What works in secondary schools? A systematic review of classroom-based body image programs

Digital Bodies: A controlled evaluation of a brief classroom-based intervention for reducing negative body image among adolescents in the digital age

BACKGROUND

A growing body of research has linked social media use to negative body image.

AIMS

The present research aimed to evaluate the efficacy of Digital Bodies, a brief classroom-based intervention that aims to improve adolescents' body image.

METHODS

British adolescents (N = 290; Age M = 12.81; SD = 0.40; Range = 12-13; Female = 151) were cluster randomized to intervention or waiting list control groups. Measures of body satisfaction, appearance ideal internalization (thin and athletic ideal internalization) and self-objectification were completed at baseline (T1), 1-week post-intervention (T2) and 8-week follow-up (T3).

RESULTS

Multi-level modelling showed adolescents in the intervention group reported improved body satisfaction at T2, in comparison to the control, and crucially this effect was sustained at T3. Additionally, girls reported less thin ideal internalization at T2 relative to the control, but this effect was not sustained at T3. No other intervention effects were found.

CONCLUSIONS

Overall, the findings provide initial support for the efficacy of Digital Bodies as an intervention for improving adolescents' body satisfaction.

Assessing the impact of body image concerns on functioning across life domains: Development and validation of the Body Image Life Disengagement Questionnaire (BILD-Q) among British adolescents

Assessing the impact of body image on engagement in a range of life domains is important; however, there is a lack of validated measures for adolescents. The current research developed the Body Image Life Disengagement Questionnaire (BILD-Q) and validated it among four samples of British adolescents. Study 1 (N = 1707; 11-13 years) indicated a 9-item unidimensional scale based on Exploratory Factory Analysis. In Study 2 (N = 1403; 11-13 years), Confirmatory Factor Analysis (CFA) showed an acceptable fit overall, but better among girls than boys. Further exploration with CFA in Study 3 (N = 2034; 13-14 years) showed a good to excellent fit overall, and acceptable among both boys and girls. The scale showed good internal consistency and test-retest reliability, and gender invariance indicated the scale can be used comparatively. In Study 4 (N = 288; 13-14 years), convergent validity was supported via expected relationships with body image and related constructs. Concurrent and predictive incremental validity were also evidenced via explaining significant unique variance in well-being. These studies provide support for the BILD-Q as a reliable and valid measure of broader impacts of body image among adolescents, which may benefit intervention evaluation and policy change efforts.

Media influence components as predictors of children's body image and eating problems: A longitudinal study of boys and girls during middle childhood

Body image problems are reported during middle childhood and are associated with exposure to appearance-focused media. This longitudinal study investigated the extent to which three media influence components, Awareness, Pressure, and Internalization of media ideals, predict body image and eating problems in children and whether gender moderates this effect. A total sample of N = 688 participants (46 % girls, aged 8-11 at T1) was studied. Self-report questionnaires were administered on the media influence components, body image and eating problems at T1 and T2 (1 year later). After controlling for age, adjusted body mass index and baseline levels of body image and eating problems, results show that media influence components significantly predicted Restraint and Concerns about Eating, Weight, and Shape one year later. Awareness, however, uniquely predicted increases in Eating Concerns in boys, while Pressure predicted increases in Concerns on Eating, Weight, and Shape in girls only. The current results indicate that media influences, some of which may be gender-specific risk factors, predict subsequent body image concerns of girls and boys during middle childhood. Thus, both boys and girls should be addressed in future research and prevention programs.

Acceptability and preliminary efficacy of a school-based body image intervention in urban India: A pilot randomised controlled trial

This pilot study evaluated the acceptability and preliminary efficacy of a culturally adapted school-based body image intervention, Dove Confident Me, for use in urban India. Two private schools in New Delhi were randomly assigned at the school level to receive either the five-session intervention facilitated by trained psychologists or lessons-as-usual (control). Participants were Year 7 students (N = 166; M_age = 11.9 years). Students, facilitators, and observing teachers, provided acceptability feedback. Fidelity was assessed. Body image and related measures were completed by students in a classroom setting at pre-intervention, post-intervention, and two-month follow-up. Most students enjoyed (73.7 %) and understood (84.2 %) the intervention. Facilitators (90 %) and observing teachers (70 %) reported that the learning objectives were achieved. Adherence and facilitator competence were rated as very good. Body esteem improved significantly among intervention students at post-intervention and follow-up (Cohen's ds = .45-.46), relative to control students. Positive affect also improved at post-intervention (d = .58). No significant effects on internalisation, life engagement, eating pathology, self-esteem, or negative affect emerged. This study provides evidence for the acceptability and preliminary efficacy of Dove Confident Me in urban India. Intervention refinements to increase acceptability and efficacy are recommended.

Body talk in the digital age: A controlled evaluation of a classroom-based intervention to reduce appearance commentary and improve body image

This research evaluates the efficacy of a classroom-based intervention - Body Talk in the Digital Age (BTIDA) - in reducing adolescents' appearance commentary and improving body image. British adolescents (N = 314; Age Range = 12-14) were cluster randomised to intervention or waiting-list control groups. Measures of appearance commentary, appearance ideal internalisation, self-objectification and body satisfaction were completed at baseline (T1), then one-week (T2) and eight-week (T3) post-intervention. Multi-level modelling showed girls who received BTIDA reported less appearance commentary engagement and thin ideal internalisation at T2 and T3, than the control, supporting the partial efficacy of BTIDA for girls. No intervention effects were found among boys.

A cascade of rejection and appearance preoccupation: Adolescents' body dysmorphic symptoms and appearance rejection sensitivity over 4 years

Adolescence is a high-risk period for body image disturbance and appearance concerns. In a cascade model, we examined interrelations of body dysmorphic symptoms (BDS) with appearance rejection sensitivity (ARS) and tested gender moderation. Participants were 397 Australian adolescents (T1 Mage = 11.7, SD = 0.91; 56% girls) who completed six surveys over 4 years. In a random-intercept cross-lag model, two (of five possible) paths showed ARS predicted higher subsequent BDS, and three (of five possible) paths showed BDS predicted higher subsequent ARS. Girls reported more BDS and ARS than boys, and random intercepts of BDS and ARS were correlated with the correlation stronger in girls than boys. Cross-lag BDD-ARS associations over the six waves were not significantly moderated by gender. Overall, girls are at higher risk of appearance concerns than boys, but BDD-ARS cascade effects do not differ between girls and boys.

