Integrating eating disorder and weight gain prevention: a pilot and feasibility trial of INSPIRE

Your Body Is Your Home: The feasibility of an intuitive eating intervention for early adolescents

OBJECTIVE

Intuitive eating (IE) is an emerging health promotion framework which has shown promise in the prevention and early intervention of disordered eating (DE) behavior in adults. This study sought to extend this work by assessing the feasibility and preliminary efficacy of a 5-week IE intervention, "Your Body is Your Home," delivered in school classrooms for early adolescents aged 11-13.

METHODS

The present study utilized a quasi-experimental design. Eligibility criteria were defined a priori and published in a registered protocol. Four classrooms (n = 128 student participants) were recruited into two streams, and self-report questionnaires were administered at pre-test, post-test, and 4-week follow-up. The questionnaires included the Intuitive Eating Scale for Early Adolescents (IES-2-EA), the Body Appreciation Scale (BAS-2), and the WHO Wellbeing Index (WHO-5). Linear mixed models were used to conduct preliminary efficacy testing.

RESULTS

The results indicate that a brief classroom-based IE intervention is feasible and acceptable for both students and teaching staff; retention, fidelity, and attendance targets were achieved. Students and teachers rated all five sessions of the intervention as a highly feasible method of health promotion. Further, preliminary efficacy data suggest IE interventions aimed at early adolescents may be a feasible way of improving certain aspects of IE (p < .001) in male and female participants, and body appreciation (p < .001) in male participants.

DISCUSSION

The study provides preliminary support for the implementation and evaluation of an IE intervention as part of school-based health promotion and offers preliminary effect size estimates for a larger-scale randomized trial.

PUBLIC SIGNIFICANCE

Existing evidence suggests that IE may be a useful framework through which relationships with food and the body can be improved. The present study seeks to extend this work by adapting the framework for early adolescents (among whom the framework is not well understood) and examining feasibility, acceptability, and preliminary changes to several health and well-being metrics following a 5-week school-based intervention.

Cultural adaptation of an integrated eating disorders prevention and healthy weight management program

BACKGROUND

Both eating disorder (ED) prevention and weight management interventions often focus on the thin ideal. Yet, many Black and Latina women do not view thinness as their body ideal. This study used focus groups to investigate the influence of race, ethnicity, and culture on appearance ideals and inform the cultural adaptation and integration of two established programs addressing EDs and weight management: the Body Project, and Healthy Weight Interventions.

METHODS

White (n = 10), Black (n = 14), and Latina (n = 6) women participated in racially and ethnically homogenous focus groups.

RESULTS

Thematic analysis identified several themes, including: (1) diverse beauty standards across groups, (2) lack of acknowledgement of racialized beauty standards in prevention and cultural appropriation, (3) culturally-specific impacts of standards, (4) harm of appearance-related comments, (5) limitations of available resources, (6) stigma/minimization of mental health, (7) barriers to inclusive programming, and (8) facilitators of inclusive programming.

CONCLUSIONS

Results suggested that current programs' emphasis on thinness limit their relevance for women of color, and perpetuate the misconception that EDs primarily affect White women. Findings highlight the need for culturally responsive prevention.

Prevention of eating disorders: 2020 in review

Fifteen prevention-related publications in Eating Disorders during 2020 are reviewed. Two models frame this analysis: (1) the Mental Health Intervention Spectrum: health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into a cycle: rationale, theory, and methodology, shaped by critical, integrative reviews → clarification of risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination. In this cycle the first two phases and the last phase inform advocacy for social policies supporting prevention. Ten articles comprising a special issue on yoga demonstrate the value of investing in translational prevention science that acknowledges (a) embodying experiences as a broad category of protective factors; (b) the utility of multidimensional theoretical models; and (c) social justice issues that advocacy efforts must address to make programs widely and equitably available. Other articles reviewed show, for example, that studies of emotion dysregulation and emotional eating are needed to enter a prevention cycle that moves us beyond body image (or weight/shape) concerns in defining high-risk groups and developing indicated prevention. Finally, implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies are discussed.

Impact of Strategies for Preventing Obesity and Risk Factors for Eating Disorders among Adolescents: A Systematic Review

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.