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Martínez de Alva P, Ghaderi A, Andersson G, Feldman I, Sampaio F. The cost-effectiveness of a virtual intervention to prevent eating disorders in young women in Sweden. Int J Eat Disord 2023; 56:1887-1897. [PMID: 37415559 DOI: 10.1002/eat.24018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of a virtual version of the Body Project (vBP), a cognitive dissonance-based program, to prevent eating disorders (ED) among young women with a subjective sense of body dissatisfaction in the Swedish context. METHOD A decision tree combined with a Markov model was developed to estimate the cost-effectiveness of the vBP in a clinical trial population of 149 young women (mean age 17 years) with body image concerns. Treatment effect was modeled using data from a trial investigating the effects of vBP compared to expressive writing (EW) and a do-nothing alternative. Population characteristics and intervention costs were sourced from the trial. Other parameters, including utilities, treatment costs for ED, and mortality were sourced from the literature. The model predicted the costs and quality-adjusted life years (QALYs) related to the prevention of incidence of ED in the modeled population until they reached 25 years of age. The study used both a cost-utility and return on investment (ROI) framework. RESULTS In total, vBP yielded lower costs and larger QALYs than the alternatives. The ROI analysis denoted a return of US $152 for every USD invested in vBP over 8 years against the do-nothing alternative and US $105 against EW. DISCUSSION vBP is likely to be cost-effective compared to both EW and a do-nothing alternative. The ROI from vBP is substantial and could be attractive information for decision makers for implementation of this intervention for young females at risk of developing ED. PUBLIC SIGNIFICANCE This study estimates that the vBP is cost-effective for the prevention of eating disorders among young women in the Swedish setting, and thus is a good investment of public resources.
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Affiliation(s)
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Prevention and early intervention in eating disorders: findings from a rapid review. J Eat Disord 2023; 11:38. [PMID: 36899428 PMCID: PMC9999654 DOI: 10.1186/s40337-023-00758-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/19/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs. METHODS This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review. RESULTS In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist. CONCLUSIONS Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.
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Myers TA. What about being a feminist is protective? An examination of constructs related to feminist beliefs as moderators of the relationship between media awareness and thin-ideal internalization. Body Image 2022; 41:248-261. [PMID: 35306357 DOI: 10.1016/j.bodyim.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022]
Abstract
Feminist beliefs have been identified as a potential protective factor in the relationship between media awareness and thin-ideal internalization; however, the precise reason why feminist beliefs serve this role is unclear. A series of three studies examined the reasons why feminist beliefs may be protective in non-student samples, considering as possible explanations open-minded thinking, critical thinking, and media attitudes and literacy. Study 1 showed that the moderating role of feminist beliefs on the relationship between media awareness and thin-ideal internalization held in a non-undergraduate sample. Study 2 found that feminist beliefs and self-identifying as a feminist were related to open-minded thinking, critical thinking, and media attitudes and literacy. Study 3 found that most of these constructs did not serve the same moderating role as feminist beliefs. However, a complex relationship emerged when both feminist self-identification and media attitudes and literacy were considered simultaneously as moderators, adding to the literature emphasizing that self-identifying as a feminist has a protective role over and above that of merely holding feminist beliefs. These results suggest that feminist beliefs may be a unique combination of these constructs or that there may be yet a different reason why feminist beliefs are protective against thin-ideal internalization.
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Prevention of eating disorders from the different psychological perspectives. NUTR HOSP 2022; 39:68-80. [DOI: 10.20960/nh.04181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sundgot-Borgen C, Stenling A, Rosenvinge JH, Pettersen G, Friborg O, Sundgot-Borgen J, Kolle E, Torstveit MK, Svantorp-Tveiten KME, Bratland-Sanda S. The Norwegian healthy body image intervention promotes positive embodiment through improved self-esteem. Body Image 2020; 35:84-95. [PMID: 33022483 DOI: 10.1016/j.bodyim.2020.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
We examined both direct and indirect effects of the Healthy Body Image (HBI) intervention on positive embodiment among Norwegian high school students. In total, 2446 12th grade boys (43 %) and girls (mean age 16.8 years) from 30 schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. We tested mediation models using path analysis and found that among several hypothesized mediators, only self-esteem mediated a positive intervention effect on positive embodiment for both boys and girls. A direct effect of the intervention on positive embodiment was only found in girls. The study provides novel findings indicating that health promotion interventions to address a positive embodiment should focus on enhancing adolescent's self-esteem. Serial mediation modeling might reveal more complex explanations of change mechanisms and could further evolve current knowledge.
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Affiliation(s)
- Christine Sundgot-Borgen
- Norwegian School of Sport Sciences, Department of Sports Medicine, Sognsveien 220, N-0806 Oslo, Norway.
| | | | - Jan H Rosenvinge
- UiT -The Arctic University of Norway, Faculty of Health Sciences Department of Psychology, 9037 Tromsø, Norway.
| | - Gunn Pettersen
- UiT -The Arctic University of Norway, Faculty of Health Sciences Department of Health and Caring Sciences, N- 9037 Tromsø, Norway.
| | - Oddgeir Friborg
- UiT -The Arctic University of Norway, Faculty of Health Sciences Department of Psychology, 9037 Tromsø, Norway.
| | - Jorunn Sundgot-Borgen
- Norwegian School of Sport Sciences, Department of Sports Medicine, Sognsveien 220, N-0806 Oslo, Norway.
| | - Elin Kolle
- Norwegian School of Sport Sciences, Department of Sports Medicine, Sognsveien 220, N-0806 Oslo, Norway.
| | | | | | - Solfrid Bratland-Sanda
- University College of Southeast Norway, Department of Sports, Physical Education and Outdoor Studies, P.O. Box 235, N-3603 Kongsberg, Norway.