'Everybody's Different: The Appearance Game'. A randomised controlled trial evaluating an appearance-related board game intervention with children aged 9-11 years

This study evaluated the effectiveness of an educational board game aimed at increasing knowledge of appearance-related issues, positive body image, media literacy, and acceptance of appearance diversity with British school children. Two hundred and fifty-nine children, aged 9-11 (Mage = 10.26), from three primary schools in South-West England participated in a two-arm matched cluster randomised controlled trial. Outcome measures were collected pre-, post- and at two-week follow-up. Knowledge of appearance-related issues significantly increased in the intervention group, compared to the control group post-intervention, but was not maintained at follow-up. There were no significant differences between groups for body appreciation, media literacy or acceptance of visible difference. Of the intervention arm, 78 % (n=117) they would like to play again and 85.3 % (n=128) thought other children would like to play. Qualitative data suggests participants learned the key messages of the game. The findings suggest 'Everybody's Different: The Appearance Game' is an enjoyable way to increase knowledge of appearance-related issues. In future, researchers should consider how to increase body appreciation, media literacy and acceptance of appearance diversity, for example by increasing the dosage of the game or using it in conjunction with discussions and lessons surrounding appearance diversity and appearance-altering conditions.

Evaluating the "Dove Confident Me" Five-Session Body Image Intervention Delivered by Teachers in Schools: A Cluster Randomized Controlled Effectiveness Trial

PURPOSE

Body dissatisfaction is common during adolescence and predicts poor psychological and physical health. Interventions have traditionally overrelied on delivery by external providers (e.g., researchers and psychologists), preventing scalability. This study evaluated the acceptability and effectiveness of a school-based body image intervention delivered by schoolteachers.

METHODS

Six British schools participated in a pragmatic cluster randomized controlled trial. Girls and boys aged 11-13 years received the five-session intervention delivered by their teachers (n = 848) or lessons-as-usual control (n = 647) and were assessed at baseline, postintervention, and 2-, 6-, 12-, 24- and 36-month follow-up. The primary outcome was body image (body esteem), secondary outcomes included risk factors for body image (internalization of appearance ideals, sociocultural pressures, social comparisons, appearance-related teasing, and conversations), and tertiary outcomes included psychosocial well-being (negative affect, self-esteem, dietary restraint, and life engagement).

RESULTS

Compared with the control group, intervention students demonstrated improvements in the primary outcome of body esteem at postintervention (Cohen's d = .15), 2-month (d = .26), and 6-month follow-up (d = .15). For girls, there was also a significant reduction in experienced appearance-related teasing at 6-month (d = .24) and 12-month (d = .30) follow-up. No other significant intervention effects were observed. The intervention was acceptable to students.

CONCLUSIONS

These findings present the longest sustained improvements in a cognitive-affective body image outcome observed among girls and boys during a teacher-led universal body image program to date. Intervention refinement and improved teacher training may further improve outcomes. Task-shifting intervention delivery to community providers to scale up interventions is a promising strategy.

A school-based eating disorder prevention program (Me, You & Us) for young adolescents in Korea: A 3-year follow-up study

OBJECTIVE

The study aimed to examine the feasibility and long-term effects of a school-based eating disorder prevention program for young adolescents in Korea.

METHOD

We followed up the students (n = 133) who had participated in the prevention program at 3 years ago to evaluate changes in body esteem and self-esteem between postintervention and 3-year follow-up, with investigating whether gender moderated the effect of time.

RESULTS

Boys showed no decline in body esteem and self-esteem from postintervention to 3-year follow-up, indicating that the prevention program alleviated decreases in body esteem and self-esteem over time. Girls showed decreases in body esteem and self-esteem from postintervention to 3-years follow-up.

DISCUSSION

This study provides evidence supporting the feasibility of the school-based eating disorder prevention program targeting mixed-sex, young adolescents in Korea. Given the developmental trajectories of decrease in body esteem and self-esteem during adolescence, the program may be efficient for boys over time. Boosters and/or complementary prevention approaches across gender are needed.

Mixed methods pilot evaluation of interpersonal psychotherapy for body image for adolescents

Body dissatisfaction is common in adolescence and associated with poor outcomes. The aim of this mixed method pilot evaluation was to determine acceptability, feasibility and preliminary efficacy of Interpersonal Psychotherapy for Body Image (IPT-BI), a school-based group intervention for young people with high levels of body dissatisfaction. Eighteen participants (11-13 years, 78% female) took part in two IPT-BI groups (n = 10; n = 8). Feasibility was measured by recruitment and attrition rates; acceptability using a treatment satisfaction questionnaire and focus groups; and clinical outcomes at baseline, each session and post intervention. The majority of young people (72%, n = 18/25) who were referred or expressed interest went on to take part. Average session attendance was 100% and 89%. Participants expressed high levels of treatment satisfaction with 94% (n = 16/17) rating IPT-BI as 'quite helpful' or 'very helpful' and 94% (n = 16/17) stating they would recommend it to others. Preliminary exploration of efficacy showed significant improvements in body image and significant reductions in interpersonal difficulties and appearance-based conversations. Young people valued specific IPT-BI skills (role play, communication strategies), alongside generic therapeutic factors (therapeutic alliance, group cohesion). IPT-BI is feasible and acceptable with promising provisional clinical outcomes indicating the need for a fully powered randomised controlled trial.

Relationship of sociodemographic conditions with the formation of body image in Brazilian adolescents

ABSTRACT Objective To investigate the associations between sociodemographic population conditions and adolescents’ body image Methods This is a cross-sectional study using data from the Pesquisa Nacional de Saúde do Escolar (PeNSE, National School Health Survey), conducted in 2015. The objective was to analyze the relationship between students’ sociodemographic conditions and body image attending public and private schools in Brazil capitals and the Federal District. For the statistical analysis, we conducted the Poisson regression models, generating adjusted prevalence ratios and their respective 95% CI. In the multiple models, sociodemographic variables were included, which were significantly associated with body image variables (p<0.05) or which altered the prevalence ratios by at least 10%. Results The research involved 10,926 adolescentes The analyses showed that the older the adolescents, the greater their dissatisfaction with their body. As for the school administrative status, students from private schools were more unhappy with their image (Girls: 33% and Boys: 17.6%) and, they tend to have more attitudes to lose weight (Girls: 42.8% and Boys: 28%). The mother’s level of education causes daughters to be more dissatisfied with their bodies (33.3%) and sons showing more attitudes of wanting to lose weight (26.6%). Conclusion Sociodemographic conditions are directly and indirectly associated with the adolescents’ body image. Negative deviations in body image can result in binge eating and social disorders hindering the development of these pubescent children. The consequences of these actions become a risk to health and psychological well-being, strongly supporting the initiative of programs aimed at issues related to body image in the school setting.

