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A study of U.S. high school students provides additional evidence that eating disorders may be contagious.

In a study, researchers found that binging, fasting, diet pill use and other eating disorder symptoms clustered within counties, particularly among female students.

“These findings confirm the strong social influences on female adolescents in the U.S. to be thin, sometimes using unhealthy behaviors to achieve this goal,” the researchers write in the current issue of the International Journal of Eating Disorders.

Based on their results, the researchers think it may be more effective to target eating disorder prevention efforts to counties or schools where they are more common, rather than individual students.

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