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Leme ACB, Haines J, Tang L, Dunker KLL, Philippi ST, Fisberg M, Ferrari GL, Fisberg RM. Impact of Strategies for Preventing Obesity and Risk Factors for Eating Disorders among Adolescents: A Systematic Review. Nutrients 2020; 12:nu12103134. [PMID: 33066501 PMCID: PMC7602154 DOI: 10.3390/nu12103134] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023] Open
Abstract
An effective behavior change program is the first line of prevention for youth obesity. However, effectiveness in prevention of adolescent obesity requires several approaches, with special attention paid to disordered eating behaviors and psychological support, among other environmental factors. The aim of this systematic review is to compare the impact of two types of obesity prevention programs, inclusive of behavior change components, on weight outcomes. "Energy-balance" studies are aimed at reducing calories from high-energy sources and increasing physical activity (PA) levels, while "shared risk factors for obesity and eating disorders" focus on reducing disordered eating behaviors to promote a positive food and eating relationship. A systematic search of ProQuest, PubMed, PsycInfo, SciELO, and Web of Science identified 8825 articles. Thirty-five studies were included in the review, of which 20 regarded "energy-balance" and 15 "shared risk factors for obesity and eating disorders". "Energy-balance" studies were unable to support maintenance weight status, diet, and PA. "Shared risk factors for obesity and eating disorders" programs also did not result in significant differences in weight status over time. However, the majority of "shared risk factors for obesity and eating disorders" studies demonstrated reduced body dissatisfaction, dieting, and weight-control behaviors. Research is needed to examine how a shared risk factor approach can address both obesity and eating disorders.
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Affiliation(s)
- Ana Carolina B. Leme
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
- Correspondence:
| | - Jess Haines
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
| | - Lisa Tang
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
| | - Karin L. L. Dunker
- Department of Psychiatric, Federal University of São Paulo, São Paulo 04038-000, Brazil;
| | - Sonia T. Philippi
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
| | - Mauro Fisberg
- Nutrition and Feeding Difficulties Excellence Center, PENSI Institute, Sabará Children’s Hospital, São Paulo 01228-200, Brazil;
- Department of Pediatrics, Escola Paulista, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Gerson L. Ferrari
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320000, Chile;
| | - Regina M. Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
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Rutsztein G, Elizathe L, Murawski B, Scappatura ML, Lievendag L, Custodio J. Prevention of eating disorders in argentine adolescents. Eat Disord 2019; 27:183-204. [PMID: 31084425 DOI: 10.1080/10640266.2019.1591837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the last few decades much effort has been devoted to developing prevention programs for eating disorders, as most individuals with these pathologies do not receive treatment and tend to become chronic. The purpose of this study was to evaluate a cognitive dissonance and media literacy intervention aimed at preventing eating disorders in female adolescents. Eighty-eight female students (aged 12-17) from Argentina, participated in a 3-session program. Adolescents completed a baseline, post-intervention and a 6-month follow-up survey. A significant decrease in thin-ideal internalization, body image concerns, influence of advertising, drive for thinness and bulimic attitudes was found at post-intervention. In addition, the number of participants with disturbed eating attitudes and behaviors decreased at post-intervention. Results for body image concerns and drive for thinness were maintained at follow-up.
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Affiliation(s)
| | - Luciana Elizathe
- a Facultad de Psicología , Universidad de Buenos Aires , Buenos Aires , Argentina.,b Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET) , Buenos Aires , Argentina
| | - Brenda Murawski
- a Facultad de Psicología , Universidad de Buenos Aires , Buenos Aires , Argentina.,b Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET) , Buenos Aires , Argentina
| | - María Luz Scappatura
- a Facultad de Psicología , Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Leonora Lievendag
- a Facultad de Psicología , Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Jesica Custodio
- a Facultad de Psicología , Universidad de Buenos Aires , Buenos Aires , Argentina.,b Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET) , Buenos Aires , Argentina
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Tilles-Tirkkonen T, Nuutinen O, Sinikallio S, Poutanen K, Karhunen L. Theory-informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross-sectional study. J Hum Nutr Diet 2018; 31:647-657. [PMID: 29888471 DOI: 10.1111/jhn.12568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The eating patterns of school-aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar-sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils. METHODS The curriculum was developed in collaboration with school teachers using self-determination theory as a theoretical standpoint. The Health at Every Size concept and sensory-based food education were utilised in the curriculum. Self-reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012-2013 with 194 pupils aged 10-13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum. RESULTS The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar-sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools. CONCLUSIONS The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.
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Affiliation(s)
- T Tilles-Tirkkonen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - O Nuutinen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - S Sinikallio
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - K Poutanen
- VTT - Technical Research Centre of Finland Ltd, Finland
| | - L Karhunen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, Kuopio, Finland
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Wilksch SM. How can we improve dissemination of universal eating disorder risk reduction programs? Eat Behav 2017; 25:58-61. [PMID: 27085662 DOI: 10.1016/j.eatbeh.2016.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/15/2016] [Accepted: 03/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Simon M Wilksch
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia, Australia.
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Adametz L, Richter F, Strauss B, Walther M, Wick K, Berger U. Long-term effectiveness of a school-based primary prevention program for anorexia nervosa: A 7-to 8-year follow-up. Eat Behav 2017; 25:42-50. [PMID: 27260298 DOI: 10.1016/j.eatbeh.2016.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Luise Adametz
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, D-07743 Jena, Germany.
| | - Felicitas Richter
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, D-07743 Jena, Germany.
| | - Bernhard Strauss
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, D-07743 Jena, Germany.
| | - Mario Walther
- Jena University Hospital, Institute of Medical Statistics, Computer Sciences und Documentation, Bachstr. 18, D-07743 Jena, Germany.
| | - Katharina Wick
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, D-07743 Jena, Germany.
| | - Uwe Berger
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, D-07743 Jena, Germany.
