One of the worst-written books to ever dominate best-seller lists, 50 Shades of Grey isn’t just bad for the literary world. It may actually be bad for the health of its readers, it turns out.

A new study by Amy Bonomi, a human development researcher at Michigan State University, surveyed 650 college-aged women about their sexual health, eating habits, and substance use. She also asked her subjects whether or not they had read 50 Shades.

The results were striking (no pun intended): Readers were more likely to have an abusive partner and “exhibit signs of eating disorder” than non-readers. If they had slogged their way through the whole trilogy, those super fans were at an “increased risk of engaging in binge drinking and having multiple sex partners.”

It’s not clear if the book drove readers to drink or have sex—but one could imagine the tedium of reading the trilogy leading down those path. “If women experienced adverse health behaviors such as disordered eating first, reading ‘Fifty Shades’ might reaffirm those experiences and potentially aggravate related trauma,“ Bonomi theorizes. "Likewise, if they read ‘Fifty Shades’ before experiencing the health behaviors seen in our study, it’s possible the books influenced the onset of these behaviors.”

Still, it seems hard to believe that readers would be unable to separate the lessons of a piece of fan fiction they picked up at the airport from reality. Or that the book’s influence can be separated from the messages we absorb from advertising, media, and works of culture every single day that promote disordered eating, violence against women, and getting faded.

This isn’t the first in depth look Bonomi has taken at the book. A previous study found that the protagonist Anastasia suffered harm consistent with the experiences of real-life victims of violence form their partners. “This book is perpetuating dangerous abuse standards and yet it’s being cast as this romantic, erotic book for women,” Bonomi said at the time. “The erotic content could have been accomplished without the theme of abuse.”

All of this begs the question: why does anyone care that much about 50 Shades?