Eating disorders and eco-anxiety: exploring mental health challenges in university students

Abstract

Background

Climate change is a major global challenge with profound psychological impacts, including eco-anxiety, defined as a chronic fear of environmental catastrophe. Despite its potential role of exacerbating vulnerabilities to maladaptive coping mechanisms such as eating disorders (EDs), the relationship between eco-anxiety and eating disorders EDs remains underexplored, particularly in student populations. This study aimed to investigate the associations between eco-anxiety, EDs, and psychological variables among university students.

Methods

A cross-sectional study was conducted among students, using an anonymous online questionnaire. Eco-anxiety was measured with the Hogg Eco-Anxiety Scale (HEAS-13), EDs were screened using the SCOFF questionnaire combined with body mass index to classify EDs into four categories: restrictive, hyperphagic, bulimic, and others. Additional measures included depression (CESD-8), insomnia severity (ISI), burnout (MBI-SS), and pro-environmental behaviors (PEBs). Multivariate analyses were used to identify determinants of EDs, and Multiple Correspondence Analysis (MCA) was conducted to explore relationships between categorical variables.

Results

A total of 1826 university students were included. Overall, 47.3% of the sample screened positive for a probable ED, with a higher prevalence among women (53.6%) compared to men (29.2%).; (p < 0.0001). Higher eco-anxiety quartile was associated with restrictive, hyperphagic, and bulimic EDs in multivariate model. By adding depression in the multivariate model, associations with restrictive and hyperphagic EDs diminished, suggesting a mediating role for depression. In contrast, eco-anxiety maintained a direct effect on bulimic EDs. The MCA revealed distinct clusters, with high eco-anxiety, insomnia, and depression closely linked to restrictive and hyperphagic EDs. Bulimic EDs were associated with intermediate levels of eco-anxiety and emotional exhaustion.

Conclusions

The study underscores eco-anxiety as an emerging risk factor for EDs, mediated in part by depression and other psychological factors. Differences in mechanisms across ED subtypes suggest that eco-anxiety contributes both directly and indirectly. This study enriches the knowledge by demonstrating how environmental stressors intersect with mental health and eating behaviors in vulnerable populations like university students. Public health initiatives should address eco-anxiety and its psychological sequelae to mitigate the risk of EDs, emphasizing tailored interventions based on ED subtype.

Plain Language summary

Climate change not only threatens the environment but also impacts mental health. Some people experience eco-anxiety—a chronic fear of environmental destruction. University students, already exposed to academic stress and life changes, may be especially vulnerable to mental health problems, including eating disorders. We surveyed over 1,800 university students in France to examine whether eco-anxiety is linked to eating disorders (ED) and how it relates to other mental health symptoms like depression, insomnia, and burnout. Students completed an anonymous online questionnaire assessing their ED, eco-anxiety levels, and psychological well-being. Based on their answers, we identified four categories of ED: restrictive (eating very little), bulimic (overeating with purging), hyperphagic (overeating without purging), and other types. Nearly half of students screened positive for a probable ED. We found that students with higher levels of eco-anxiety were more likely to have an ED, especially bulimic or restrictive types. Depression seemed to partly explain this link in some cases, particularly for restrictive and hyperphagic eating patterns. However, the connection between eco-anxiety and bulimic behaviors remained strong even after accounting for depression. These results suggest that eco-anxiety may be a risk factor for disordered eating. Addressing eco-anxiety in student mental health services could help reduce the risk of ED.

