Can we reduce eating disorder risk factors in female college athletes? A randomized exploratory investigation of two peer-led interventions

An Umbrella Review of Body Image Concerns, Disordered Eating, and Eating Disorders in Elite Athletes

Background/Objectives: Several systematic reviews and meta-analyses have been conducted to date indicating a high prevalence of disordered eating in elite athletes and associated risk factors. However, the substantial time burden associated with locating and comparing these reviews, which are varied in methodology and sampling focus, may be a barrier for informing policy and best practice as well as directing future research. This umbrella review aimed to provide a summary of evidence across published reviews regarding the prevalence and risk factors for disordered eating (including body image concerns and eating disorders) in elite athletes. Methods: Five databases (CINAHL, PsycINFO, MEDLINE, Scopus, and SPORTDiscus) were systematically searched for peer-reviewed systematic reviews and meta-analyses that met the following inclusion criteria: (1) investigated prevalence and risk factors for disordered eating, (2) included a sample of elite athletes, and (3) available in English. The included studies underwent data extraction and risk of bias assessment using the AMSTAR 2. Results: The initial search identified 1828 articles that were screened for title and abstract and then full text, leaving 24 systematic reviews (including 10 meta-analyses). Disordered eating was prevalent across elite athletes, including males and females and across sport type. Elite athletes were at elevated risk for disordered eating and eating disorders but at lower risk for body image concerns versus non-athlete controls. Several risk factors were identified, including female gender, competing in lean sports, and experiencing career changes. Few reviews or meta-analyses examined perceived pressures within the sporting environment, and most had substantial risk of bias concerns. Conclusions: Elite athletes are at risk for the spectrum of disordered eating, and all should be considered for primary prevention and screening. Further research is needed regarding sport-specific versus general pressures and mediators of risk to better inform interventions.

Body Appreciation is Associated with Emotional Eating in Turkish Female Athletes

It is known that female athletes are at risk for eating disorders. It is thought that factors such as pressure and stress experienced by professional athletes may affect emotional eating and body appreciation. In this context, the aim of this study was to evaluate the emotional eating and body appreciation of professional Turkish female athletes. A total of 265 professional female athletes were categorized according to their sport types and nationality. Emotional eating was found to be higher and body appreciation to be lower in athletes competing at the national level. The results of the hierarchical regression analysis, which included variables such as age, body mass index, professional sports background, national level, and sport type show that the most effective factor in explaining emotional eating in professional female athletes is body appreciation. The present study findings support that professional female athletes are at risk in terms of emotional eating and body appreciation. In addition, emotional eating scores were found to be higher and body appreciation scores were lower in national athletes. Psychological factors such as intense stress and pressure have an impact on the eating behavior and body appreciation of national athletes. These results suggest that athletes should be evaluated by nutritionists, doctors, and psychologists from a multidisciplinary perspective.

Preventing eating pathology among elite adolescent ballet dancers: a pilot trial of the Athlete Body Project

Adolescent ballet dancers are commonly recognized as aesthetic athletes who are at higher risk for body dissatisfaction, disordered eating, and eating disorders. Although athletic participation can generally protect against negative mental and physical health outcomes, idealization of a body ideal specific to ballet can confer unique vulnerability for eating pathology. Despite this known vulnerability, rigorous efforts to prevent eating pathology among young dancers are lacking. Previously, we reported on a trial of the Female Athlete Body Project adapted for professional female ballet dancers. The current study tested a subsequent adaptation, the Athlete Body Project (ABP), tailored for younger dancers, including a version for boys. This non-randomized, uncontrolled pilot trial tested ABP among boys and girls in two elite ballet schools (N = 23), formatted in-person and via video-conferencing. Program delivery met benchmarks for feasibility and acceptability across gender and delivery formats, and dancers provided positive qualitative feedback. Overall results suggest the potential of ABP in intervening on pre-post eating pathology and body appreciation, and significantly decreasing drive for muscularity among young ballet dancers. Taken together, this pilot work addresses a gap in the field and advances the needed development of eating disorder prevention programming for young, high-risk aesthetic athletes.

Disordered eating is not associated with musculoskeletal injury in university athletes

TAKE HOME MESSAGE

Musculoskeletal injuries and disordered eating are prevalent in varsity-level athletes but are not associated in our participants.

Investigating pre-professional dancer health status and preventative health knowledge

Introduction

Dance is a highly demanding physical pursuit coupled with pressure to conform to aesthetic ideals. Assessment of health status and preventative health knowledge of pre-professional dancers may help inform educational strategies promoting dancers' health and career longevity. The aim of this research was to establish a baseline understanding of dance students at a single pre-professional institution based on metrics focused on current health, nutrition, lifestyle, and wellbeing while also gauging knowledge of longer-term health implications.

Methods

Adopting a cross-sectional study design, the Dance-Specific Energy Availability Questionnaire was tailored for Australian participants and administered online.

Results

The response rate was 59.5% (69/116 eligible students) and the survey was completed in full by 63 students. Mean BMI was 20 kg/m2, although among females, 47% had a BMI < 20 (range 16 to 25 kg/m2), and at their lowest reported weight BMI was 14 to 25 kg/m2. Over a third had either experienced (31%) or were currently experiencing (3.4%) secondary amenorrhea (period absence ≥ 3 consecutive months). Most dancers did not exclude food groups, however, 24% had been advised to exclude particular foods in the past, mostly by dance teachers. A large percentage used nutritional supplements (68%) with 60% supplementing with iron and more than half (53%) taking two or more supplements. Only 25% had ever utilised a qualified dietitian, although 16% reported a history of eating disorders and 25% reported vegetarian or vegan eating patterns. REDs risk scores ranged from -16 to +16 points with negative scores indicating LEA and higher risk of REDs. The mean score for males was 5.2 (SD = 3.9) and 2.1 (SD = 5.9) for females, with 33.3% producing a negative score.