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Mora M, Penelo E, Rosés R, González ML, Espinoza P, Deví J, Raich RM. Pilot assessment of two disordered eating prevention programs. Preliminary findings on maladaptive beliefs related to eating disorders. Eat Behav 2017; 25:51-57. [PMID: 27600592 DOI: 10.1016/j.eatbeh.2016.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 06/21/2016] [Accepted: 08/17/2016] [Indexed: 11/20/2022]
Abstract
AIMS As eating disorders have severe consequences, they require prevention. We aimed to compare maladaptive beliefs related to eating disorders by following two programs based on media literacy in adolescents at post-test intervention, and after 6 and 12month-follow-ups. The Male and Female Nutrition and Media Literacy Model preventive program (NUT+MEF+MEM+ML in Spanish) and the Theater Alive program are both based on the same contents, the former being presented in a multimedia and interactive format and the latter in a drama format. Both were compared to a control group without intervention, whose participants received usual classes before the assessments. METHOD Participants were 178 adolescents in the second year of compulsory secondary education from fours schools of Terrassa (Catalonia, Spain). All participants in each school were assigned to the same group, depending on school schedules. A mixed 3 (group: Theater Alive, NUT+MEF+MEM+ML, control)×3 (time: post-test, 6-month-follow-up, 12-month-follow-up) factorial design was used to evaluate the effect on maladaptive beliefs measured using a CE-TCA tool. RESULTS When compared to the control group, both Theater Alive (d=0.88) and NUT+MEM+MEF+ML (d=0.60) obtained lower scores over time, the latter being not statistically significant. DISCUSSION The Theater Alive program may produce an effect of cognitive dissonance that might eliminate the discrepancy between the contents of the play and those that are internalized, thus modifying maladaptive beliefs. Participants in the Theater Alive program, as actors in front of an audience, had to defend certain content that was rehearsed over and over again to the point until it became internalized.
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Affiliation(s)
- Marisol Mora
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Eva Penelo
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i, Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Rocío Rosés
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Marcela L González
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Paola Espinoza
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Josep Deví
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Rosa M Raich
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain.
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Le LKD, Barendregt JJ, Hay P, Mihalopoulos C. Prevention of eating disorders: A systematic review and meta-analysis. Clin Psychol Rev 2017; 53:46-58. [PMID: 28214633 DOI: 10.1016/j.cpr.2017.02.001] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To systematically review and quantify the effectiveness of Eating Disorder (ED) prevention interventions. METHODS Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsychInfo, EMBASE, and Scopus) were searched for published randomized controlled trials of ED prevention interventions from 2009 to 2015. Trials prior to 2009 were retrieved from prior reviews. RESULTS One hundred and twelve articles were included. Fifty-eight percent of trials had high risk of bias. Findings indicated small to moderate effect sizes on reduction of ED risk factors or symptoms which occurred up to three-year post-intervention. For universal prevention, media literacy (ML) interventions significantly reduced shape and weight concerns for both females (-0.69, confidence interval (CI): -1.17 to -0.22) and males (-0.32, 95% CI -0.57 to -0.07). For selective prevention, cognitive dissonance (CD) interventions were superior to control interventions in reducing ED symptoms (-0.32, 95% CI -0.52 to -0.13). Cognitive behavioural therapy (CBT) interventions had the largest effect size (-0.40, 95% CI -0.55 to -0.26) on dieting outcome at 9-month follow-up while the healthy weight intervention reduced ED risk factors and body mass index. No indicated prevention interventions were found to be effective in reducing ED risk factors. CONCLUSIONS There are a number of promising preventive interventions for ED risk factors including CD, CBT and ML. Whether these actually lower ED incidence is, however, uncertain. Combined ED and obesity prevention interventions require further research.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin University, Centre Population Health Research, Geelong, Australia.
| | - Jan J Barendregt
- School of Public Health, University of Queensland, Brisbane, Australia; Epigear International Pty Ltd, Queensland, Australia
| | - Phillipa Hay
- School of Medicine and Centre for Health Research, Western Sydney University, NSW, Australia
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Wilksch SM, Paxton SJ, Byrne SM, Austin SB, O'Shea A, Wade TD. Outcomes of three universal eating disorder risk reduction programs by participants with higher and lower baseline shape and weight concern. Int J Eat Disord 2017; 50:66-75. [PMID: 27768806 DOI: 10.1002/eat.22642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/13/2016] [Accepted: 09/30/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate if baseline shape and weight concern (SWC) moderated outcomes in Prevention Across the Spectrum, a randomized-controlled trial (RCT) of 3 school-based programs aimed at reducing eating disorder and obesity risk factors. METHOD N = 1,316 Grade 7 and 8 girls and boys (M age = 13.21 years) across three Australian states were randomly allocated to: Media Smart; Life Smart; Helping, Encouraging, Listening and Protecting Peers Initiative (HELPP) or control (usual school class). Moderation was explored by testing interaction effects for group (Media Smart; Life Smart; HELPP; Control) × moderator (SWC: higher-SWC; lower-SWC) × time (post-program; 6-month follow-up; 12-month follow-up), with baseline risk factor scores entered as covariates. RESULTS Moderation effects were found for shape concern, weight concern, eating concern, regular eating (i.e., meal skipping), physical activity, body dissatisfaction, dieting, and perfectionism. Post-hoc testing found eating concern at post-program was the only variable where higher-SWC Media Smart participants experienced a reduction in risk relative to controls. Both higher-SWC Life Smart and HELPP participants reported an increase in eating concern relative to controls and both groups were skipping more meals than controls at 12-month follow-up. Amongst lower-SWC participants, Media Smart was the only group to experience a benefit relative to controls (physical activity). CONCLUSIONS This study highlights the need for moderator analyses to become more routinely conducted in universal trials, to ensure that participants across baseline risk levels are benefiting and not harmed from program participation. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:66-75).