Introduction

Climate change, with extreme weather events and indirect effects such as infectious diseases and lack of food and water, is one of the greatest challenges [1]. In 2017, Watts et al. highlighted the countdown to the unequivocal and potentially irreversible impact of climate change on health [2]. The psychological burden and distress stemming from environmental changes are conceptualized as “eco-anxiety,” defined as a chronic fear of environmental doom [3]. Eco-anxiety includes “climate change anxiety,” encompassing global warming and various environmental disasters not directly caused by climate change. Recently, the increase in severe climatic phenomena and the COVID-19 pandemic have exacerbated psychological distress [4]. In a large study of 10,000 participants aged 16 to 25 in ten countries in 2021, 59% were “very” or “extremely” worried about climate change, and 45% reported that their climate-related feelings negatively influenced their daily lives [5]. Eco-anxiety acts as a general social determinant for mental health, contributing to conditions like post-traumatic stress disorder after disasters [6, 7] and may increase the risk of developing a mental illness or exacerbate existing mental health concerns [8–10], particularly among university students who often face multiple life stressors [11, 12]. Eco-anxiety appears to be more common in younger populations, and particularly among university students [13–15]. This may be linked to both their developmental stage and their greater engagement with environmental discourse through academic and social media [16]. While emerging research suggests it may also contribute to psychological distress and maladaptive coping mechanisms such as eating disorder (ED) as anorexia [17], eco-anxiety can lead to positive engagement and pro-environmental behaviors [18, 19]. Undergraduate students, particularly female students, may adopt behaviors such as eliminating meat, and seeking local foods, in response to climate change concerns [20]. While connections between mental health, eco-anxiety, and EDs are hypothesized, there is limited empirical data on how these factors intersect in student populations [21, 22]. These overlapping concerns—emotional vulnerability to environmental threats, changes in eating behavior, and heightened health or ethical motivations—suggest that eco-anxiety may influence both maladaptive eating patterns and intentional dietary choices.

The objectives were to examine the association between eco-anxiety and EDs among university students.explore the mediating role of mental health, and describe pro-environmental food behaviors across ED profiles.

Methods

A cross-sectional study was conducted among 30,000 students at the University of Rouen-Normandy, France. The survey consisted of an electronic questionnaire sent via the university e-mail list, from March to April 2023. Volunteer students completed an anonymous online questionnaire.

Socio demographics characteristics

Gender, age, curriculum (categorised into three groups: Healthcare [medicine and others healthcare], Sciences, and Others [neither healthcare nor sciences], and academic year of study were collected.

Eco-anxiety

Eco-anxiety was assessed by the Hogg Eco-Anxiety Scale (HEAS-13), a 13-item scale (with responses: 0 = not at all, 1 = several of the days, 2 = over half the days, 3 = nearly every day) that is scored 0 (low eco-anxiety) to 39 (high eco-anxiety) [23]. HEAS-13 captured four dimensions of eco-anxiety: affective symptoms when they think of global environmental problems (0 to 13); rumination (0 to 9); behavioural symptoms (0 to 9); and anxiety about one’s negative impact on the planet (0 to 9). The Hogg Eco-Anxiety Scale (HEAS-13), which measures various dimensions of eco-anxiety, has been validated in French, and demonstrated good internal consistency in our sample (Cronbach’s alpha = 0.84) [24].

Students reported also their frequency of Pro Environmental Behavior (PEB) to food-related actions: eat local/seasonal produce, limit meat and dairy consumption, and eat vegan (no meat and animal products) (never, seldom, sometimes, often, very often).

Mental health

Depression was assessed using the eight items of the Center for Epidemiologic Studies Depression (CESD-8) () scale, which has shown adequate psychometric properties (a Cronbach alpha of 0.82) and has been validated in French [25]. The response values were scored on a 4-point Likert scale (range 0 to 3) and totalled from 0 to 24, with higher scores indicating a higher frequency of depressive complaints. Quality of life was measured by satisfaction scale: “In general, my life closely matches my ideals”, “My living conditions are excellent”, “I am satisfied with my life”, “So far, I’ve gotten the important things I wanted from life” (1 = strongly disagree to 7 = strongly agree), and totalled from 5 to 35, with higher scores indicating a higher quality of life [26].

Burn out was measured by the Malasch Burnout Inventory-Students Survey (MBI-SS) that retains a 3-dimensional structure: Emotional Exhaustion due to the study requirements (five items such as, “I feel emotionally drained by my studies”); Cynicism, which refers to a detached attitude towards one’s studies (four items such as, “I have become more cynical about the use of my studies”); and Academic Effectiveness, which is linked to a sense of achievement as a student (six items such as, “In my opinion, I am a good student”). The assessment is completed by the students on a 6-point Likert scale ranging from 1 (never) to 6 (always) and had been validated in French (a Cronbach alpha of 0.86) [27].

