Psychol 1998;
207:263 – 71.
[12] Wing RR, Jeffery RW. Effect of modest weight loss on changes in
cardiovascular risk factors: are there differences between men and
women or between weight loss and maintenance? Int J Obes
1995;19:67 – 73.
[13] Friedman MA, Wilfley DE, Pike KM, Striegel-Moore RH, Rodin J.
The relationship between weight and psychological functioning
among adolescent girls. Obes Res 1995;3:57 – 62.
[14] Stice E, Cameron RP, Killen JD, Hayward C, Taylor CB. Naturalistic
weight-reduction efforts prospectively predict growth in relative
weight and onset of obesity among female adolescents. J Consult Clin
Psychol 1999;67:967 – 74.
[15] French SA, Jeffery RW. Consequences of dieting to lose weight:
effects on physical and mental health. Health Psychol 1994;13:
195 – 212.
[16] French SA, Perry CL, Leon GR, Fulkerson JA. Dieting behaviors and
weight change history in female adolescents. Health Psychol
1995;14:548 – 55.
[17] Friedman MA, Schwartz MB, Brownell KB. Differential relation of
psychological functioning with the history and experience of weight
cycling. J Consult Clin Psychol 1998;66:646 – 50.
[18] Garner DM, Garner MV, Van Egeren LF. Body dissatisfaction ad-
justed for weight: the body illusion index. Int J Eating Disord
1992;12:263 – 71.
136 D.M. Ackard et al. / Journal of Psychosomatic Research 52 (2002) 129–136
[19] Shisslak CM, Crago M, McKnight KM, Estes LS, Gray N, Parnaby
OG. Potential risk factors associated with weight control behaviors in
elementary and middle school girls. J Psychosom Res 1998;301 – 13.
[20] Ackard DM. Development of bulimia nervosa: familial and psycho-
logical pathways. Unpublished doctoral dissertation, University of
Cincinnati, Cincinnati, OH, 1998.
[21] Garner DM. Eating disorder inventory: 2. Professional manual. Odes-
sa (FL): Psychological Assessment Resources, 1991.
[22] Schoemaher C, van Strien T, can der Staak C. Validation of the Eating
Disorders Inventory in a nonclinical population using transformed and
untransformed responses. Int J Eating Disord 1994;15:387 – 93.
[23] Thelen MH, Farmer J, Wonderlich S, Smith M. A revision of the
Bulimia Test: the BULIT-R. Psychol Assess 1991;3:119 – 24.
[24] Williamson DA, Davis CJ, Bennett SJ, Goreczny AJ, Gleaves DH.
Development of a simple procedure for assessing body image distur-
bances. Behav Assess 1989;11:433 – 46.
[25] Radloff LS. The CES-D scale: a self-report depression scale for re-
search in the general population. Appl Psychol Meas 1977;1:
385 – 401.
[26] Rosenberg M. Society and the adolescent self-image. Princeton (NJ):
Princeton Univ. Press, 1965.
[27] Fleming JS, Courtney BE. The dimensionality of self-esteem: hier-
archical facet model for revised measurement scales. J Pers Soc Psy-
chol 1984;404 – 42.
[28] Salovey P, Mayer JD, Goldman SL, Turvey C, Palfai TP. Emotional
attention, clarity, and repair: exploring emotional intelligence using
the Trait Meta-Mood Scale. In: Pennebaker JW, editor. Emotion, dis-
closure, and health. Washington (DC): American Psychological Asso-
ciation, 1995. pp. 125 – 54.
[29] Pasman L, Thompson JK. Body image and eating disturbance in
obligatory runners, obligatory weightlifters, and sedentary individuals.
Int J Eating Disord 1998;7:759 – 69.
[30] Steffen JJ, Brehm BJ. The dimensions of obligatory exercise. Eating
Disord: J Treat Prev 1999;7:219 – 26.
[31] SPSS. SPSS 6.1 base system user’s guide, Part 1 & 2 Macintosh
version. Chicago (IL): SPSS, 1994.
[32] Stice E, Agras WS. Subtyping bulimic women along dietary restraint
and negative affect dimensions. J Consult Clin Psychol 1999;67:
460 – 9.
[33] US Department of Health and Human Services. People healthy 2000:
national health promotion and disease prevention objectives—full re-
port, with commentary. Washington (DC): US Government Printing
Office, 1991.
[34] Neumark-Sztainer D, Jeffery RW, French SA. Self-reported dieting:
how should we ask? What does it mean? Associations between
dieting and reported energy intake. Int J Eating Disord 1997;22:
437 – 49.