One size does not fit all: Trajectories of body image development and their predictors in early adolescence

Background: Negative body image predicts many adverse outcomes. The current study prospectively examined patterns of body esteem development in early adolescence and identified predictors of developmental subtypes. Methods: 328 girls and 429 boys reported annually across a 4-year period (Mage at baseline = 11.14, SD = 0.35) on body esteem, appearance ideal internalization, perceived sociocultural pressures, appearance comparisons, appearance-related teasing, self-esteem, positive and negative affect, and dietary restraint. We performed latent class growth analyses to identify the most common trajectories of body esteem development and examine risk and protective factors for body image development. Results: Three developmental subgroups were identified: (a) high body esteem (39.1%); (b) moderate body esteem (46.1%); and (c) low body esteem (14.8%). Body esteem was stable within the low trajectory and there were minor fluctuations in the high and moderate trajectories. Greater appearance-related teasing, lower self-esteem, less positive affect, and higher dietary restraint predicted the low trajectory, whereas higher self-esteem and lower dietary restraint best predicted the high trajectory. Conclusions: Low body esteem appears to be largely stable from age 11 years. Prevention programming may be enhanced by incorporating components to address transdiagnostic resilience factors such as self-esteem and positive affect.

Adolescent body image: influencing factors and the clinician's role

PURPOSE OF REVIEW

Body image is a crucial part of adolescent development for teens all over the world. Studies show that negative body image impacts many aspects of adolescent health and that anticipatory guidance about body image is important at the annual health maintenance exam visit. Weight bias is closely tied to body image and is associated with negative health effects as well; research shows weight bias is a problem throughout healthcare. The purpose of this review is to discuss influencing factors on adolescent body image and to explore interventions to promote positive body image.

RECENT FINDINGS

Research shows that adolescent body image is shaped by media influence, athletics and personal relationships. Studies have also begun to show that negative and positive body image are separate entities, and that overall health outcomes seem to be better in adolescents with positive body image. In thinking about intervention, there are ways to promote positive body image in the provider--patient interaction, within the school and community, in healthcare education, and at the societal level.

SUMMARY

Body image is an incredibly important aspect of adolescent health, and clinicians should be aware of ways to help promote positive body image in adolescents.

Meta-Review on the Effectiveness of Classroom-Based Psychological Interventions Aimed at Improving Student Mental Health and Well-Being, and Preventing Mental Illness

This meta-review summarizes existing evidence from systematic reviews and meta-analyses on the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness. Systematic reviews and meta-analyses were identified via the electronic databases PsycINFO, Web of Knowledge, Medline, Embase, and HMIC (Health Management Information Consortium). Ten systematic reviews and meta-analysis were eligible for inclusion in the final analyses. These systematic reviews and meta-analyses evaluated the effects of five types of school-based psychological interventions: Mindfulness, Social Emotional Learning, Cognitive Behavioral Therapy, Yoga, and Body-Image. Overall effectiveness reported in the included studies was significant for the most part, and ranging from small to large with respect to the effect size. The authors of all of the studies emphasized the need for additional high-quality trials to further examine the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness.

A cluster randomized controlled trial of the SoMe social media literacy body image and wellbeing program for adolescent boys and girls: Study protocol

Youth spend substantial time on social media, which can foster self-critical processes that increase risk of body dissatisfaction, disordered eating, and depressed mood. To date, there have been few investigations of interventions to decrease the negative impacts of social media engagement in adolescent boys and girls. This paper outlines the protocol for a cluster randomized controlled trial (RCT) of a four-lesson social media literacy program that was developed based on pilot results and aims to decrease body dissatisfaction, dietary restraint, and strategies to increase muscles. The RCT will be conducted with grades 7-8 students from Australian secondary schools. Using block randomization, grade levels within schools will be assigned to either the SoMe program (intervention) or health lessons as usual (control). Primary outcomes will be body satisfaction, dietary restraint, and strategies to increase muscles. Secondary outcomes will be self-esteem and depressed mood. Participants will complete assessments on four occasions - baseline, five-weeks post-baseline, and six- and 12-month post-baseline. Analyses will compare outcomes in the intervention compared to the control group. This study will be the first to implement a RCT design to evaluate the impact of a school-based social media literacy program designed to mitigate negative impacts of social media.

Evaluation of Teen BodyWise: A pilot study of a body image group adapted for adolescent inpatients with anorexia nervosa

PURPOSE

Body image disturbance is a key characteristic of anorexia nervosa (AN); however, research into these difficulties among adolescents with AN is limited and is yet to assess the best treatments for this population.

METHODS

Fifty-two adolescents receiving inpatient treatment for AN attended Teen BodyWise, an eight-session body image group adapted for adolescents. Measures assessing shape and weight concerns, ability to discuss body image, sociocultural attitudes, body avoidance, body checking, and motivation were given before and after the group, and participant feedback was elicited.

RESULTS

Significant improvements were found for shape and weight concerns, ability to discuss body image, body checking and sociocultural attitudes. Participants were generally satisfied with the group and found it helpful, yet some aspects were experienced as challenging.

CONCLUSIONS

Teen BodyWise has potential benefits for adolescents with AN. Controlled research is needed to determine the effectiveness of Teen BodyWise.

LEVEL OF EVIDENCE

Evidence obtained from multiple time series with or without the intervention, such as case studies, Level IV.

Research Review: Effectiveness of universal eating disorder prevention interventions in improving body image among children: a systematic review and meta-analysis

BACKGROUND

Increasingly, children are at risk of developing eating disorders. A systematic review and a meta-analysis were conducted to examine the effectiveness of universal eating disorder prevention interventions in improving body image, internalization of appearance ideals, and self-esteem among children aged 5-17 years old.

METHODS

Nine electronic databases were systematically searched from each database's point of inception to March 2019. The Cochrane Risk of Bias tool assessed each study's risk of bias, while the GRADE approach judged the overall evidence for each review outcome. A meta-analysis was conducted using the random-effect model to obtain standardized mean differences with 95% confidence intervals under the inverse variance method. Heterogeneity was assessed using I² statistic and Cochran's Q chi-squared test. Publication bias was assessed using funnel plots.

RESULTS

A total of 24 studies (22 trials) were included in this review. Universal interventions were found to be effective in improving children's body esteem, self-esteem, and internalization of appearance ideals at postintervention and at follow-up timepoints. Subgroup analyses found that girls benefited more from these interventions than boys. Multisessional interventions with an optimal duration of approximately one month were found to be more effective.

CONCLUSIONS

The findings encourage the incorporation of universal preventive interventions into school curricula to benefit most children. Laypeople such as teachers can deliver these interventions, but content experts should address topics on body dissatisfaction. Due to the low quality of evidence, as accorded by the GRADE approach, current findings should be validated by future research.