The Insomnia Severity Index (ISI) is a 7-item self-report questionnaire assessing the nature, severity, and impact of insomnia. A 5-point Likert scale is used to rate each item (0 = no problem to 4 = very severe problem), yielding a total score ranging from 0 to 28. The total score is interpreted as absence of insomnia (0–7), sub-threshold insomnia (8–14), moderate insomnia (15–21), and severe insomnia (22–28) and had been validated in French (a Cronbach alpha of 0.86) [28, 29].

Eating disorders

Students filled in the French version of the five-item “Sick, Control, One stone, Fat, Food” (SCOFF) questionnaire to screen for EDs. A diagnostic threshold was fixed at two positive responses, with a sensitivity of 0.88 and a specificity of 0.93 [30, 31]. The Expali™-validated algorithmic tool, combining SCOFF and body mass index, was used to screen EDs into four diagnostic categories: bulimic ED, hyperphagic ED, restrictive ED and other ED (purging disorder, Night Eating Syndrome and any other ED) [32].

Statistical analysis

Because sampling did not lead to complete representativeness, collected data were weighted based by gender and curricula. All reported findings are based on these weighted data. Categorical variables were reported by percentages and continuous variables by means and standard deviation (SD). Eco-anxiety stress level was analysed by quartiles of HEAS-13: the first quartile represented the lowest eco-anxious students, with a HEAS-13 of less than 8, the second quartile had a HEAS-13 of 8 to 12, the third quartile had a HEAS-13 of 13 to 18, and the fourth quartile represented the highest eco-anxious students with a HEAS-13 of more than 18. Depression level was also analysed by quartiles of CESD-8: the first quartile represented the lowest depressive students, with a CESD-8 of less than 14, the second quartile had a CESD-8 of 14 to 17, the third quartile had a CESD-8 of 18 to 22 and the fourth quartile represented the highest depressive students with a CESD-8 of more than 22. Multiple Correspondence Analysis (MCA) was conducted to explore the relationships between categorical variables (gender, EDs, insomnia, depression, and eco-anxiety). The analysis identifies underlying dimensions that summarize the data and visualize the associations between variables. The first two dimensions, explaining the highest variance, were retained for interpretation. Categories were plotted on a two-dimensional perceptual map, with proximities indicating associations between variable categories. Contributions of variables and categories to each dimension were assessed to identify key patterns. Univariate analysis was performed to compared the four categories of ED (restrictive, hyperphagic, bulimic and other) to no ED. Logistic regressions adjusted on gender and curricula were performed to evaluate the independent determinants of each category ED with an adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were calculated. Factors with a p-value lower than 0.25 in univariate analysis were included in the multivariate analysis and a p-value lower than 0.05 was considered significant. Multivariate analyses with Model 1 adjusted for gender, year of study, and academic curriculum and Model 2 adjusted for the same variables as Model 1 and additionally includes depression as a covariate. As answers were obligatory there were no missing data.

Results

A total of 1,826 students completed the questionnaire, with mean age 21.1 years (SD = 6.8) and 74.3% were women (Table 1). Overall, 47.3% of the sample screened positive for a probable ED, with a higher prevalence among women (53.6%) compared to men (29.2%).; (p < 0.0001). Among those screening positive, bulimic EDs were the most prevalent subtype, followed by hyperphagic, restrictive, and other EDs (Fig. 1). The mean score on the HEAS-13 was 13.2 (SD = 2.6), with subscale means as follows: affective symptoms 4.1 (SD = 2.7), eco-rumination 3.7 (SD = 2.4), behavior 1.0 (SD = 1.5), and anxiety about personal impact on the planet 4.4 (SD = 2.5). Frequency of PEB to food-related actions according the category of ED are shown in Fig. 2. Restrictive and bulimic EDs most often limit meat and dairy products, and most often eat local or seasonal produce. Approximately 13% of students with ED are vegan.

Table 1.