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Affiliation(s)
- Simon M Wilksch
- School of Psychology, Flinders University, South Australia, Australia
| | - Susan J Paxton
- School of Psychological Science, La Trobe University, Victoria, Australia
| | - Susan M Byrne
- School of Psychology, University of Western Australia, Western Australia, Australia
| | - S Bryn Austin
- Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Social and Behavioral Sciences Harvard Chan School of Public Health, Boston, Massachusetts
| | - Anne O'Shea
- School of Psychology, Flinders University, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, South Australia, Australia
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14
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Rodger S, Bourdage R, Hancock K, Hsiang R, Masters R, Leschied A. Supporting Students: A GRADE Analysis of the Research on Student Wellness and Classroom Mental Health Support. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2016. [DOI: 10.1177/0829573516684069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recommendations derived from research evidence regarding program implementation in school-based mental health [SBMH] require knowledge of the intervention outcomes as well as the potential to translate program components into schools. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) analysis was applied to major areas of the SBMH literature in addressing the areas of effectiveness and the strength of recommendation in implementation. Nine areas were addressed: emotional intelligence, stigma reduction, mindfulness, anxiety, depression, addictions, suicide prevention, trauma, and eating disorders. Ninety-eight studies were retrieved across the nine areas. Effect sizes based on reported outcomes and estimates on the strength of recommendation were generated in each of the nine areas of interest. These results provide an overview of the quality of the evidence that will be of relevance to school personal in making program selections.
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Affiliation(s)
- Susan Rodger
- The University of Western Ontario, London, Canada
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15
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McLean SA, Paxton SJ, Wertheim EH. The role of media literacy in body dissatisfaction and disordered eating: A systematic review. Body Image 2016; 19:9-23. [PMID: 27572000 DOI: 10.1016/j.bodyim.2016.08.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 07/21/2016] [Accepted: 08/06/2016] [Indexed: 11/30/2022]
Abstract
This study comprised a systematic review of literature examining empirical relationships between levels of media literacy and body dissatisfaction and disordered eating. The review aimed to integrate research on this topic. Electronic databases were searched for key concepts: media literacy, body dissatisfaction, and disordered eating. Media literacy measures were coded for consistency with media literacy constructs. Sixteen eligible studies were identified. Cross-sectional outcomes depended upon the media literacy construct assessed. Some relationships between high scores on measures consistent with media literacy constructs and low scores on body dissatisfaction and related attitudes were found. Media literacy-based interventions revealed improvements in media literacy constructs realism scepticism, influence of media, and awareness of media motives for profit, and improvements in body-related variables, but not disordered eating. Further research examining relationships between theoretically driven media literacy constructs and body and eating concerns is needed. Recommendations are made for evaluating media literacy-based eating disorder prevention.
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Affiliation(s)
- Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
| | - Eleanor H Wertheim
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
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16
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Gutiérrez T, Espinoza P, Penelo E, Mora M, González ML, Rosés R, Raich RM. Association of biological, psychological and lifestyle risk factors for eating disturbances in adolescents. J Health Psychol 2016; 20:839-49. [PMID: 26032800 DOI: 10.1177/1359105315577302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We aimed to assess the association of several risk factors for eating disturbances in adolescents. Participants were 448 girls and boys aged 12-15 years. Being female, higher body mass index, internalisation of standard of appearance, perfectionism, body dissatisfaction, number of lifetime addictive behaviours and lower self-esteem were associated with higher eating disturbance scores, whereas frequency of sedentary behaviours and physical activity were not (R(2) ⩾ 41%). Findings suggest the need to guide prevention efforts towards the broad spectrum of individual potentially modifiable factors. A non-specific comprehensive perspective may be adequate to prevent problems related to weight, body image and drug use.
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Affiliation(s)
- Teresa Gutiérrez
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Paola Espinoza
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Eva Penelo
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Marisol Mora
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Marcela L González
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Rocío Rosés
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Rosa M Raich
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
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17
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Ciao AC, Latner JD, Brown KE, Ebneter DS, Becker CB. Effectiveness of a peer-delivered dissonance-based program in reducing eating disorder risk factors in high school girls. Int J Eat Disord 2015; 48:779-84. [PMID: 25959408 DOI: 10.1002/eat.22418] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This pilot study investigated the feasibility, acceptability, and effectiveness of a peer-led dissonance-based eating disorders (ED) prevention/risk factor reduction program with high school girls. METHOD Ninth grade girls (n = 50) received the peer-led program within the school curriculum. A quasi-experimental design was used to assess changes in ED risk factors preintervention and postintervention compared with waitlist control. Participants were followed through 3-month follow-up. RESULTS Peer-leader adherence to an intervention manual tailored for this age group was high. The intervention was rated as highly acceptable, with a large proportion of participants reporting that they enjoyed the program and learned and applied new information. Intervention participants exhibited significantly greater pre-post reductions in a majority of risk-factor outcomes compared to waitlist controls. When groups were combined to assess program effects over time there were significant pre-post reductions in a majority of outcomes that were sustained through 3-month follow-up. DISCUSSION This pilot study provides tentative support for the effectiveness of using peer leaders to implement an empirically supported ED risk factor reduction program in a high school setting. Additional research is needed to replicate results in larger, better-controlled trials with longer follow-up.