Conclusion

Results provide insight to health knowledge and particular issues pertinent for dancers and highlights the need for specific education strategies to promote a preventative health focus for those entering a pre-professional programme. This study also highlights the need for improved awareness of LEA and REDs among all practitioners working with dancers along with cultural and structural changes within the broader dance community to help protect and promote the wellbeing of dancers.

The Design and Implementation of a Novel Mental Health Literacy Educational Intervention Program in Gaelic Footballers

CONTEXT

Lack of education, stigma, and negative self-attitudes are key barriers to help-seeking in Gaelic footballers. With the prevalence of mental health issues in Gaelic footballers and the increased risk of experiencing mental health challenges after injury, mental health literacy (MHL) interventions are necessary.

OBJECTIVES

To design and implement a novel MHL educational intervention program in Gaelic footballers.

DESIGN

Controlled laboratory study.

SETTING

Online.

PATIENTS OR OTHER PARTICIPANTS

Elite and subelite Gaelic footballers divided into intervention (n = 70; age = 25.1 ± 4.5 years) and control (n = 75; age = 24.4 ± 6.0 years) groups. In the intervention group, 85 participants were recruited, but 15 dropped out after completing baseline measures.

INTERVENTIONS

A novel educational intervention program, "GAA [Gaelic Athletic Association] and Mental Health-Injury and a Healthy Mind," was designed to address the key components of MHL and was underpinned by the Theory of Planned Behavior and the Help-Seeking Model. The intervention was implemented online via a brief 25-minute presentation.

MAIN OUTCOME MEASURES

Measures of stigma, help-seeking attitudes, and MHL were completed by the intervention group at baseline, immediately after viewing the MHL program, and at 1 week and 1 month after the intervention. The control group completed the measures at similar time points.

RESULTS

Stigma decreased, and attitudes toward help-seeking and MHL increased in the intervention group from baseline to after the intervention (P < .05), with significant differences sustained at 1-week and 1-month follow-ups. Our results showed differences in stigma, attitudes, and MHL between groups across time points. Intervention participants provided positive feedback, and the program was appraised as informative.

CONCLUSIONS

Remote online delivery of a novel MHL educational program can effectively decrease mental health stigma, improve attitudes toward help-seeking, and increase the recognition and knowledge of mental health issues. Gaelic footballers with improved MHL may be better equipped to manage their mental health and cope with stressors, leading to improved mental health outcomes and overall mental well-being.

2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.

Best practice recommendations for body composition considerations in sport to reduce health and performance risks: a critical review, original survey and expert opinion by a subgroup of the IOC consensus on Relative Energy Deficiency in Sport (REDs)

BACKGROUND

The assessment of body composition (BC) in sport raises concern for athlete health, especially where an overfocus on being lighter or leaner increases the risk of Relative Energy Deficiency in Sport (REDs) and disordered eating.

METHODS

We undertook a critical review of the effect of BC on performance (29 longitudinal, prospective or intervention studies) and explored current practice related to BC considerations via a follow-up to a 2013 internationally distributed survey.

RESULTS

The review found that a higher level of body fat was negatively associated with endurance performance, while a gain in muscle mass resulted in performance benefits across sports. BC did not contribute to early talent identification, and no unique cut-off to signify a performance advantage for BC was identified. BC appears to be one of an array of variables impacting performance, and its influence should not be overstated. The survey (125 practitioners, 61 sports and 26 countries) showed subtle changes in BC considerations over time, such as an increased role for sport dietitian/nutrition practitioners as BC measurers (2013: 54%, 2022: 78%); less emphasis on reporting of body fat percentage (2013: 68%, 2022: 46%) and reduced frequency of BC assessment if ≥every fourth week (2013: 18%, 2022: 5%). Respondents remained concerned about a problematic focus on BC (2013: 69%, 2022: 78%). To address these findings, we provide detailed recommendations for BC considerations, including an overview of preferable BC methodology.

CONCLUSIONS

The 'best practice' guidelines stress the importance of a multidisciplinary athlete health and performance team, and the treatment of BC data as confidential medical information. The guidelines provide a health focus around BC, aiming to reduce the associated burden of disordered eating, problematic low energy availability and REDs.

Body image concerns across different sports and sporting levels: A systematic review and meta-analysis

Mixed findings exist regarding whether athletes have different levels of body image concerns to non-athletes. Such body image concerns have not been reviewed recently, meaning that new findings need to be incorporated into our understanding of the adult sporting population. This systematic review and meta-analysis aimed first to characterise body image in adult athletes versus non-athletes, and second to explore whether specific sub-groups of athletes report different body image concerns. Impact of gender and competition level were considered. A systematic search identified 21 relevant papers, mostly rated moderate quality. Following a narrative review, a meta-analysis was conducted to quantify the outcomes. While the narrative synthesis indicated possible differences between types of sport, the meta-analysis demonstrated that athletes in general reported lower body image concerns than non-athletes. In general, athletes had a better body image than non-athletes, with no reliable differences between different type of sport. A combination of prevention and intervention strategies might assist athletes in focusing on the benefits to their body image without encouraging restriction/compensation or overeating. Future research should define comparison groups clearly, along with attending to training background/intensity, external pressures, gender and gender identity.

Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs

Relative Energy Deficiency in Sport (REDs) is common among female and male athletes representing various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA). It is essential to prevent problematic LEA to decrease the risk of serious health and performance consequences. This narrative review addresses REDs primary, secondary and tertiary prevention strategies and recommends best practice prevention guidelines targeting the athlete health and performance team, athlete entourage (eg, coaches, parents, managers) and sport organisations. Primary prevention of REDs seeks to minimise exposure to and reduce behaviours associated with problematic LEA. Some of the important strategies are educational initiatives and de-emphasising body weight and leanness, particularly in young and subelite athletes. Secondary prevention encourages the early identification and management of REDs signs or symptoms to facilitate early treatment to prevent development of more serious REDs outcomes. Recommended strategies for identifying athletes at risk are self-reported screening instruments, individual health interviews and/or objective assessment of REDs markers. Tertiary prevention (clinical treatment) seeks to limit short-term and long-term severe health consequences of REDs. The cornerstone of tertiary prevention is identifying the source of and treating problematic LEA. Best practice guidelines to prevent REDs and related consequences include a multipronged approach targeting the athlete health and performance team, the athlete entourage and sport organisations, who all need to ensure a supportive and safe sporting environment, have sufficient REDs knowledge and remain observant for the early signs and symptoms of REDs.

A randomized controlled trial to evaluate the acceptability and effectiveness of two eating disorders prevention interventions: the HEIDI BP-HW project

BACKGROUND

Eating disorders (ED) are common in Switzerland, as in other Western countries, with a prevalence of any ED of 3.5%. However, no specific prevention intervention has been evaluated in the French-speaking part of the country. In this study, we assessed the acceptability and effectiveness of two well-validated eating disorders prevention interventions: the Body Project intervention (BP), based on cognitive dissonance techniques, and the Healthy Weight intervention (HW), based on the implementation of a healthy lifestyle.

METHODS

Forty female students, aged 18-28, with body dissatisfaction, were randomized into three arms: a BP group, an HW group, and a waiting-list control group (WLCG). The primary outcome measure was body dissatisfaction. Secondary outcomes were thin-ideal internalization, dietary restraint, negative affect, and ED psychopathology. Thirty-three participants completed the assessments before and after the one-month interventions or waiting period. A follow-up measurement was conducted one month after the interventions to assess the stability of the results.

RESULTS

Both interventions, delivered via a virtual web platform, were considered acceptable. The reduction in body dissatisfaction was greater in the BP group (r = 0.7; p < 0.01) or the HW group (r = 0.6; p < 0.01) than in the WLCG, with large effect sizes. Dietary restraint and shape concern were also significantly reduced in the BP group (r = 0.6 and r = 0.7, respectively; p < 0.01) and HW group (r = 0.5 and r = 0.5, respectively; p < 0.05) compared to the WLCG, with moderate to large effect sizes. The results obtained in each intervention group were stable at the one-month follow-up.

CONCLUSIONS

This study showed encouraging results in young women with body dissatisfaction, arguing in favor of the French adaptations of the BP and HW interventions. However, the feasibility of recruitment was difficult, partly due to the pandemic situation at the time of the study, and should be further considered to improve dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04558073, 22/09/2020 and Swiss National Clinical Trial Portal (SNCTP000003978).

Sex-related differences in hip and groin injuries in adult runners: a systematic review

OBJECTIVES

Hip/groin running-related injuries (RRIs) are relatively uncommon. It is unclear if runners of either sex are disproportionately affected. Our objective was to systematically review differences in hip/groin RRIs between males and females.

DATA SOURCES

A structured and comprehensive search of four medical literature databases was performed (PubMed, Embase, Ovid Medline, and CINAHL). Terms searched were as follows: risk, epidemiology, hip injury, groin injury, overuse injury, running, sprinting, and track and field.

STUDY SELECTION

Studies reporting sex-specific data on hip/groin RRIs in adult runners were included. Data was extracted and reviewed independently by two authors.

STUDY APPRAISAL AND DATA SYNTHESIS

Sex-specific injury rates, risk factors, and return to sport (RTS) following hip/groin RRI were extracted. Risk of bias was assessed using the Joanna-Briggs Institute Critical Appraisal Tool.

RESULTS

Ten studies with 7,353 total runners were included: 2,315 (47%) males and 2,559 (53%) females. The mean age of the included runners was 37.3 ± 8.9 years and the mean weekly running distance was 10.4 ± 8.4 km. Hip/groin injuries comprised 10.1% (491/4,874) of total RRIs, including 6.3% of RRIs sustained by males and 11.0% by females. Three studies reported significantly higher rates of hip/groin RRIs in female runners. One study reported significantly higher rates of gluteus medius and adductor RRIs for females and males, respectively. One study identified female sex as an independent risk factor for hip/groin RRIs. Three studies reported on RTS after hip/groin RRIs: the pooled RTS rate was 81.4% (57/70) at 1 to 368 days after injury.

LIMITATIONS

Data was pooled when possible; however, there was considerable clinical, methodological, and statistical heterogeneity across studies.

CONCLUSIONS

Hip/groin RRIs comprise a greater percentage of total injuries among injured female runners relative to males. Females may be at a higher risk for sustaining hip/groin RRIs though more research on risk factors and RTS is needed.

Addressing anxiety through conversation and campus programming: a mixed methods exploration of student and parent perspectives

Objective: This mixed methods study examined student and parent experiences with anxiety and preferences for campus-based programming to address anxiety. Participants: College students (n = 156) completed a survey, and 20 students participated in focus groups. Parents of college students (n = 85) completed a survey, and 12 parents completed a phone interview. Methods: Students and parents completed surveys about trait worry, mental health literacy, and preferences for proposed programming. Descriptive statistics were calculated. Students participated in focus groups, and parents completed interviews regarding their experiences and preferences. Thematic analysis was conducted with the coded focus group and interview transcripts. Results: Quantitative and qualitative findings revealed specific program preferences (eg scheduling). Qualitative findings highlighted mismatches between student and parent perspectives and opportunities for parental skill building. Conclusions: Students and their parents are open to and eager for campus programming that provides education, skills, and support for college students with anxiety.

Prevention and early intervention in eating disorders: findings from a rapid review

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.

Athlete-specific risk factors for the development of disordered eating behaviors in first-year college athletes

OBJECTIVE

The current study tested whether proposed sport-related risk factors for disordered eating behaviors were associated with increases in disordered eating over first-year college athletes' first four months of collegiate sport participation.