Characteristics of the university students according of the eating disorder category (N = 1826)

	Total % (N = 1826)	No ED (n = 962)	Restrictive ED (n = 90)	Hyperphagic ED (n = 143)	Bulimic ED (n = 528)	Other ED (n = 103)	P
Gender (%)							< 0.0001
Women	74.6	65.5	72.2	83.9	87.5	77.7
Men	25.4	34.5	27.8	16.1	12.5	22.3
Curricula (%)							< 0.0001
Healthcare	48.4	51.0	46.7	34.3	46.4	55.3
Science	17.7	20.5	14.4	18.2	12.5	20.4
Others*	33.9	28.5	38.9	47.5	41.1	24.3
Year of study (%)							< 0.0001
1	30.1	27.9	43.3	23.8	36.0	19.4
2	19.7	18.6	23.3	19.6	20.1	22.3
3	16.7	14.7	14.5	19.6	17.4	25.2
4 and 5	24.7	26.0	14.5	28.7	22.1	31.1
6 and more	8.8	12.8	4.4	8.4	4.4	1.9
HEAS-13 (%)							< 0.0001
Q1	24.3	30.7	15.6	21.7	16.1	22.23
Q2	26.6	26.9	23.3	22.4	26.9	27.2
Q3	25.7	23.2	27.8	25.1	29.2	28.2
Q4	23.4	19.2	33.3	30.8	27.8	22.3
Insomnia Severity Index (%)							< 0.0001
No	43.2	54.4	25.0	33.8	29.6	37.3
Subthreshold	37.1	34.9	42.0	35.2	40.6	38.2
Moderate/severe	19.7	10.7	33.0	31.0	29.8	24.5
CESD-8 (%)	17.8 (5.5)	16.1 (4.7)	20.2 (5.6)	20.0 (5.5)	19.7 (5.8)	18.6 (5.5)	< 0.0001
Quality of life(%)	22.9 (6.8)	24.3 (6.3)	21.0 (6.3)	19.9 (7.1)	21.4 (7.1)	22.6 (6.6)	< 0.0001
Malasch burn out inventory Emotional exhaustion (%)							< 0.0001
Low	18.6	24.6	12.5	13.4	10.7	14.7
Moderate	55.7	57.1	52.3	54.9	53.5	58.8
High	25.7	18.3	35.3	31.7	35.8	26.5
Cynicism (%)							< 0.0001
Low	61.3	69.1	48.9	45.1	53.5	61.8
Moderate	26.8	22.4	39.8	35.2	30.7	24.5
High	11.9	8.5	11.3	19.7	15.8	13.7
Academic efficacy (%)							< 0.0001
Low	8.6	5.9	6.8	11.3	12.8	9.8
Moderate	68.0	66.7	66.2	73.2	68.1	71.6
High	23.4	27.3	25.0	15.5	19.1	18.6

HEAS: Hogg Eco Anxiety Scale; CESD: Center for Epidemiologic Studies Depression

Fig. 1.

Prevalence of eating disorder and distribution of categories among university students, by gender and overall (N=1826)

Fig. 2.

Distribution of food related pro environmental behaviors among university students according to eating disorder category (N=1826)

Figure 3 presents the results of the Multiple Correspondence Analysis (MCA). The first two dimensions (F1 = 15.56%, F2 = 9.20%) explain 24.76% of the total variance. The MCA reveals a gradient of psychological distress across the F1 axis, where higher levels of eco-anxiety, insomnia and depression are associated with ED types, such as restrictive or hyperphagic ED (purple box). Gender differences are notable, with males showing a stronger association with low distress and normal eating patterns (green box), while females are linked to intermediate eco-anxiety, insomnia and depression with bulimic disorders (orange box).

Fig. 3.

Multiple Correspondence Analysis: psychological and behavioural profiles of university students associated with eating disorders (N=1826)

Tables 1 and 2 display respectively y univariate and multivariate associated factors with ED. ED risk is significantly higher in women, except for restrictive EDs. Students in neither science nor health curricula are most at risk of bulimia and other EDs. Sleep and depression are impaired in all ED categories. Emotional exhaustion concerns students with restrictive and bulimic EDs, cynicism is high in students with hyperphagic EDs and academic efficiency is low in students with bulimic EDs. Table 3 presents the results of Model 1 with a significant and graded association between eco-anxiety and risk of hyperphagic EDs (HEAS Q4), restrictive EDs (HEAS Q3 and Q4), and bulimic EDs (HEAS Q2, Q3 and Q4). In Model 2, the AOR decrease for restrictive and hyperphagic ED, losing significance (except Q4 for restrictive EDs) while eco-anxiety remains significantly associated in bulimic EDs.