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Affiliation(s)
- Anna C Ciao
- Department of Psychology, Western Washington University, Bellingham, Washington.,Department of Psychology, The University of Hawaii at Manoa, Honolulu, Hawaii
| | - Janet D Latner
- Department of Psychology, The University of Hawaii at Manoa, Honolulu, Hawaii
| | - Krista E Brown
- Department of Psychology, The University of Hawaii at Manoa, Honolulu, Hawaii
| | - Daria S Ebneter
- The University of North Carolina, School of Medicine, Chapel Hill, North Carolina
| | - Carolyn B Becker
- Department of Psychology, Trinity University, San Antonio, Texas
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18
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Wilksch SM, Paxton SJ, Byrne SM, Austin SB, McLean SA, Thompson KM, Dorairaj K, Wade TD. Prevention Across the Spectrum: a randomized controlled trial of three programs to reduce risk factors for both eating disorders and obesity. Psychol Med 2015; 45:1811-1823. [PMID: 25524249 DOI: 10.1017/s003329171400289x] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A randomized controlled trial of three school-based programs and a no-intervention control group was conducted to evaluate their efficacy in reducing eating disorder and obesity risk factors. METHOD A total of 1316 grade 7 and 8 girls and boys (mean age = 13.21 years) across three Australian states were randomly allocated to: Media Smart; Life Smart; the Helping, Encouraging, Listening and Protecting Peers (HELPP) initiative; or control (usual school class). Risk factors were measured at baseline, post-program (5 weeks later), and at the 6- and 12-month follow-ups. RESULTS Media Smart girls had half the rate of onset of clinically significant concerns about shape and weight than control girls at the 12-month follow-up. Media Smart and HELPP girls reported significantly lower weight and shape concern than Life Smart girls at the 12-month follow-up. Media Smart and control girls scored significantly lower than HELPP girls on eating concerns and perceived pressure at the 6-month follow-up. Media Smart and HELPP boys experienced significant benefit on media internalization compared with control boys and these were sustained at the 12-month follow-up in Media Smart boys. A group × time effect found that Media Smart participants reported more physical activity than control and HELPP participants at the 6-month follow-up, while a main effect for group found Media Smart participants reported less screen time than controls. CONCLUSIONS Media Smart was the only program to show benefit on both disordered eating and obesity risk factors. Whilst further investigations are indicated, this study suggests that this program is a promising approach to reducing risk factors for both problems.
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Affiliation(s)
- S M Wilksch
- School of Psychology, Flinders University,SA,Australia
| | - S J Paxton
- School of Psychological Science, La Trobe University,VIC,Australia
| | - S M Byrne
- School of Psychology, University of Western Australia,WA,Australia
| | - S B Austin
- Adolescent and Young Adult Medicine, Boston Children's Hospital,Boston,MA,USA
| | - S A McLean
- School of Psychological Science, La Trobe University,VIC,Australia
| | - K M Thompson
- School of Psychology, University of Western Australia,WA,Australia
| | - K Dorairaj
- School of Psychology, University of Western Australia,WA,Australia
| | - T D Wade
- School of Psychology, Flinders University,SA,Australia
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19
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González ML, Mora M, Penelo E, Goddard E, Treasure J, Raich RM. Gender differences found in a qualitative study of a disordered eating prevention programme: What do boys have to say? J Health Psychol 2015; 20:858-74. [PMID: 26032802 DOI: 10.1177/1359105315573426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Qualitative studies examining gender differences of eating disorder prevention programmes are scarce. We aimed to evaluate gender differences in adolescents who participated in a larger study on effectiveness of a disordered eating prevention programme. Perceptions of eating, female and male aesthetic models, media influences, prevention programmes and emerging topics from 12 school-going boys who received a media-literacy programme (n = 4), media-literacy plus nutrition-awareness programme (n = 4) or neither (n = 4) were explored using Interpretative Phenomenological Analysis and compared with previous results in girls. Findings suggest that the prevention programme is effective for both genders. Gender differences and consumer-culture influences may be considered in future interventions.
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Affiliation(s)
- Marcela L González
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Marisol Mora
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Eva Penelo
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Elizabeth Goddard
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK
| | - Janet Treasure
- Department of Academic Psychiatry, Guy's, King's and St. Thomas's Medical School, London, UK
| | - Rosa M Raich
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
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20
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Francisco R, Espinoza P, González ML, Penelo E, Mora M, Rosés R, Raich RM. Body dissatisfaction and disordered eating among Portuguese and Spanish adolescents: The role of individual characteristics and internalisation of sociocultural ideals. J Adolesc 2015; 41:7-16. [PMID: 25754193 DOI: 10.1016/j.adolescence.2015.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/05/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to explore the differences in patterns of risk factors for body dissatisfaction and disordered eating attitudes in both female and male adolescents from Portugal and Spain. The sample included 455 adolescents aged 12-16 years (M = 13.28, SD = 0.65) from two urban areas of each country. Body mass index, self-reported self-esteem, perfectionism, internalisation of sociocultural ideals, body dissatisfaction and disordered eating attitudes were assessed. Path analyses provided partial support for a cross-cultural model of body dissatisfaction and disordered eating in Western countries due to the presence of certain differences in the patterns of relationships across sex and country. The findings suggest the importance not only of identifying cultural specificities, even in "neighbouring" countries, but also of developing a global and comprehensive preventive approach that focuses on the influence of the ideal of beauty transmitted by Western societies.