Effectiveness of a school-based intervention on knowledge, attitude and practice on healthy lifestyle and body composition in Malaysian adolescents

Background

The ‘Eat Right, Be Positive About Your Body and Live Actively’ (EPaL) intervention programme was developed to prevent overweight and disordered eating in Malaysian adolescents. This study aimed to evaluate the effectiveness of the EPaL programme on knowledge, attitudes and practices on healthy lifestyle and body composition (body mass index z-score [zBMI], waist circumference [WC] and body fat percentage [BF%]) among adolescents.

Methods

All measures were taken at three time points: before intervention (Pre), after intervention (Post I) and 3 months after intervention (Post II). The intervention group (IG) participated in the EPaL programme for 16 weeks, whereas the comparison group (CG) received no intervention. Seventy-six adolescents (IG: n = 34; CG: n = 42) aged 13–14 years were included in the final analysis. Repeated measures analysis of covariance (ANCOVA) was used to assess the impact of the EPaL intervention programme on the measures between groups (IG and CG) at Post I and Post II.

Results

The IG reported significantly higher knowledge scores at both Post I (adjusted mean difference = 3.34; 95% confidence interval [CI] = 0.99, 5.69; p = 0.006) and Post II (adjusted mean difference = 2.82; 95% CI = 0.86, 4.78; p = 0.005) compared with the CG. No significant differences between the IG and CG were found at either Post I or Post II in attitudes, practices, zBMI, WC and BF%. The proportion of participants who were overweight or obese was consistent from Pre to Post II in the IG (35.3%) and increased from 26.2% at Pre to 28.5% at Post II in the CG, but the difference was not statistically significant. The proportion of participants who had abdominal obesity in the IG decreased from 17.6% at Pre to 14.7% at Post II and increased from 16.7% at Pre to 21.4% at Post II in the CG, but the differences were not statistically significant.

Conclusion

Despite no significant reduction of body composition, this programme shows the positive effect on the adolescents’ knowledge regarding healthy lifestyle. This study contributes to the evidence on the effectiveness of school-based health interventions in Malaysian adolescents.

Trial registration

UMIN Clinical Trial Registration UMIN000024349. Registered 11 October 2016.

School health class associated with reduced odds of eating disorder symptoms in American adolescents

OBJECTIVE

Eating disorder symptoms, including eating disorder diagnosis, binge eating, and unhealthy weight loss, are associated with health risks, and adolescence may be an optimal time to provide education on healthy alternatives. This research explored whether in-school health information during adolescence is associated with eating disorder symptoms in young adulthood.

METHOD

Data were used from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of American youth, including information from Wave I, when participants were in Grades 7-12, and from Wave III, when participants were aged 18-26. Logistic regression analyses predicted eating disorder symptoms from in-school health information, adjusting for demographic and educational covariates. In-school health information and eating disorder symptoms were based on participant self-report.

RESULTS

In-school health information about both diet (the foods you should and should not eat) and the importance of exercise compared to no health information reduced the odds of youth-reported eating disorder history odds ratio ((OR) = 0.23, 95% CI = 0.11-0.48). Individuals who received information on exercise alone compared to no health information were also less likely to use weight pills to control weight (OR = 0.26, 95% CI = 0.11-0.61). There was no difference in binge-eating symptoms based on school health class.

DISCUSSION

Findings from this exploratory research study indicate that in-school receipt of information on diet and exercise has modest associations with eating disorder symptoms, including lower odds of a self-reported eating disorder and lower odds of using weight loss pills. Further research is needed to definitely test the role of school health class on eating disorder symptoms.

Looking to the future: Priorities for translating research to impact in the field of appearance and body image

The field of body image and appearance research and practice is progressing; however, there is still work to be done to ensure broad societal impact. This article consolidates reflections from a range of established and early career experts in the field of appearance and body image, with a focus on stimulating and guiding future agenda setting and translation from research to impact. We conducted a thematic analysis of transcripts from nine recorded 5-minute presentations, delivered by researchers and clinicians as part of a special invited presentation session at a biennial international conference, 'Appearance Matters,' in the UK. Four themes were identified: Moving Beyond the Individual; Consolidation and Collaboration; Commitment to Implementation; and Positive and Protective Frameworks. These themes are discussed alongside recommendations for researchers and practitioners working in these fields to advance research, advocacy, and impact outside of academia.

[Promoting a positive body image in young people.]

INTRODUCTION

Positive body image is a recent concept that includes several facets, such as the acceptance of one&#8217;s body and the ability to take care of it with safe, nurturing methods. The purpose of this article is to explain this concept and its importance, and to review prevention and health promotion interventions that might be effective for its development.

METHOD

We conducted a narrative review, including the latest publications that summarize the concept&#8217;s usefulness and the effectiveness of prevention programs that may contribute to the&#160;development of positive body image in youth.

RESULTS

The development of a positive body image is proposed as a key factor that would allow integrated prevention of the entire spectrum of weight and eating issues in young people, as well as other problems such as depression. Three approaches used for prevention interventions developed primarily to target body dissatisfaction as a risk factor might promote certain aspects of positive body image. It would be advisable to adopt a universal and ecological prevention approach, in order to standardize the messages received throughout the social environment regarding healthy eating, an active lifestyle, and respect for the diversity of weight, shape, and beauty.

CONCLUSION

This review highlights the importance of positive body image for public health, as well as the various preventive interventions that have proven effective for youth and young adults, so that future developments can build on what has already been performed.

Study protocol for Goodform - a classroom-based intervention to enhance body image and prevent doping and supplement use in adolescent boys

BACKGROUND

Very few programs aimed at improving body image among adolescent boys have been effective, and there is still no clear evidence as to what will work for universal prevention of eating disorders and body dissatisfaction with this group. We combined two previously efficacious programs and used a design thinking framework to optimise program content alongside potential end-users including adolescent boys, teachers, parents, and experts. Goodform is a four-session universal program that aims to reduce body dissatisfaction and prevent the use of muscle-building supplements among 14-to-16 year old adolescent boys.

METHODS/DESIGN

Goodform will be trialled using a cluster randomised controlled trial (RCT) conducted in Australian schools, with Year 9 boys as participants. The intervention is teacher-delivered. Data will be collected at three time points: baseline, post-intervention, and follow-up (2 months). Three primary outcome constructs will be examined, including body dissatisfaction (Male Body Attitudes Scale-Revised) and attitudes towards appearance and performance enhancing substances (APES; Outcome Expectations for Steroid and Supplement Use, Intentions to use APES) and actual use of APES at each time point. Three secondary outcome constructs will be examined, which are social norms for APES (adapted Peer Norms Scale), negative body talk (Male Body Talk Scale), and internalisation of and pressure to attain appearance ideals (Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised). Internalisation of appearance ideals will also be examined as a mediator of change in primary outcomes. Teachers will provide data on adherence to lessons, student engagement/enjoyment, and understanding of the content.