Table 2.

Associated factors with eating disorders category among university students: (multivariate analysis) (N = 1826)

	AOR (CI95%)	AOR (CI95%)	AOR (CI95%)	AOR (CI95%)
	Restrictive ED	Hyperphagic ED	Bulimic ED	Other ED
Gender
Men	Ref	Ref	Ref	Ref
Women	1.34 (0.82–2.19	2.82 (1.76–4.53)	3.59 (2.67–4.82)	1.90 (1.16–3.12)
Curricula
Healthcare	1.24 (0.63–2.43)	0.79 (0.46–1.33)	(0.94–1.86)	1.06 (0.63–1.78)
Science	Ref	Ref	Ref	Ref
Others*	1.73 (0.75–2.01)	1.57 (0.94–2.60)	1.86 (1.31–2.64)	0.53 (0.28–0.98)
Year of study
1	Ref	Ref	Ref	Ref
2	0.80 (0.45–1.42)	1.07 (0.61–1.86)	0.77 (0.55–1.07)	1.90 (1.00-3.59)
3	0.61 (0.31–1.23)	1.53 (0.88–2.69)	0.98 (0.69–1.39)	2.76 (1.47–5.19)
4 and 5	0.35 (0.18–0.68)	1.11 (0.67–1.85)	0.64 (0.47–0.87)	1.82 (1.00-3.29)
6 and more	0.27 (0.09–0.77)	1.02 (0.50–2.07)	0.33 (0.20–0.54)	0.22 (0.05–0.96)
Insomnia Severity Index
No	Ref	Ref	Ref	Ref
Subthreshold	2.48 (1.43–4.29)	1.52 (0.99–2.32)	2.03 (1.56–2.63)	1.61 (1.00-2.59)
Moderate/severe	6.43 (3.52–11.76)	3.84 (2.40–6.16)	4.53 (3.28–6.24)	3.17 (1.81–5.54)
CESD-8	1.15 (1.10–1.20)	1.14 (1.10–1.17)	1.13 (1.10–1.15)	1.10 (1.06–1.14)
Quality of life	0.93 (0.90–0.96)	0.91 (0.89–0.94)	0.94 (0.93–0.96)	0.96 (0.93–0.99)
Malasch burn out inventory Emotional exhaustion
Low	Ref	Ref	Ref	Ref
Moderate	1.72 (0.86–3.44)	1.48 (0.86–2.56)	1.92 (1.36–2.71)	1.43 (0.78–2.62)
High	3.38 (1.53–7.49)	1.77 (0.92–3.42)	3.27 (2.17–4.94)	1.72 (0.81–3.65)
Cynicism
Low	Ref	Ref	Ref	Ref
Moderate	2.39 (1.39–4.09)	1.89 (1.22–2.95)	1.44 (1.08–1.92)	1.12 (0.65–1.91)
High	1.34 (0.56–3.21)	2.06 (1.10–3.88)	1.21 (0.79–1.87)	1.40 (0.65–3.04)
Academic efficacy
Low	0.60 (0.21–1.69)	1.60 (0.74–3.48)	1.73 (1.06–2.82)	1.67 (0.68–4.10)
Moderate	0.79 (0.46–1.37)	1.38 (0.83–2.30)	1.10 (0.82–1.48)	1.33 (0.77–2.31)
High	Ref	Ref	Ref	Ref

Adjusted on Gender, year of study and Curricula

AOR: Adjusted Odds ratio, CI95%: 95% Confidence Interval; CESD: Center for Epidemiologic Studies Depression

The reference group for all comparisons is the group with no eating disorder (No ED)

Table 3.