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Affiliation(s)
- Rita Francisco
- Faculdade de Psicologia, Universidade de Lisboa, Portugal
| | - Paola Espinoza
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Marcela L González
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Eva Penelo
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Marisol Mora
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Rocío Rosés
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Rosa M Raich
- Unitat d'Avaluació i Intervenció en Imatge Corporal, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain.
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21
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Assessment of two school-based programs to prevent universal eating disorders: media literacy and theatre-based methodology in Spanish adolescent boys and girls. ScientificWorldJournal 2015; 2015:328753. [PMID: 25802888 PMCID: PMC4353415 DOI: 10.1155/2015/328753] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/25/2014] [Indexed: 11/17/2022] Open
Abstract
AIMS To evaluate the long-term effects of two school-based prevention programs administered to a universal mixed-sex sample of school-going adolescents on disturbed eating attitudes, aesthetic ideal internalization, and other eating disorder risk factors, when compared to a control group. METHODS Participants were 200 adolescents aged 12-15 selected by means of incidental sampling from second-year compulsory secondary education at schools. An interactive multimedia media literacy program (ML + NUT, Media Literacy and Nutrition) and a program focused on the same topics using dramatic arts (Theatre Alive) were applied and compared with a control group. Pretest, posttest (1 month later), and 5- and 13-month follow-up measurements were taken. Analyses were conducted with two-way mixed 3 × 3 ANCOVA (group × phase) adjusted by baseline levels, body mass index, and sex. RESULTS Participants in both experimental groups showed significantly higher self-esteem scores than the control group over time. The ML + NUT group also presented lower aesthetic ideal internalization scores than the control group. DISCUSSION Both programs can benefit students' self-esteem. Moreover, ML + NUT program was useful in reducing thin-ideal internalization. However, differences in body dissatisfaction and disordered eating attitudes were not found. The programs may be protective on the core psychological variables, which are essential to adaptive adolescent development.
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22
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López CC, Raimann TX, Gaete P. MV. Prevención de los trastornos de conducta alimentaria en la era de la obesidad: rol del clínico. REVISTA MÉDICA CLÍNICA LAS CONDES 2015. [DOI: 10.1016/j.rmclc.2014.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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23
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Ciao AC, Loth K, Neumark-Sztainer D. Preventing eating disorder pathology: common and unique features of successful eating disorders prevention programs. Curr Psychiatry Rep 2014; 16:453. [PMID: 24821099 PMCID: PMC4104660 DOI: 10.1007/s11920-014-0453-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Over the past two decades, the field of eating disorders has made remarkable strides in identifying, evaluating, and disseminating successful prevention programs. The current review identifies and discusses nine distinct eating disorders prevention programs that reduce existing eating disorder pathology or prevent the onset of future pathology. Each program was evaluated in one or more controlled trial with a follow-up period of at least six months. We review the evidence base for these nine successful programs and discuss their common and unique features. Based on authors' descriptions of their programs in published trials, we found that all programs were theory-driven, targeted one or more eating disorder risk factor (e.g., body dissatisfaction), were delivered across multiple group sessions, and included at least some interactive content. Most programs included content related to healthy eating/nutrition, media literacy/sociocultural pressures, and body acceptance/body satisfaction. Notably, there was wide variation in some participant features (e.g., participant age, sex, risk status) and intervention features (e.g., setting and format, length and dose, providers), suggesting that a variety of programs are beneficial in impacting eating disorder pathology. Implications and directions for future research are discussed, including an increased focus on universal and indicated prevention programs, expanding programs to a wider age range and a broader spectrum of weight-related problems, and rigorous evaluation of programs through efficacy, effectiveness, and implementation research.
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Affiliation(s)
- Anna C. Ciao
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Katie Loth
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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24
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Golan M, Hagay N, Tamir S. Gender related differences in response to "in favor of myself" wellness program to enhance positive self & body image among adolescents. PLoS One 2014; 9:e91778. [PMID: 24618996 PMCID: PMC3950257 DOI: 10.1371/journal.pone.0091778] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/14/2014] [Indexed: 01/24/2023] Open
Abstract
Background Physical, neurological and psychological changes are often experienced differently by male and female adolescents. Positive self-esteem, emotional well-being, school achievements, and family connectedness are considered as protective factors against health-compromising behaviors. This study examines the gender differences in respect to the effect of a school-based interactive wellness program – “In Favor of Myself” – on self-image, body image, eating attitudes and behaviors of young adolescents. Methods Two hundred and ten adolescents (mean age 13.5) participated in the intervention group, 55% were girls and 45% boys. Program consisted of eight 90-minutes structured sessions integrated into a regular school coping skills curriculum. The program focused on self-esteem, self-image, body image, media literacy and cognitive dissonance. The overall impact of the program and the study protocol were previously published. Results Overall, there are gender related differences in respect to body image and self-image in young adolescents in response to “In Favor of Myself”. Compared to boys, girls reported at baseline higher self-esteem, being more contingent by appearance, and their self-image was more influenced by popularity, appearance, interpersonal communication and admired people. Furthermore girls presented greater gap between current body figure and perceived ideal figure. Not only were girls more dissatisfied with their body, but they were more active in attempts to become and/or remain “thin”. At program termination, gender × time effect was detected in reduction of self-worth contingent by others, change in importance given to achievements at schools, parents' perceptions, as well as the impact of comparisons to friends and family members on self-image. Conclusions Girls exhibited more gains than boys from ‘In Favor of Myself’ which raise the questions about how effective would be the program when delivered in mixed gender groups vs. mono-gender groups.