PARTICIPANTS

Participants included a sample of first-year college athletes (N = 59, 45% female) from a Division I National Collegiate Athletics Association (DI) university.

METHOD

This follow-up study tested whether 1) wearing a uniform that emphasizes body concerns, 2) participating in a lean sport, and 3) perceived pressure for thinness from coaches and teammates would lead to increases in weight/shape concerns and disordered eating behaviors over the first four months of collegiate sport participation.

RESULTS

Wearing a uniform that emphasizes body concerns and perceived coach pressure for thinness predicted increases in weight/shape concern. Both teammate and coach pressure for thinness predicted increases in restrained eating behaviors.

CONCLUSION

Findings suggest that there are identifiable, athlete-specific risk factors for the development of disordered eating behaviors among first-year college athletes.

The body satisfaction and psychological well-being of retired women athletes: A long-term qualitative analysis of bodies in motion

We conducted a qualitative evaluation of Bodies in Motion (BIM), a dissonance, mindful self-compassion-based program that addresses the unique experiences and needs of female athletes with respect to their bodies and their well-being. Using semi-structured interviews, 12 collegiate female athletes (retired 2 - 6 years) reflected and provided feedback on the enduring impact of BIM on their body image, relationship to food and exercise, and overall psychological well-being. Through thematic analysis, we found that these retired athletes, extending from their initial program learning, reported increased awareness of sport and societal messages and their impact on body image, shifted perspectives in their view of themselves and their bodies, and used learned skills to manage body image in their lives. Further, with the passage of time, athletes emphasized how what they had learned in BIM remained essential as they navigated challenging life transitions, such as their retirement from collegiate sports. Our findings indicate that the benefits female athletes report accruing in the immediate aftermath of BIM remain with them, even growing and becoming more salient as they continue to reflect on the program and its impact on their body awareness and how they navigate their lives as women and former athletes.

Self-compassion, body satisfaction, and disordered eating symptoms in male collegiate athletes: A longitudinal analysis

Male athletes are a subpopulation at risk for developing eating disorders and disordered eating concerns, primarily due to the presence of socioculturally-based factors, including body dissatisfaction. Self-compassion may alleviate this risk by improving body satisfaction. To date, no study has examined longitudinally self-compassion's effect on body satisfaction and, ultimately, disordered eating in male athletes. Across two time points separated by four months, we assessed self-compassion, body satisfaction, and disordered eating in 454 male collegiate athletes. Through cross-lagged, panel analysis, after controlling for the Time 1 scores, we determined that: (a) Time 1 self-compassion was neither directly related to Time 2 body satisfaction (β = 0.02, p = .755), nor indirectly to Time 2 disordered eating (β = -0.002, 95% BCaCI [-0.028, 0.014]), and (b) Time 1 body satisfaction directly predicted Time 2 disordered eating (β = -0.12, p < 0.05). Our findings extend past research, demonstrating that body satisfaction is a primary antecedent to disordered eating among male athletes. However, the proposed effects of self-compassion on the body satisfaction to disordered eating relationship were not supported and may be dependent on gender and athlete status.

Symptoms of mental illness among university student-athletes during the second wave of the COVID-19 pandemic lockdown in Canada

The COVID-19 pandemic lockdown disrupted the university sports season and had negative consequences on the academic and personal life of university student-athletes, resulting in several psychological challenges. The goal of this study is to document the symptoms of mental illness among university student-athletes during the second wave of the COVID-19 pandemic lockdown in Canada. It aims to (a) assess the prevalence of mental illness symptoms (anxiety, depression, disordered eating, and dangerous drinking) among university student-athletes and (b) identify which sociodemographic and sports characteristics, pandemic impacts, and levels of perceived stress most influence these symptoms. A total of 424 university student-athletes completed an online survey, which included questions on mental illness and the impact of the pandemic lockdown. The results revealed a notable prevalence of the symptoms of mental illness; depressive symptoms are reported by 37.9% of the participants, anxiety symptoms by 24.9%, dangerous drinking symptoms by 10.1%, and disordered eating by 8.6%. In addition, being female [OR = 0.56, 95% CI (0.33, 0.95)] or a member of a visible minority group [OR = 2.63, 95% CI (1.02, 6.78)] are significantly associated with the presence of depressive symptoms. Low academic motivation has a significant negative influence on the presence of depressive [OR = 3.37, 95% CI (1.82, 6.25)] and anxiety symptoms [OR = 2.75, 95% CI (1.35, 5.62)]. However, the presence of perceived stress was strongly associated with depressive [OR = 7.07, 95% CI (3.26, 15.35)], anxiety [OR = 6.51, 95% CI (3.30, 12.84)], and dangerous drinking symptoms [OR = 5.74, 95% CI (2.51, 13.14)]. This study advocates for specific mental illness prevention and treatment resources tailored to the unique needs of university student-athletes. Accordingly, partnerships and practical interventions to support university student-athletes' mental health are presented.

General and sport-specific weight pressures as risk factors for body dissatisfaction and disordered eating among female collegiate athletes

Female collegiate athletes are a high-risk group for disordered eating. Petrie and Greenleaf's (2007) sociocultural model proposes that both general and sport-related weight pressures lead athletes to internalize unrealistic body ideals, ultimately resulting in body dissatisfaction and disordered eating. In this study, we used structural equation modeling to assess general and sport-specific weight pressures in relation to thin- and muscular-ideal internalization, body dissatisfaction, and disordered eating among 212 female Division I college athletes. General weight pressures from parents, peers, and the media were associated with disordered eating indirectly via thin- and muscular-ideal internalization. In contrast, sport-specific weight pressures were not associated with disordered eating in the full model. After controlling for weight pressures and body ideal internalization, body dissatisfaction was also not associated with disordered eating. These findings suggest that female athletes are vulnerable to weight- and appearance-related pressures from outside the sport context and that the mechanisms underlying the development of disordered eating may differ between athletes and non-athletes.