Eco-anxiety and category of eating disorders among university students (multivariate analysis) (N = 1826)

	Model 1				Model 2
	AOR (CI95%)	AOR (CI95%)	AOR (CI95%)	AOR (CI95%)	AOR (CI95%)	AOR (CI95%)	AOR (CI95%)	AOR (CI95%)
	Restrictive ED	Hyperphagic ED	Bulimic ED	Other ED	Restrictive ED	Hyperphagic ED	Bulimic ED	Other ED
HEAS Q1	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref
HEAS Q2	1.66 (0.82–3.35)	1.07 (0.63–1.82)	1.69 (1.22–2.35)	1.35 (0.75–2.41)	1.55 (0.75–3.21)	0.88 (0.51–1.52)	1.46 (1.04–2.05)	1.21 (0.67–2.18)
HEAS Q3	2.30 (1.16–4.56)	1.34 (0.80–2.25)	2.10 (1.51–2.91)	1.64 (0.92–2.94)	1.68 (0.85–3.48)	0.95 (0.56–1.63)	1.54 (1.09–2.18)	1.30 (0.72–2.37)
HEAS Q4	3.45 (1.76–6.76)	1.78 (1.07–2.97)	2.42 (1.72–3.39)	1.58 (0.85–2.94)	2.32 (1.13–4.74)	1.12 (0.66–1.92)	1.64 (1.14–2.35)	1.14 (0.60–2.17)

HEAS: Hogg Eco Anxiety Scale

Q: Quartile

Model 1: Adjusted on gender, year of study and curricula

Model 2: Model 1 + adjusted on depression

The reference group for all comparisons is the group with no eating disorder (No ED)

Discussion

This study is among the first to explore the relationship between eco-anxiety and eating disorder symptoms in a large student population, using validated psychometric tools. The HEAS-13 scale does not measure climate change anxiety alone, but encompasses a broader construct of eco-anxiety, including emotional, cognitive, and behavioral responses to various global environmental threats beyond climate change specifically. Currently published studies have primarily focused on confirming its reliability and factorial validity of HEAS-13 across different languages and cultural contexts and no values are available to allow direct comparison across populations or age group. The results of this study highlight significant associations between EDs eco-anxiety, and related psychological factors among university students. This aligns with existing literature emphasizing the psychological impact of climate change on mental health but extends knowledge by specifically linking eco-anxiety to EDs, a relationship that remains underexplored [13]. Our findings show that nearly half of the students surveyed presented with a probable ED, with a clear predominance among women The prevalence of EDs after an increase in 2021 has not changed significantly since and, as expected, women are more at risk [33]. Students in non-healthcare and non-science fields are at higher risk of bulimic EDs. Students, especially those in fields like environmental or political science, are frequently exposed to detailed and alarming information about climate change, which can exacerbate feelings of anxiety [34]. Restrictive and bulimic ED were associated with high emotional exhaustion and for these students, it could be relevant to focus on stress management and emotional. Individuals with hyperphagic ED often experience a low sense of control and motivation, which may contribute to a cynical attitude toward academic or social expectations as a form of emotional disengagement. Unlike emotional exhaustion, cynicism represents a withdrawal from emotional engagement, which could explain why it is more prominent in this group.

Bulimic EDs were the most prevalent subtype, and these were strongly associated with elevated eco-anxiety levels, even after adjusting for depressive symptoms. This suggests a direct psychological vulnerability linking eco-anxiety and emotional regulation difficulties through maladaptive eating behaviors, suggest unique psychological mechanisms, potentially related to emotional dysregulation or impulsivity, that are less influenced by depression. In contrast, the associations between eco-anxiety and restrictive or hyperphagic EDs were attenuated when controlling for depressive symptoms, suggesting that depression may act as a partial mediator in these cases. These patterns are consistent with the perceptual map from the Multiple Correspondence Analysis, which illustrated clustering of bulimic EDs with other psychological conversely. Hyperphagic ED, characterized by overeating, are often linked to emotional regulation difficulties and comfort-seeking in response to depressive symptoms. Eco-anxiety likely exacerbates these depressive states, indirectly fueling hyperphagic tendencies. Eco-anxiety may contribute to psychological distress and depressive symptoms, which, in turn, drive restrictive eating behaviors [22]. These behaviors may serve as a maladaptive coping mechanism to regain control amidst the emotional turmoil caused by both eco-anxiety and depression.