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Affiliation(s)
- Moria Golan
- Shahaf, Community Services for the Management of Weight-Related Problems, Tel Aviv, Israel
- School of Nutritional Sciences, Tel Hai College, Upper Galilee, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
- * E-mail:
| | - Noa Hagay
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Snait Tamir
- School of Nutritional Sciences, Tel Hai College, Upper Galilee, Israel
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25
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Affiliation(s)
- Simon M Wilksch
- a School of Psychology, Flinders University , Adelaide , South Australia , Australia
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26
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Wilksch SM, Wade TD. Depression as a moderator of benefit from Media Smart: A school-based eating disorder prevention program. Behav Res Ther 2014; 52:64-71. [DOI: 10.1016/j.brat.2013.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 11/26/2022]
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27
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Golan M, Hagay N, Tamir S. The effect of "in favor of myself": preventive program to enhance positive self and body image among adolescents. PLoS One 2013; 8:e78223. [PMID: 24265681 PMCID: PMC3827050 DOI: 10.1371/journal.pone.0078223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 09/11/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Positive self-esteem, emotional well-being, school achievements and family connectedness are considered protective factors against health-compromising behaviors. This study examined the effect of an interactive, community-based, media literacy and dissonance wellness program, In Favor of Myself, on the self-image, body image, eating attitudes and behavior of young adolescents. A preliminary cohort study was conducted among 972 program participants who did not take part in the controlled trial. Over 75% of participants said they would recommend the program to their friends. METHODS A controlled trial was conducted to evaluate program acceptability, efficacy and effectiveness among 259 participants (210 in the intervention group and 49 in the control group), aged 12-14 years, who completed questionnaires during at least two assessment times. Program materials were provided, along with leaders' training, in order to ensure quality program delivery and creation of a wide network of committed program leaders. RESULTS The program significantly reduced drive for thinness and self-worth contingent upon others' approval, the gap between current body figure and ideal figure, and the impact of mood on girls' self-image. Superiority was found among those participating in the intervention group with respect to recognizing media strategies, the influence of media on desire to change, and the influence of appearance on self-confidence and drive for thinness. CONCLUSIONS In Favor of Myself shows promising results for strengthening adolescents' ability to cope with the challenges of their life stage. Suggestions for improving In Favor of Myself are presented.
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Affiliation(s)
- Moria Golan
- Shahaf, Community Services for the Management of Weight-Related Problems, Tel Aviv, Israel
- Department of Nutrition, Tel Hai Academic College, Upper Galilee, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Noaa Hagay
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Snait Tamir
- Department of Nutrition, Tel Hai Academic College, Upper Galilee, Israel
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28
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Schober I, Sharpe H, Schmidt U. The reporting of fidelity measures in primary prevention programmes for eating disorders in schools. EUROPEAN EATING DISORDERS REVIEW 2013; 21:374-81. [PMID: 23881537 DOI: 10.1002/erv.2243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 06/03/2013] [Accepted: 06/19/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this paper was to examine the extent to which controlled trials of face-to-face school-based primary prevention for eating disorders report their strategies for maintaining fidelity. METHOD A systematic review located 38 articles eligible for inclusion. These studies were assessed using 18 criteria for reporting fidelity maintenance strategies based on those recommended by the Treatment Fidelity Workgroup of the National Institute of Health Behavior Change Consortium. RESULTS Fidelity reporting was generally poor. The studies reported between 22% and 56% of fidelity criteria. Detailed reporting of curriculum-as-usual control conditions was generally lacking, as were methods to ensure high-quality training and mechanisms to assess provider adherence to intervention protocol. DISCUSSION Poor fidelity assessment and reporting is a problem in school-based primary prevention programmes for eating disorders. Recommendations for improving fidelity maintenance and reporting practices are provided.
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Affiliation(s)
- Ilka Schober
- Section of Eating Disorders, Institute of Psychiatry, King's College London, UK
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Yager Z, Diedrichs PC, Ricciardelli LA, Halliwell E. What works in secondary schools? A systematic review of classroom-based body image programs. Body Image 2013; 10:271-81. [PMID: 23683611 DOI: 10.1016/j.bodyim.2013.04.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 03/15/2013] [Accepted: 04/04/2013] [Indexed: 11/17/2022]
Abstract
Governments, schools, and curriculum authorities are increasingly recognizing that body image during adolescence is a public health issue that warrants attention in the school setting. After 30 years of eating disorder prevention research, and given the current interest in this area, it seems timely to review the research on interventions to improve body image in schools. We reviewed universal-selective, classroom-based programs that have been conducted since the year 2000, among adolescents, and found 16 eligible intervention programs. Seven of these programs were effective in improving body image on at least one measure, from pre to post test, though effect sizes were small (d=0.22-0.48). These effective programs were conducted among younger adolescents 12.33-13.62 years, and included activities focusing on media literacy, self esteem, and the influence of peers. Implications for school personnel and curriculum authorities are discussed, and we provide recommendations for a strategic approach to future research in this area.
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Affiliation(s)
- Zali Yager
- Faculty of Education, La Trobe University, Edwards Road, Bendigo, Victoria 3550, Australia.
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Prevention programme for eating disturbances in adolescents. Is their effect on body image maintained at 30 months later? Body Image 2013; 10:175-81. [PMID: 23287047 DOI: 10.1016/j.bodyim.2012.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 11/05/2012] [Accepted: 11/26/2012] [Indexed: 11/22/2022]
Abstract
We assessed changes in the body image of Spanish adolescents who participated in a programme aimed at preventing disordered eating, with a 30-month follow-up. 254 girls and 189 boys aged 12-14 were assigned to a control group (n=201) or one of two possible experimental conditions: media literacy programme (ML, n=143) and media literacy plus nutrition awareness programme (ML+NUT, n=99). Body image was assessed with the Body Image Questionnaire (Qüestionari d'Imatge Corporal; QÜIC). Pre-test, post-test, 7- and 30-month follow-up measurements were taken. Linear model analyses were carried out with a 2×3×3 ANOVA (sex×group×phase), adjusted by the baseline level. At 30-month follow-up, ML and ML+NUT participants showed fewer body problems and more body satisfaction than the control group. There is a need for prevention programmes addressing eating and body image disturbances that involve both boys and girls.