Proof-of-Concept Feasibility Trial of a Dissonance-Based Sun Safety Intervention for Young Adult Tanners

BACKGROUND

Melanoma is the second most common cancer in young adults. Social media may be a means to conduct interventions to increase sun safety in young adults.

PURPOSE

We conducted a randomized proof-of-concept pilot trial to evaluate the feasibility and acceptability of a dissonance-based social media intervention designed to promote sun safety in young adult tanners.

METHODS

Young adult tanners (N = 66) were randomized into two 4-week interventions in which participants were incentivized to create content for a social media campaign on healthy skin or healthy lifestyle. Feasibility outcomes included retention, participation, acceptability, and contamination. We also examined the impact of participation on motivation to engage in the target health behaviors and outdoor tanning intentions.

RESULTS

Retention was 100%. Most Healthy Skin (88%) and Healthy Lifestyle participants (91%) created ≥1 post. Acceptability was high with 94% and 97% of participants in Healthy Skin and Healthy Lifestyle conditions, respectively, agreeing they would recommend the campaign to a friend. At 4 weeks, Healthy Skin participants reported greater declines in motivation to tan indoors (p = .0017) and outdoors (p = .0003), and greater increases in motivation to wear sunscreen (p = .0009) and protective clothing (p = .0342). Healthy Skin participants reported greater declines in intentions to tan outdoors in the next year (p = .0286).

CONCLUSIONS

A dissonance-based, social media sun safety intervention was feasible and acceptable. Future research should examine the efficacy and longer-term effects of this intervention in young adults at elevated risk for skin cancer.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03834974 https://clinicaltrials.gov/ct2/show/NCT03834974.

Evaluating a motivational and psycho-educational self-help intervention for athletes with mild eating disorder symptoms: A mixed methods feasibility study

Objective

The primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho‐Educational Self‐Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED‐A). A mixed‐methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED‐A in reducing athletes' eating disorder symptoms.

Method

Thirty‐five athletes were recruited. Participation involved completing MOPED‐A over a 6‐week period and completing self‐report measures at baseline (T1), post‐intervention (T2) and 4‐week follow‐up (T3). A subsample (n = 15) completed an interview at T2.

Results

Retention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED‐A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3.

Conclusions

The MOPED‐A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted.

Participant recruitment to the study was feasible, and an acceptable proportion of participants were retained throughout the study.

This is the first study to show that the format and delivery of a self‐help intervention is acceptable to athletes with mild eating disorder symptoms, and that athletes valued the intervention being tailored to them which facilitated participation and completion.

The intervention demonstrates potential for reducing athletes' eating disorder symptoms.

Reducing eating disorder risk among male athletes: A randomized controlled trial investigating the male athlete body project

OBJECTIVE

No study to date has investigated an intervention program for male athletes that targets eating disorder risk factors. The purpose of this study was to measure the effects of the Male Athlete Body Project (MABP), an adaptation of the Female Athlete Body Project on body dissatisfaction, drive for muscularity, body-ideal internalization, and muscle dysmorphia.

METHOD

Participants were 79 male collegiate athletes who were randomized to the MABP (n = 39) or an assessment-only control condition (n = 40). All participants completed psychometrically validated measures at three time points: baseline, post-treatment (3 weeks after baseline for the control condition), and 1-month follow-up.

RESULTS

Hierarchical Linear Modeling assessed differences between conditions across time. Interaction effects revealed that participation in the MABP improved satisfaction with specific body parts and reduced drive for muscularity and body-ideal internalization at post-treatment compared to a control group. Athletes in the MABP also reported increased body areas satisfaction and reductions in drive for muscularity at 1-month follow-up. Reductions in supplement use were observed at 1-month follow-up only.

DISCUSSION

This study provides preliminary evidence of the efficacy of the MABP in reducing some eating disorder risk factors up to 1 month after the intervention; follow-up study considerations are discussed.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04077177 PUBLIC SIGNIFICANCE: This study highlights the importance of eating disorder and body image intervention efforts for male athletes. Findings suggest that male college athletes who attended a 3-session group intervention based on a well-established program for college women experienced an increase in satisfaction with specific body areas and a reduction in some eating disorder risk factors (e.g., drive for muscularity, supplement use, and body-ideal internalization) compared to a control group.

Diet Quality and Mental Health Status among Division 1 Female Collegiate Athletes during the COVID-19 Pandemic

The International Olympic Committee has identified mental health as a priority that significantly affects the physical health and safety of collegiate athletes. Interventions that improve diet quality have been shown to improve mental health in several populations. However, studies are needed to examine this relationship in female collegiate athletes, who have elevated risk of experiencing anxiety and depression symptoms, as well as dietary insufficiencies. In a quantitative, cross-sectional study, female student athletes at a U.S. university completed three mental health questionnaires: Depression Anxiety and Stress Scale (DASS-21), Athlete Psychological Strain Questionnaire (APSQ), and COVID Stress Scales (CSS). Each female athlete also completed a validated, web-based Diet History Questionnaire (DHQ-III) resulting in a Healthy Eating Index (HEI). Seventy-seven participants completed all survey information. HEI scores were consistently higher for athletes with poorer mental health. HEI scores were significantly positively associated with stress (p = 0.015), performance concerns (p = 0.048), CSS components of danger (p = 0.007), contamination (p = 0.006), and traumatic stress (p = 0.003). Although findings support statistically significant associations among dietary quality and mental health indicators, including broad symptom severity or stressors specific to athletics or COVID-19, these associations were in the opposite direction hypothesized. Possible reasons for results and suggestions for future research are discussed.