Students with restrictive EDs reported the highest engagement in PEBs, such as reducing meat consumption or adopting vegan diets, patterns likely influenced by eco-anxiety. This aligns with the idea that restrictive behaviors are often driven by a strong need for control, including control over one’s environmental impact (e.g., adopting veganism or reducing meat consumption). In contrast, students with hyperphagic EDs appear less engaged in environmentally motivated behaviors, oriented toward immediate emotional regulation than long-term ecological concerns. Innocenti et al. suggest that climate change anxiety has a dual effect on PEB [35] while rumination and anxiety about one’s personal impact on the planet may promote eco-friendly behaviors, this same anxiety can also lead to distress or avoidance [12]. A European country comparison has shown that French individuals are more likely to adopt individual-level mitigation strategies [36]. Such engagement may offer psychological benefits by fostering a sense of agency and positive coping [37, 38]. In our sample, approximately 13% of participants identified as vegan, which is consistent with findings by Zickgraf et al. Notably, vegetarian students who avoid meat for weight-related reasons report higher levels of ED symptoms than those whose motivations are primarily ethical or environmental [39, 40]. Sustainable eating may thus function as a constructive coping mechanism for eco-anxiety, but it is essential to remain vigilant about the risk of rigid or extreme behaviors, especially in students prone to restrictive or bulimic EDs.

Strength and limitations

This study is one of the first to quantitatively investigate the association between eco-anxiety and eating disorder symptoms in a large university student population. It uses validated psychometric instruments to assess both psychological distress (depression, insomnia, burnout) and eco-anxiety, ensuring measurement reliability. The inclusion of a multidimensional categorization of eating disorders, based on the Expali™ algorithm, allows for a more nuanced understanding of symptom profiles beyond simple screening. The study also integrates an original focus on pro-environmental food behaviors, contributing new insights into how ecological concerns and dietary practices intersect in university students Caution is warranted when interpreting and generalizing these findings. The use of a convenience sample and voluntary participation may have introduced self-selection and response biases, potentially limiting the representativeness of the results. Additionally, the proportion of women in our sample was slightly higher than in the general French university student population (74% vs. 60%), which may have influenced the observed prevalence of ED symptoms. The cross-sectional design also prevents any conclusions regarding causality between eco-anxiety and disordered eating behaviors. Nevertheless, our results underscore the urgent need for further research into the potential bidirectional relationship between eco-anxiety and eating disorders. Finally, unlike validated psychometric tools, pro-environmental food behaviors (PEBs) in this study were measured through individual self-reported items rather than a standardized composite score, which may limit the precision, reliability, and cross-study comparability of this variable.

Conclusions

These findings underscore the importance of considering eco-anxiety as an emerging factor in the mental health and eating behaviors of university students. Addressing environmental concerns should be an integral component of a comprehensive approach to student well-being. Given the high prevalence of probable eating disorders in this population, integrating climate-related psychological stress into prevention, screening, and care strategies may facilitate earlier identification of at-risk individuals and improve outcomes. In addition, implementing environmental engagement opportunities, strengthening emotional coping skills, and promoting climate-related awareness may help reduce the impact of eco-anxiety [41]. Scalable and evidence-based interventions are needed to support healthcare professionals and campus mental health services in managing eco-anxious students [42]. From a public health perspective, universities should adopt proactive strategies, including eco-anxiety-informed counselling, workshops on stress management, and education on sustainable and balanced eating habits. Further research is necessary to confirm these associations in diverse populations and to better understand the psychological mechanisms through which eco-anxiety may influence disordered eating.

Abbreviations

AOR

Adjusted odds ratios

CI

Confidence Interval

HEAS

Hogg Eco-Anxiety Scale

PEB

pro-environmental behaviours

SCOFF

Sick, Control, One stone, Fat, Food

SD

Standard Deviation

Author contributions

MPT and JL design of the work; MPT makes the analysis, MPT and JL: interpretation of data; MPT draft the work, MPT and JL approve the submitted version AND agree both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the wor.

Funding

No funding.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Name of the ethics Committee: The Rouen University Hospital’s Institutional Review Board (IRB), The Rouen University Hospital’s Institutional Review Board (IRB) approved the observational study design according to the Helsinki declaration. The Rouen University Hospital’s Institutional review: consent: reference number: E2023-26.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.