DISCUSSION

The GoodForm RCT will trial a novel, generalizable, and extensively developed program intended to improve boys' body image and reduce actual and intended APES use. We anticipate that it will provide a novel contribution to the field of boys' body dissatisfaction prevention.

TRIAL REGISTRATION

This trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry on May 14th 2019, registration number ACTRN12619000725167.

Does the Healthy Body Image program improve lifestyle habits among high school students? A randomized controlled trial with 12-month follow-up

Objectives

Positive embodiment and healthy lifestyle habits seem to be related; therefore, stimulating positive embodiment should promote healthy lifestyle habits. In the current study, we delivered the Healthy Body Image (HBI) intervention among Norwegian high school students and examined the effects on healthy lifestyle habits.

Methods

The HBI intervention comprises three interactive workshops, with three overarching themes related to body image, social media literacy, and lifestyle. A total of 2446 boys (43%) and girls in grade 12 (mean age 16.8 years) from 30 high schools participated in this cluster-randomized controlled study. Schools were randomized to the HBI intervention or control study arm. Data on physical activity, eating habits, and sleep were collected at baseline, post intervention, and 3- and 12-month follow-up and analyzed using linear mixed regression models.

Results

The intervention had a minor negative effect on physical activity levels in boys at 12-month follow-up and short-term small-to-moderate positive effects on consumption of breakfast and fruit and vegetables, and sleep duration on school days.

Conclusions

In future, the lack of satisfactorily long-term effects might be better addressed using a combination of cognitive and behavioral approaches to more optimally integrate positive embodiment and lifestyle changes in the daily life of adolescents.

Trial registration: ClinicalTrials.gov ID: PRSNCT02901457. Approved by the Regional Committee for Medical and Health Research Ethics.

Life after childhood bullying: Body image development and disordered eating in adulthood

Studies have demonstrated that being bullied in childhood may have long-term associations with lower psychological well-being in adulthood. However, although bullying incidents frequently target the victim’s body and appearance, research has overlooked studying victims’ long-term body image development and risk of engaging in disordered eating later in life. This 14-year longitudinal research project examined childhood bullying in relation to body image development and disordered eating in emerging adulthood. Growth curve analyses of participants’ body image at ages 10–21 years ( N = 960) revealed that more victimized children experienced more body dissatisfaction at baseline and maintained their negative body image throughout adolescence and into adulthood. Mediation analyses showed that childhood bullying (age 10 years) predicted more negative body image in adolescence (age 18 years), which in turn predicted more disordered eating in adulthood (age 24 years). The indirect effect was stronger for girls than for boys. The findings suggest that bullied children are likely to face both more body image problems and disordered eating as they evolve through adolescence and into adulthood, indicating the need for early and effective interventions. Incorporating components known to promote a more positive body image could be a valuable feature of future interventions. Thus, as children and adolescents are taught to cope with bullying situations, they could also be helped to deal with the appearance culture that permeates many of these situations.

Can subjective well-being and body concern in adolescence predict prescribed medication in adulthood? Findings from the Nord-Trøndelag Health Study and the Norwegian Prescription Database

Aim: To examine whether subjective well-being (SW) and body concern among adolescents aged 15-19 years has an impact on adult health, measured by medications dispensed on average 18 years later. Methods: Data collected in the Nord-Trøndelag Health Study (HUNT) was paired with data from the Norwegian Prescription database (NorPD). We investigated the effects of adolescent SW and body concern on total number of medications, on use of anti-infectives (ATC-group J), medication for the musculo-skeletal system (ATC-group M), anxiolytics, hypnotics and sedatives (ATC-groups N05B and N05C), and finally antipsychotics, antidepressants and psychostimulants, agents used for attention-deficit/hyperactivity disorder and nootropics (ATC-groups N05A, N06A and N06B). We used multi-variable models where we entered body dissatisfaction and SW simultaneously in the models in order to adjust for the associations between the predictors, and also adjusted for possible confounders in the models. Results: Both body concern (dieting and dieting desire) and impaired SW predicted drug use 17-18 years after the participants were surveyed in adolescence. The impact was disease specific as body concern was the most influential predictor for drugs used for somatic diseases and complaints, whereas impaired SW was more strongly associated with drug use for mental health diseases and complaints. Conclusions: SW and body concern are important health determinants in the transition between adolescence and adulthood.

Physical Activity Trends in Separate Contexts Among South Australian Older Children (10-12 Y) and Early Adolescents (13-15 Y) From 1985 to 2013

PURPOSE

To assess trends in South Australian children's physical activity between 1985 and 2003 and 2013 in the contexts of school active transport, organized sport, physical education, and school break times.

METHOD

The 1985 Australian Health and Fitness Survey was administered in South Australian schools in 2004 (8 schools) and 2013 (9 schools) and was demographically matched to the 10 South Australian schools in the Australian Health and Fitness Survey. Ordinal logistic modeling was used to identify trends, stratified by older children (10-12 y) and early adolescent (13-15 y) subgroups.

RESULTS

School active transport generally declined for males and older female children (19 and 20 percentage points per decade, respectively), whereas early adolescent females increased in walking to school (11 percentage points per decade). School sport participation declined for early adolescents, and club sport participation declined in early adolescent females (23 percentage points per decade). Moderate to vigorous physical activity participation during school break times (particularly lunchtime) generally declined (16-26 percentage points per decade). Observed changes in most contexts occurred between 2004 and 2013.

CONCLUSION

There was evidence of context-specific declines in children's physical activity participation over this time span. Early adolescent females were the subgroup of most concern, experiencing declines in most contexts.

The healthy body image (HBI) intervention: Effects of a school-based cluster-randomized controlled trial with 12-months follow-up

We examined the effects of the Healthy Body Image (HBI) intervention on positive embodiment and health-related quality of life among Norwegian high school students. The intervention comprised three interactive workshops, with body image, media literacy, and lifestyle as main themes. In total, 2,446 12^th grade boys (43%) and girls (mean age 16.8 years) from 30 high schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. Data were collected at baseline, post-intervention, 3- and 12-months follow-up, and analysed using linear mixed regression models. The HBI intervention caused a favourable immediate change in positive embodiment and health-related quality of life among intervention girls, which was maintained at follow-up. Among intervention boys, however, weak post-intervention effects on embodiment and health-related quality of life vanished at the follow-ups. Future studies should address steps to make the HBI intervention more relevant for boys as well as determine whether the number of workshops or themes may be shortened to ease implementation and to enhance intervention effects.