A study protocol for a preliminary randomised controlled trial assessing the acceptability and effectiveness of two eating disorders prevention interventions in Switzerland: The HEIDI BP-HW project

Because of the serious consequences of eating disorders on young women’s lives and because of the lack of specialised care facilities, assessing and implementing evidence-based prevention interventions is necessary. Switzerland, like other Western countries, has high prevalence rates of eating disorders. However, no prevention interventions have been evaluated in this country so far. This paper presents the protocol of a preliminary study with the aim to evaluate the acceptability and effectiveness of two interventions, the Body Project (BP) and the Healthy Weight Program (HW), for female students from French-speaking Switzerland. These two interventions were chosen because they have been widely evaluated and they proved to be effective in various countries. They take place in groups and include four weekly sessions over one month. Because of the pandemic situation, the group sessions will take place online on an collaborative platform. The design is a three-arm randomised controlled study. Ninety female students aged 18–25 and presenting with at least moderate body dissatisfaction will be randomised into three groups: (1) one-month BP intervention, (2) one-month HW intervention, and (3) one-month waiting-list control group followed by the BP intervention. Assessments of body dissatisfaction, thin-ideal internalisation, dietary restraint, negative affect, and eating disorder psychopathology will be conducted before and after the interventions or waiting list and after a one-month follow-up. ANCOVA and ANOVA with repeated measures will be used to assess group differences and follow-up stability. Acceptability will be assessed with a questionnaire on participants’ satisfaction with the interventions, group discussion at the end of the intervention, and with participants’ rate of attendance to the group sessions. The study results will provide additional data on these two eating disorders prevention interventions and will suggest ways for their dissemination and further evaluation in Switzerland.

Food and alcohol disturbance by athlete status: the roles of drive for thinness, drive for muscularity, and sex

OBJECTIVE

This study investigated the association between self-identified athlete status and Food and Alcohol Disturbance (FAD) behaviors, and whether this association was moderated by drives for thinness or muscularity, and sex.

PARTICIPANTS

575 individuals (77.6% female, 40.0% identifying as athletes) recruited from a large southeastern university.

METHODS

Participants completed online measures of athletic identity, drives for muscularity and thinness, FAD behaviors, and demographic variables.

RESULTS

Compared to non-athletes, male athletes with higher drive for muscularity endorsed more alcohol effects behaviors; female athletes endorsed the inverse relationship. Higher drive for thinness was associated with more diet and exercise behaviors among all participants, and extreme weight control behaviors among athletes.

CONCLUSIONS

Athlete status moderated the associations between drives for thinness/muscularity and FAD Alcohol Effects and Extreme Weight Control Behaviors. Regardless of athlete status, college students with higher drive for thinness are at risk for engaging in more FAD Diet & Exercise behaviors.

Psychometric properties of the contextual body image questionnaire for athletes: a replication and extension study in female collegiate athletes

BACKGROUND

Although the link between body dissatisfaction and eating disorder (ED) pathology is well-established in general female samples, less is known about contextual body image (CBI) among female athletes. CBI refers to female athletes' body image concerns in two contexts: sport and daily life. The Contextual Body Image Questionnaire for Athletes (CBIQA) measures four dimensions of body image (Appearance, Thin-Fat Self-Evaluation, Thin-Fat Others' Evaluation, and Muscularity) in both contexts. In a sample of female collegiate athletes, this study sought to A) investigate the psychometric properties of the CBIQA, B) examine the cross-sectional relation of CBI with ED pathology and negative affect, and C) assess the degree to which CBI prospectively predicts ED pathology and negative affect.

METHOD

Using self-report data collected from a multi-site parent trial, we examined the psychometric properties of the CBIQA by confirmatory factor analysis. We assessed construct and criterion validity via cross-sectional bivariate correlation analyses with thin-ideal internalization, negative affect, and ED pathology. Using data from Time 1 and 6 months later (Time 2), we investigated the degree to which CBI prospectively predicted ED pathology and negative affect.

RESULTS

Results from the CFA largely confirmed de Bruin et al.'s (2011) original factor analysis. Two CBIQA dimensions (Thin-Fat Self and Appearance) in both contexts correlated with ED pathology and negative affect. Thin-Fat Others also correlated with ED pathology in both contexts and negative affect in the sport context. The Muscularity dimension was predominantly orthogonal with other measures. CBIQA dimensions were uncorrelated with thin-ideal internalization. When controlling for BMI and Time 1 scores, daily life and sport appearance concerns predicted ED pathology, whereas perceived evaluation of thin-fat by others in the sport context predicted negative affect 6 months later.

CONCLUSIONS

Results support the psychometric validity of the CBIQA and suggest that it captures variance discrete from thin-ideal internalization. The Muscularity dimension largely was not related to other outcomes. Further, specific elements of perceived self- and other-evaluation in both contexts is relevant to risk for ED pathology and negative affect. Future research could examine the impact of dual body image between sports seasons and after transitioning out of sport.

CLINICAL TRIALS REGISTRATION

NCT01735994 .

Relative energy deficiency in sports (RED-S): elucidation of endocrine changes affecting the health of males and females

The purpose of this review is to present a different perspective of the relative energy deficiency syndrome, to improve understanding of associated endocrine alterations, and to highlight the need for further research in this area. The term "female athlete triad" was coined over 25 years ago to describe three interrelated components: disordered eating, menstrual dysfunction, and low bone mass. The syndrome's etiology is attributed to energy intake deficiency relative to energy expenditure required for health, function, and daily living. Recently, it became clear that there was a need to broaden the term, as the disorder is not an issue of only three interrelated problems but of a whole spectrum of insults resulting from low energy availability (LEA; i.e., insufficient energy availability to cover basic physiological demands) that can potentially affect any exerciser, irrespective of gender. The new model, termed relative energy deficiency in sport (RED-S), has received greater scrutiny in sports medicine due to its effects on both health and performance in athletes of both sexes. RED-S results from low-energy diets (intentional or unintentional) and/or excessive exercise. Energy deficiency reduces hypothalamic pulsatile release of gonadotropin-releasing hormone, this impairing anterior pituitary release of gonadotropins. In women, reduced FSH and LH pulsatility produces hypoestrogenism, causing functional hypothalamic amenorrhea and decreased bone mass. In men, it reduces testosterone and negatively affects bone health. Moreover, LEA alters other hormonal pathways, causing physiological consequences, such as alteration of the thyroid hormone signaling pathways, leptin levels, carbohydrate metabolism, the growth hormone/insulin-like growth factor-1 axis, and sympathetic/parasympathetic tone. This review explains and clarifies the effects of RED-S in both sexes.

