Body Image, Weight Perception, and Feeding and Eating Disorder Risk Among Sicilian University Students: A Cross-Sectional Study

Abstract Background: Feeding and eating disorders (FEDs) are increasingly prevalent among university students, due to the combined effects of at risk age, academic stress, performance pressure, and societal expectations regarding body image. The SMS‑ME (Sicilian Medical Students’ Mental Health) project aimed to assess the prevalence and predictors of disordered eating behaviors, as well as preferred mental‑health support strategies, in an underrepresented group in the literature: Sicilian university students enrolled in healthcare degree programs Methods: A cross-sectional web-based survey was conducted between 2022 and 2024 across multiple Sicilian universities. The questionnaire included sociodemographic data, the EAT-26 scale, DASS-21, and behavioral items assessing binge eating, vomiting, laxative use, and suicidal ideation. Stepwise regression analysis was used to identify predictors of disordered eating. Results: We collected 3,278 participants. Despite most students having a normal BMI, many reported significant body dissatisfaction and unhealthy weight control behaviors. 14.1% scored above the EAT-26 threshold, indicating risk for FEDs, and 38.2% met criteria for specialist referral. Key predictors included vomiting episodes, psychological distress, lifetime weight fluctuation, laxative use, weight dissatisfaction, binge eating, female sex, younger age, and suicidal ideation. The model explained 32% of the variance in EAT-26 scores. Conclusions: Healthcare students in Sicily exhibited high levels of psychological distress and disordered eating behaviors, underscoring the need for targeted mental health interventions. Universities should prioritize early detection, stigma-free psychological support, and the integration of mental health resources, such as mentoring programs and self-monitoring tools, within academic environments to support student well-being.