Young men's body dissatisfaction: A qualitative analysis of anonymous online accounts

Associated with numerous adverse health outcomes, body dissatisfaction in young men requires close examination. This study explores online accounts relating to male body image, including young men's personal disclosures within one online newspaper article, and posts responding to this topic. Discursively informed thematic analysis indicated that non-disclosure was considered a problematic social expectation by the young men featured in the article. Also, reader posts variously constructed body dissatisfaction as a symptom of adolescence, a lack of self-care and an incapacity to capitalise on compensatory qualities. Our analysis suggests young men may welcome safe opportunities to critically discuss prevailing body image ideals.

Body Image in the Context of Eating Disorders

Body dissatisfaction is a risk factor for development of eating disorders and represents a core psychopathologic feature of eating disorders. Prevention and treatment interventions address established risk and maintaining factors for body dissatisfaction: appearance pressures, internalization of appearance ideals, upward appearance comparison, avoidance and checking, and body disparagement. It is essential to address body dissatisfaction within eating disorders treatment to improve outcomes and reduce risk of relapse. Future directions in research and treatment aim to reach populations increasingly recognized as in need, including children, men, and individuals at higher weights, with the ultimate goal of reducing the significant distress associated with body dissatisfaction.

A randomized experimental evaluation of a yoga-based body image intervention

Recent literature argues that body image interventions need to become more embodied. This paper evaluates a brief yoga-based body image intervention which incorporates themes specifically tailored to focus on positive body image. Young women (M_age = 20.21, SD_age = 2.15) were randomly allocated to a four-session yoga intervention (n = 22) or a control condition (n = 22). Compared to controls, participants in the yoga condition reported significant increases in body appreciation, body connectedness, body satisfaction, and positive mood at posttest and at 4-week follow-up. There were no significant changes in negative mood or body surveillance. These findings add to existing evidence that yoga can improve women's body image and positive mood. In addition, they suggest that a strong thematic focus on positive body image can achieve benefits at relatively low yoga doses. These findings are important as intervention length impacts the potential for dissemination.

School-based versus after-school delivery of a universal wellness programme - A randomized controlled multi-arm trial

Positive self-image and body image as well as high self-esteem and media literacy are considered protective factors against health-compromising behaviours. Investigation of the optimal setting for body image prevention programmes is important to maximize outcomes from such programmes. Most universal wellness programmes are school based and thus delivered to a "captive" population. Only a few reports have been published about wellness programmes delivered in after-school settings, and none of them compared delivery after school to delivery in a school-based setting.

AIMS

To assess the acceptability, feasibility and efficacy of an interactive wellness preventive programme (In Favour of Myself) when delivered in a school-based setting versus an after-school setting.

METHODS

A randomized controlled multi-arm trial with 224 adolescent girls aged 13-15 years old was conducted. There were 102 girls participating in the after-school setting and 102 girls in the school-based setting. The programme contained nine 90-minute lessons, delivered weekly over 2 months. An intention-to-treat assessment was performed three times: at baseline, at the programme's conclusion (two months) and at follow-up (3 months).

RESULTS

At programme termination and follow-up, the impact of In Favour of Myself was higher among participants in the after-school setting than in the school-based setting with respect to advertisement strategies, media pressure, gap between current and ideal body image, drive for thinness and self-esteem.

CONCLUSIONS

This study provides support for a community-led approach to promote health behaviours, an approach that currently is a significant feature of health improvement policy and practice.

"You look great!": The effect of viewing appearance-related Instagram comments on women's body image

Instagram is an increasingly popular social networking site where users post and share photos. The aim of the present study was to experimentally investigate the effect of viewing appearance-related comments accompanying Instagram images on women's body image. Participants were 128 female undergraduate students who viewed a set of attractive images paired with a brief positive comment. For half the participants, comments were related to appearance; the other half viewed the same images with place-related comments. As predicted, exposure to appearance comments led to greater body dissatisfaction than exposure to place comments. There was no significant effect on state self-objectification, but trait self-objectification predicted increase in body dissatisfaction regardless of experimental condition. It was concluded that comments form an important and integral part of Instagram imagery, one that has implications for body image in its own right.

Altered Images: Understanding the Influence of Unrealistic Images and Beauty Aspirations

In this paper we consider the impact of digitally altered images on individuals’ body satisfaction and beauty aspirations. Drawing on current psychological literature we consider interventions designed to increase knowledge about the ubiquity and unreality of digital images and, in the form of labelling, provide information to the consumer. Such interventions are intended to address the negative consequences of unrealistic beauty ideals. However, contrary to expectations, such initiatives may not be effective, especially in the long-term, and may even be counter-productive. We seek to understand this phenomenon of our continued aspiration for beauty ideals we know to be unreal and even impossible. We draw on our respective disciplines to offer psychological and philosophical accounts for why this might be. We conclude that beauty ideals are deeply embedded in our aspirations, practices, and in our constructions of ourselves. Given this, it is not surprising that simply increasing knowledge, or providing information, will be insufficient to challenge them.

Achieving body confidence for young children: Development and pilot study of a universal teacher-led body image and weight stigma program for early primary school children

Negative body image attitudes develop in early childhood and there is a need for school-based resources during the early school years, but no teacher-delivered curriculum-based resources exist to mitigate these attitudes in young children. Achieving Body Confidence for Young Children (ABC-4-YC), a universal body dissatisfaction and weight stigma prevention program, was developed and then delivered in a pilot study. Fifty-one 5- to 8-year-old children completed pre- and post-intervention interviews assessing body image attitudes, and seven teachers provided feedback. Significant improvement in body esteem and positive teacher feedback were found. The results provide preliminary support for ABC-4-YC to improve children's body image attitudes, but extensive evaluation is needed.

Feasibility and acceptability of a prevention program for eating disorders (Me, You and Us) adapted for young adolescents in Korea

PURPOSE

The aim of this study was to assess the adaptability and acceptability of a prevention program.

METHODS

A total of 169 Korean students (83 boys and 86 girls) with a mean age of 12.3 years from a 6th grade class at an elementary school participated in the study. Mental health social workers delivered Me, You and Us, a school-based body image intervention program originally developed in the UK, through a set of six sessions. The participants were assessed in terms of their body satisfaction and self-esteem before the program, after the program, and at 1-month follow-up. They were also surveyed about their satisfaction and acceptability levels after the program.

RESULTS

At baseline, girls had lower body satisfaction and self-esteem than boys, and their body satisfaction and self-esteem improved after the program. The improved body satisfaction was maintained at the 1-month follow-up. The efficacy of the program on body satisfaction was positively correlated with the frequency of their baseline level of "fat talk." The program was more effective in girls with possible symptoms of an eating disorder at baseline. 93.7% of boys and 77.4% of girls responded that they enjoyed the program.

CONCLUSIONS

The program Me, You and Us was well-accepted by early adolescents in Korea and it can play a role in increasing body satisfaction and self-esteem by reducing "fat talk" in 6th grade students.