Female Athlete Body Project Intervention with Professional Dancers: A Pilot Trial

As aesthetic athletes, professional dancers have increased vulnerability for eating disorders (EDs), with three times higher risk than non-dancers. Among ballet dancers, generalized risk for EDs associated with internalization of western cultural female beauty ideals is compounded by idealization of a ballet-specific body ideal, a combination that confers unique vulnerability for eating pathology. Empirical support has been established for an athlete-specific intervention promoting body acceptance and reduced eating pathology among general populations of young-adult women and female collegiate athletes; the current study adapted this intervention for pilot implementation among professional ballet dancers. Participants from two elite ballet companies (N = 19) were randomized to a control and intervention condition. All participants self-reported eating pathology and related variables pre- and post-intervention, and at six-week follow-up. Post-intervention, participants receiving the intervention demonstrated reductions in body dissatisfaction, p = .005, r = -.63, dietary restraint, p = .008, r = -.59, and eating pathology, p = .007, r = -.60, as compared to control group counterparts; significant differences were retained at follow-up. Results provide preliminary evidence that this intervention has the potential to provide a feasible and acceptable means of ED prevention in female professional ballet dancers. Barriers to feasibility are identified and discussed.

Community-Based Prevention Programs for Disordered Eating and Obesity: Updates and Current Limitations

PURPOSE OF REVIEW

To review the status of community-based disordered eating and obesity prevention programs from 2014 to 2019.

RECENT FINDINGS

In the last 5 years, prevention programs have found success in intervening with children and parental figures in wellness centers, physical activity centers, childcare centers, workplaces, online, and over-the-phone through directly reducing disordered eating and obesity or by targeting risk factors of disordered eating and obesity. Community-based prevention programs for disordered eating and programs targeting both disordered eating and obesity were scarce, highlighting the critical need for the development of these programs. Qualities of the most effective programs were those in which parents and children were educated on physical activity and nutrition via multiple group-based sessions. Limitations of current prevention programs include few programs targeting high-risk populations, a dearth of trained community members serving as facilitators, inconsistent reporting of adherence rates, and few direct measurements of disordered eating and obesity, as well as few long-term follow-ups, precluding the evaluation of sustained effectiveness.

Prevention of eating disorders: 2019 in review

This article reviews 11 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2019. Two models from the 2018 review continue to frame this analysis: (1) the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into rationale, theory, and methodology → clarification of risk factors → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. These articles illustrate how the theoretical complexity and rigorous methodological demands of prevention science are manifest in the eating disorder field. A subset of articles also demonstrates the importance of working with researchers and community stakeholders to improve our understanding of how ethnicity, class, and gender intersect with planning for improvements in all phases of prevention. Other subsets show the need to expand the list of relevant risk factors, and how the traditional schema of masculinity creates both maladaptive biases in case identification and obstacles to an effective and compassionate understanding of EDs. Finally, implications of the absence of efficacy, effectiveness, and dissemination studies are discussed.

The Female Athlete Body project study: 18-month outcomes in eating disorder symptoms and risk factors

OBJECTIVE

To evaluate the efficacy of the Female Athlete Body project (FAB) in reducing eating disorder (ED) symptoms and risk factors.

METHOD

This study was a community participatory three-site, two-arm, cluster randomized controlled trial (RCT). Female collegiate athletes (N = 481) were randomly assigned by team to the FAB intervention, a behavioral ED risk factor reduction program, or a waitlist control condition. Primary analyses examined 18-month effects for ED pathology. Secondary analyses examined risk factors and correlates (e.g., thin-ideal internalization, negative mood, Female Athlete Triad knowledge, and body mass index [BMI]).

RESULTS

Linear mixed effects models with team as a cluster level variable and study condition as a between-subjects variable revealed significantly reduced dietary restraint in FAB teams relative to control teams. FAB teams also reported significantly fewer objective and subjective binge episodes than control teams. Finally, FAB teams showed significantly lower thin-ideal internalization and increased BMI at 18-months. No other significant differences were found.

DISCUSSION

This RCT examined the effects of a short intervention on ED pathology and risk factors in female collegiate athletes through 18-month follow-up. This trial is one of only three trials with female athletes that have shown long-term reductions in any ED symptoms or produced positive effects on ED risk factors. The present study is the first to find such effects with athletes using a brief (i.e., 4 hr) intervention at 18-month follow-up. Although small effects were found, the current trial provides valuable lessons about future design and implementation of similar trials with athletes.

TRIAL REGISTRATION

Clinical trials NCT01735994.

Implementation of a dissonance-based, eating disorder prevention program in Southern, all-female high schools

Adolescence represents a high-risk period for eating disorder development, and there is great need for effective prevention programs targeted at this population. The Body Project, a dissonance-based eating disorder prevention program, has robust literature showing reductions in body dissatisfaction and eating disorder symptoms. However, many additional factors (i.e., comorbid symptoms, transdiagnostic factors) have not yet been examined in relation to the Body Project. Additionally, there is little known about how to most effectively and broadly disseminate this intervention. The current study (N = 332 adolescents) examines eating disorder symptoms, comorbidities, and transdiagnostic risk factors pre- and post-Body Project and at 1-month follow-up. This study is the first examination of the effectiveness of the Body Project implemented within school programming in southern, all-female high schools. Social appearance anxiety, physical and social anxiety sensitivity, rumination, worry, perfectionism, and guilt, but not depression, cognitive anxiety sensitivity, shame, or exercise dependence, decreased pre- to post-intervention and/or 1-month follow-up. These results support the effectiveness of the Body Project in addressing eating disorder symptoms and suggest it may aid in the prevention of comorbid conditions. Additionally, the effectiveness of the intervention was comparable to past investigations, supporting its use in schools across the United States.

