A new paper has linked unhealthy weight control behavior, like vomiting and diet pills, to indoor tanning among high school students.

Another supposed problem for middle class white girls? Not so, say the authors in the Journal of Developmental&Behavioral Pediatrics, the association is even stronger for males.

Stephen M. Amrock, SM, and Michael Weitzman, MD, of the New York University School of Medicine say that indoor tanning might identify a group of teens at increased risk of eating disorders.

The researchers analyzed nationally representative survey data on nearly 27,000 high school students. About 23 percent of females and 6.5 percent of males reported indoor tanning within the past year. For older teens, indoor tanning was even more common: 33 percent of females and 11 percent of males aged 18 years or older. ("Indoor tanning" excluded spray-on tans.)

Students who reported indoor tanning were also more likely to report various unhealthy weight control behaviors over the past month. These included fasting for over 24 hours; taking pills, powders, or liquids; or vomiting or taking laxatives to lose weight.

With adjustment for other factors, females who used indoor tanning were 20 percent more likely to report fasting, 40 percent more likely to report vomiting or taking laxatives, and more than twice as likely to report taking weight-loss pills, powders, or liquids.

For males, the associations were even stronger. Males who used indoor tanning were more than twice as likely to fast, four times more likely to use pills, powders, or liquids, and seven times more likely to report vomiting or laxative use.

The survey added to previous surveys that linked indoor tanning to negative body image. Females who used indoor tanning were more likely to perceive themselves as normal weight, yet more likely to say they were trying to lose weight.

The study can't show a definitive link to eating disorders, it is just a correlation-causation inference that cultural advocates tend to make, so they instead suggest that teens who use indoor tanning have higher rates of unhealthy weight control behaviors linked to eating disorders. Negative body image may also contribute to high rates of indoor tanning among adolescents, although the mechanism of the association may differ for males versus females.

The researchers suggest that screening adolescents for indoor tanning could serve a double purpose: addressing a major risk factor for skin cancer as well as identifying teens at risk for unhealthy weight control behaviors. "Greater attention to these issues by pediatricians may help reduce the number of adolescents risking potentially deadly consequences," Amrock and Weitzman conclude.