LEVEL OF EVIDENCE

Level III, cohort study with intervention.

The effect of Instagram "likes" on women's social comparison and body dissatisfaction

Photo-based activity on social networking sites has recently been identified as contributing to body image concerns. The present study aimed to investigate experimentally the effect of number of likes accompanying Instagram images on women's own body dissatisfaction. Participants were 220 female undergraduate students who were randomly assigned to view a set of thin-ideal or average images paired with a low or high number of likes presented in an Instagram frame. Results showed that exposure to thin-ideal images led to greater body and facial dissatisfaction than average images. While the number of likes had no effect on body dissatisfaction or appearance comparison, it had a positive effect on facial dissatisfaction. These effects were not moderated by Instagram involvement, but greater investment in Instagram likes was associated with more appearance comparison and facial dissatisfaction. The results illustrate how the uniquely social interactional aspects of social media (e.g., likes) can affect body image.

Girls-only vs. mixed-gender groups in the delivery of a universal wellness programme among adolescents: A cluster-randomized controlled trial

BACKGROUND

Investigation of the optimal setting for body image prevention programmes is important to maximize the outcomes of such programmes.

OBJECTIVES

We examined the preferred setting for a school-based wellness programme called "In Favour of Myself".

METHODS

A total of 259 girls (mean 13.82±0.64 years) were divided into a girls-only intervention group, a mixed-gender intervention and a waiting list control group. The participants completed self-report questionnaires at baseline, post-intervention (2 months) and at follow-up (3 months) examining changes in self-esteem, media literacy, body image and risk factors for eating disorders. The intervention group participants also completed a satisfaction questionnaire.

RESULTS

Both intervention groups demonstrated statistically significant improvements in identifying advertising strategies (p<0.01) compared with the controls, with the girls-only arm (p<0.001) showing better results. Compared with the girls-only arm and the control group, the mixed-gender group demonstrated statistically significantly greater improvements in the internalization of pressure for thinness (p<0.004), the body-esteem appearance subscale (p<0.025) and body-esteem body-weight subscale (p<0.012) as well as reductions in their perceived current body silhouettes and in the gap between their current and ideal body image (p<0.003). Body dissatisfaction was increased following the programme, although not in a statistically significant manner, with the worst negative effect observed in the girls-only arm. All other differences among the study arms did not show statistically significant differences. Mediation models revealed that body-esteem was directly mediated by group, with statistically significant mediation only in the mixed group. Current body image was mediated indirectly by group through media literacy (i.e., recognizing advertisement strategies and internalization of pressure for thinness), with statistical significance only in the mixed-gender arm compared with the girls-only arm. Higher programme satisfaction was reported in the mixed-gender group (91%) vs. the girls-only groups (79%).

CONCLUSIONS

These outcomes provide preliminary evidence indicating the superiority of a mixed-gender setting compared with a girls-only setting for delivering prevention programmes to 13- to 14-year-old adolescents to enhance their media literacy, positive self-esteem and body image.

TRIAL REGISTRATION

NCT02653586.

The Norwegian healthy body image programme: study protocol for a randomized controlled school-based intervention to promote positive body image and prevent disordered eating among Norwegian high school students

BACKGROUND

Body dissatisfaction and disordered eating raise the risk for eating disorders. In the prevention of eating disorders, many programmes have proved partly successful in using cognitive techniques to combat such risk factors. However, specific strategies to actively promote a positive body image are rarely used. The present paper outlines a protocol for a programme integrating the promotion of a positive body image and the prevention of disordered eating.

METHODS AND DESIGN

Using a cluster randomized controlled mixed methods design, 30 high schools and 2481 12th grade students were allocated to the Healthy Body Image programme or to a control condition. The intervention comprised three workshops, each of 90 min with the main themes body image, media literacy, and lifestyle. The intervention was interactive in nature, and were led by trained scientists. The outcome measures include standardized instruments administered pre-post intervention, and at 3 and 12 months follow-ups, respectively. Survey data cover feasibility and implementation issues. Qualitative interviews covers experiential data about students' benefits and satisfaction with the programme.

DISCUSSION

The present study is one of the first in the body image and disordered eating literature that integrates a health promotion and a disease prevention approach, as well as integrating standardized outcome measures and experiential findings. Along with mediator and moderator analyses it is expected that the Healthy Body Image programme may prove its efficacy. If so, plans are made with respect to further dissemination as well as communicating the findings to regional and national decision makers in the education and health care services.

TRIAL REGISTRATION

The study was registered and released at ClinicalTrials.gov 21th August 2016 with the Clinical Trial.gov ID: PRSNCT02901457 . In addition, the study is approved by the Regional Committee for Medical and Health Research Ethics.

Perceived Weight and Bullying Victimization in Boys and Girls

BACKGROUND

Research suggests that perceived weight poses separate risks from objective weight on adolescents' risks of being bullied. We examined if the prevalence of bullying victimization differed by perceived and objective weight status, and how these associations varied by sex.

METHODS

Data were analyzed for 6716 8th and 11th graders from the School Physical Activity and Nutrition project, a Texas statewide survey of public school students. Participants reported demographics, bullying victimization, and weight perceptions. Height and weight were measured.

RESULTS

In the last 6 months, 10.8% of students reported being bullied. Nearly 70% of normal weight and overweight and 50% of obese adolescents perceived themselves as weighing the right amount. Perceiving oneself as weighing too little or too much was significantly associated with increased bullying victimization (p < .05 for both), whereas objective weight was not. Statistical interactions between perceived weight and sex were significantly associated with victimization (p < .05) among boys only; boys who perceived themselves as weighing too little had higher predicted probabilities of victimization.

CONCLUSIONS

Perceived weight may play a greater role in bullying victimization than objective weight, especially among boys. Interventions to prevent bullying should consider adolescents' self-perceptions of weight to effectively identify those at greater risk for victimization.

Adults’ Narratives of Growing up with a Cleft Lip and/or Palate: Factors Associated with Psychological Adjustment

Background

Growing up with a cleft lip and/or palate presents a number of challenges for those affected and their families. Understanding why some individuals cope well while others struggle is key to psychological research in this field. A better appreciation of the factors and processes that contribute to psychological adjustment to cleft lip and/or palate (CL/P) from the patient perspective would be of value to both researchers and clinicians.

Design

Qualitative data elicited from individual interviews with 52 adults born with CL/P.

Result

Inductive thematic analysis identified three main themes: “background” factors (age, gender, sexual orientation, culture, additional conditions, socioeconomic status, and adoption), “external” factors (treatment autonomy, familial coping and support, salience, public understanding, psychological input, and peer support), and “internal” psychological factors (perceptions of difference, noticeability and teasing, social confidence, internalization of beauty ideals, valence, expectations of treatment, responding to challenges, social comparisons, acceptance, faith, dispositional style, and recognition of strengths and positive growth).