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31
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González ML, Mora M, Penelo E, Goddard E, Treasure J, Raich RM. Qualitative findings in a long-term disordered eating prevention programme follow-up with school-going girls. J Health Psychol 2012; 18:587-98. [DOI: 10.1177/1359105312437433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The assessment of eating disorder prevention-programmes has mainly been addressed quantitatively excluding complexity that may improve prevention. We compared perceptions of eating, female and male aesthetic-models, media influences, prevention-programmes and emerging topics among 12 young females who received a media literacy programme ( N = 4), media literacy plus nutrition awareness programme ( N = 4) or were assigned to a control condition ( N = 4). Interpretative Phenomenological Analysis highlighted ego-syntonic eating-patterns and signs of internalization of the thin ideal. Findings provide invaluable and rich information to improve future iterations of the programme.
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Affiliation(s)
- Marcela L. González
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Marisol Mora
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Eva Penelo
- Laboratori d’Estadística Aplicada, Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Elizabeth Goddard
- Department of Psychological Medicine, King’sCollege London, Institute of Psychiatry
| | - Janet Treasure
- Department of Psychological Medicine, King’sCollege London, Institute of Psychiatry
| | - Rosa M. Raich
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain
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Abstract
PURPOSE OF REVIEW Addressing youth mental health in secondary schools has received greater attention globally in the past decade. It is essential that educators, mental health experts, researchers, and other related service providers understand the most current research findings to inform policy making, and identify priority areas for the development of future interventions and research strategies. This review describes literature during the past year on school-based mental health programs addressing mental health promotion, prevention, early identification and intervention/treatment. RECENT FINDINGS In contrast to the abundance of school-based mental health programs, the evidence of program effectiveness, safety and cost-effectiveness in this area is somewhat insufficient, mostly due to the lack of rigorous research designs, the heterogeneity of school environments, and the complexities of interventions that require multisector collaboration. SUMMARY Although the opportunity in school mental health is substantial, much yet needs to be done to develop and evaluate interventions that can be proven to be effective, safe and cost-effective. Mental health literacy may be an appropriate start that will help to set the foundation for mental health promotion, prevention and intervention.
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Villarejo C, Fernández-Aranda F, Jiménez-Murcia S, Peñas-Lledó E, Granero R, Penelo E, Tinahones FJ, Sancho C, Vilarrasa N, Montserrat-Gil de Bernabé M, Casanueva FF, Fernández-Real JM, Frühbeck G, De la Torre R, Treasure J, Botella C, Menchón JM. Lifetime obesity in patients with eating disorders: increasing prevalence, clinical and personality correlates. EUROPEAN EATING DISORDERS REVIEW 2012; 20:250-4. [PMID: 22383308 PMCID: PMC3510304 DOI: 10.1002/erv.2166] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aims of our study were to examine the lifetime prevalence of obesity rate in eating disorders (ED) subtypes and to examine whether there have been temporal changes among the last 10 years and to explore clinical differences between ED with and without lifetime obesity. METHODS Participants were 1383 ED female patients (DSM-IV criteria) consecutively admitted, between 2001 and 2010, to Bellvitge University Hospital. They were assessed by means of the Eating Disorders Inventory-2, the Symptom Checklist-90-Revised, the Bulimic Investigatory Test Edinburgh and the Temperament and Character Inventory-Revised. RESULTS The prevalence of lifetime obesity in ED cases was 28.8% (ranging from 5% in anorexia nervosa to 87% in binge-eating disorders). Over the last 10 years, there has been a threefold increase in lifetime obesity in ED patients (p < .001). People with an ED and obesity had higher levels of childhood and family obesity (p < .001), a later age of onset and longer ED duration; and had higher levels of eating, general and personality symptomatology. CONCLUSIONS Over the last 10 years, the prevalence of obesity associated with disorders characterized by the presence of binge episodes, namely bulimic disorders, is increasing, and this is linked with greater clinical severity and a poorer prognosis.
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Affiliation(s)
- Cynthia Villarejo
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Clinical Sciences Department, University of BarcelonaSpain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Clinical Sciences Department, University of BarcelonaSpain
| | | | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de BarcelonaSpain
| | - Eva Penelo
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de BarcelonaSpain
| | - Francisco J Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de VictoriaMálaga, Spain
| | - Carolina Sancho
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
| | - Nuria Vilarrasa
- Endocrinology and Nutrition Department, Bellvitge Universitary Hospital—IDIBELLBarcelona, Spain
| | | | - Felipe F Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Division of Endocrinology, Complejo Hospitalario Universitario de Santiago de CompostelaSpain
| | - Jose Manuel Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep TruetaGirona, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Department of Endocrinology and Nutrition, University of NavarraPamplona, Spain
| | - Rafael De la Torre
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Human Pharmacology and Clinical Neurosciences Research Group, Neuroscience Research Program, IMIM—Hospital del Mar Research InstituteBarcelona, Spain
| | - Janet Treasure
- Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, King's College LondonLondon, UK
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- University Jaume ICastellón, Spain
| | - José Manuel Menchón
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
- Clinical Sciences Department, University of BarcelonaSpain
- CIBER, Salud Mental (CIBERSAM), Instituto Carlos IIISpain
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