Conclusions

The number and breadth of factors identified in this study are testament to the importance of psychology in the field of CL/P and may offer guidance in relation to developing and assessing the value of psychological interventions. There is a clear role for psychologists in tackling appearance-related concerns, designing materials, supporting patient decision making, and improving social interaction, as well as providing specialist psychological support. The findings illustrate the potential degree of individual variation in perspectives and offer insight into the conflicting results found within current literature.

Efficacy of a prevention program for eating disorders in schools: a cluster-randomized controlled trial

BACKGROUND

Previous prevention programs in the school context have not addressed both genders, have been time-consuming, or have had deficits in the evaluation method. The aim of the present study was to evaluate the impact of a universal prevention program for female and male adolescents on eating disorder pathology and related risk factors.

METHODS

Between February 2012 and July 2014, 2515 students in 23 schools from 8th or 11th grade were assessed for eligibility in this longitudinal cluster-randomized controlled trial with a six months follow-up. Of those students, 2342 were cluster-randomized to the intervention condition which received a six school hours universal prevention program or to the no treatment control condition.

RESULTS

The complete case population comprised 724 students in the intervention (54.3% female, M = 14.3 years, SD = 1.61) and 728 in the control condition (57.0% female, M = 14.7 years, SD = 1.63). Random-effects analysis of covariance on the primary outcome showed no significant differences between the intervention and control groups in their eating disorder pathology change scores six months after the intervention. Regarding secondary outcomes, participants in the intervention group showed a greater increase in knowledge about eating disorders both after the intervention (p < .001, ES = 1.06) and six months later (p = .01, ES = 0.40). Greater reductions in anxiety severity were observed in the intervention group post-intervention (p = .02, ES = 0.22) which was not maintained at the six months follow-up. Results differed between participants from grade 8 and 11.

CONCLUSION

The present universal prevention program can be particularly recommended for adolescents from grade 11.

TRIAL REGISTRATION

ISRCTN 97989348.

Sex Differences in Quality of Life Impairment Associated With Body Dissatisfaction in Adolescents

PURPOSE

Body dissatisfaction is strongly associated with quality of life impairment among both male and female adults, and the strength of this relationship is comparable between the sexes. Whether this is the case among adolescents, however, is unclear.

METHODS

Adolescent girls (n = 1,135) and boys (n = 531) aged 12-18 years were recruited from secondary schools located in the Australian Capital Territory, Australia. Students completed a survey that included measures of body dissatisfaction, eating disorder symptoms, and psychosocial health- and physical health-related quality of life.

RESULTS

Girls reported higher levels of dissatisfaction than boys for each of the 12 body features assessed. The strength of the adverse associations between body dissatisfaction and quality of life impairment did not, however, differ by sex, and this was the case for both physical health-related and psychosocial quality of life domains. For both girls and boys, associations between body dissatisfaction and both quality of life impairment persisted after controlling for eating disorder symptoms, body mass index, and other covariates.

CONCLUSIONS

While levels of body dissatisfaction remain higher in girls than in boys, the adverse impact of body dissatisfaction on adolescents' quality of life does not appear to differ by sex. This impact entails impairment in both physical health and psychosocial quality of life domains and does not appear to be accounted for by an association between body dissatisfaction and eating disorder pathology. The findings support the need to conceive of body dissatisfaction as a public health concern in its own right.

Long-term effectiveness of a school-based primary prevention program for anorexia nervosa: A 7-to 8-year follow-up

PURPOSE

This is the first study to evaluate the long-term effectiveness of a school-based prevention program in Germany. The aim is to determine the long-term effects of the primary prevention program PriMa (Primary prevention of anorexia nervosa in preadolescent girls) on disordered eating and body self-esteem from childhood to young adulthood.

METHODS

PriMa was conducted and successfully evaluated in a quasi-experimental pre-post design with a control group from 2007 to 2008 consisting of 11-13year old girls (N=1508) from Thuringian schools in Germany. Seven to eight years after the intervention, the same cohort (mean age 19.8years) was invited to complete an online survey. Disordered eating (EAT-26), body self-esteem (FBeK) and BMI were assessed via self-report. The response rate at seven-to-eight-year follow-up was very low (7%). Data of N=100 girls were analyzed.

RESULTS

Concerning changes in disordered eating, results revealed no significant long-term effect of PriMa seven to eight years after the intervention. During this time, disordered eating remained stable without a significant increase or decrease. Regarding changes in body self-esteem, group courses differed significantly from each other. The results revealed a significant main effect of group, indicating significant differences in changes of body self-esteem between the intervention and the control group. Following the analysis of these changes of body self-esteem over time, it was found that the intervention group revealed an increase of body self-esteem after program participation and remained stable over time. By contrast, the control group revealed a decrease of body self-esteem over time.

CONCLUSIONS

Long-term intervention effects of PriMa could be found for body self-esteem but not for disordered eating. The findings suggest that PriMa prevented a decrease of body self-esteem from childhood to young adulthood. For a broader dissemination it is necessary to implement prevention programs consistently in school settings. In order to maintain the prevention effects, it would be interesting to investigate the effects of booster sessions which refresh the programs content on a regular basis. Furthermore, the results of this study revealed the implementation difficulties of primary prevention programs especially concerning the retention of the sample size.

An evaluation of a body image intervention in adolescent girls delivered in single-sex versus co-educational classroom settings

Body dissatisfaction is now recognized as having considerable negative impact on social, psychological, and physical health, particularly in adolescent girls. Consequently, we have developed a six-session co-educational body image intervention (Happy Being Me Co-educational) designed to reduce body dissatisfaction and its risk factors in Grade 7 girls. In addition to evaluating the program's efficacy, we aimed to identify whether girls would benefit equally when it was delivered as a universal intervention to a whole class including both boys and girls (co-educational delivery), or delivered as a selective intervention to girls only (single-sex delivery). Participants were 200 Grade 7 girls from five schools in Melbourne, Australia. Schools were randomly allocated to receive the intervention in single-sex classes (n=74), co-educational classes (n=73), or participate as a no-intervention control (n=53). Girls completed self-report assessments of body dissatisfaction, psychological (internalization of the thin ideal, appearance comparison, and self-esteem) and peer environment (weight-related teasing and appearance conversations) risk factors for body dissatisfaction, and dietary restraint, at baseline, post-intervention, and at 6-month follow-up. Significant improvements in body dissatisfaction and psychological risk factors were observed in the intervention group at post-intervention and these were maintained at follow-up for psychological risk factors. Importantly, no significant differences between universal and selective delivery were observed, suggesting that the intervention is appropriate for dissemination in both modes.