Eating Disorder Prevention

Thirteen percent of girls and women experience an eating disorder, yet most do not receive treatment. Thus, broad implementation of eating disorder prevention programs that reduce eating disorder symptoms and future eating disorder onset is a critical priority. This article (1) reviews risk factors that have been shown to predict future onset of eating disorders, because this should guide the content of prevention programs and high-risk subgroups to target with selective prevention programs; (2) reviews the evidence base for eating disorder prevention programs that have reduced eating disorder symptoms or future onset of eating disorders; and (3) discusses directions for future research.

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

Many trials have provided support for dissonance-based eating disorder prevention programs. This meta-analytic review characterized the average intervention effects and tested whether various intervention, participant, and facilitator features correlated with larger effects to guide implementation of optimally effective versions of this program. We identified 56 trials that evaluated 68 dissonance-based eating disorder prevention programs (7808 participants). Average intervention effect sizes (d) relative to minimal intervention control conditions and credible alternative interventions (respectively) were 0.57 and 0.31 for thin-ideal internalization, 0.42 and 0.18 for body dissatisfaction, 0.37 and 0.17 for dieting, 0.29 and 0.21 for negative affect, and 0.31 and 0.13 for eating disorder symptoms. As hypothesized, effects were larger for interventions with more dissonance-inducing activities, more group sessions, and larger group sizes, as well as when delivered in-person versus on-line, sessions were recorded, participation was voluntary, body dissatisfaction was required, participants were mid-adolescents or adults (versus older adolescence), there were more ethnic minority participants, groups were led by clinicians versus researchers and at least two facilitators, and when facilitators received more training and supervision. Unexpectedly from a dissonance-induction perspective, effects were larger when participants were compensated. Results offer directions for maximizing the benefits of implementation efforts with dissonance-based eating disorder prevention programs, and may hold lessons for preventing other public health problems with dissonance-based interventions.

Energy Availability in Athletics: Health, Performance, and Physique

The reported prevalence of low energy availability (LEA) in female and male track and field athletes is between 18% and 58% with the highest prevalence among athletes in endurance and jump events. In male athletes, LEA may result in reduced testosterone levels and libido along with impaired training capacity. In female track and field athletes, functional hypothalamic amenorrhea as consequence of LEA has been reported among 60% of elite middle- and long-distance athletes and 23% among elite sprinters. Health concerns with functional hypothalamic amenorrhea include impaired bone health, elevated risk for bone stress injury, and cardiovascular disease. Furthermore, LEA negatively affects recovery, muscle mass, neuromuscular function, and increases the risk of injuries and illness that may affect performance negatively. LEA in track and field athletes may occur due to intentional alterations in body mass or body composition, appetite changes, time constraints, or disordered eating behavior. Long-term LEA causes metabolic and physiological adaptations to prevent further weight loss, and athletes may therefore be weight stable yet have impaired physiological function secondary to LEA. Achieving or maintaining a lower body mass or fat levels through long-term LEA may therefore result in impaired health and performance as proposed in the Relative Energy Deficiency in Sport model. Preventive educational programs and screening to identify athletes with LEA are important for early intervention to prevent long-term secondary health consequences. Treatment for athletes is primarily to increase energy availability and often requires a team approach including a sport physician, sports dietitian, physiologist, and psychologist.

Bodies in Motion: An empirical evaluation of a program to support positive body image in female collegiate athletes

Female athletes are at risk for eating disorders due to the experience and internalization of pressures regarding various aspects of their bodies, including weight and appearance. Evaluating programs that address psychosocial antecedents and may reduce female athletes' risk is critical. We examined Bodies in Motion, a program based on cognitive dissonance and mindful self-compassion principles that integrates components of social media. Female athletes across nine NCAA athletic departments were assigned to Bodies in Motion (n = 57) or a wait-list control group (n = 40). Athletic department personnel were trained in the standardized program. Data were collected at three time-points - baseline, post-program, and three to four months later. Using Holm's algorithm to control for multiple comparisons, repeated measures ANOVAs showed that, after program completion, Bodies in Motion athletes reported less thin-ideal internalization, as compared to the control athletes, over time. We also observed varying group trajectories in outcome responses upon visual inspection of profile plots. These findings serve as the basis for future research suggestions involving larger sample sizes and prolonged measurement of outcomes.

REbeL peer education: A model of a voluntary, after-school program for eating disorder prevention

Dissonance-based eating disorder prevention leads to decreases in risk factors for these disorders. Although controlled trials have demonstrated that targeted, manualized programs reduce eating disorder risk, concerns regarding implementation and dissemination remain. A primary concern is the difficulty in adapting programs for a high school setting for populations at highest risk: adolescents. This paper describes the REbeL Peer Education model and assesses the initial pilot trials of the intervention. The program is novel in that it utilizes a voluntary, self-selection model that is sustainable in a high school setting, and focuses on empowerment and effective cognitive dissonance based prevention activities. High school peer-educators self-selected into the semi-manualized dissonance based intervention. Group activities were peer led, designed to critique the thin ideal, and designed to empower macro (school and larger community wide) changes in the pilot trial (N=47) assess the effectiveness and feasibility of the intervention. Results of the initial pilot study revealed preliminary support for the feasibility of the program, increases in feelings of empowerment, and decreases in eating disorder cognitions and behaviors with moderate to large effect sizes. Feedback from participants indicated that the intervention was enjoyable, educational, and empowering. This study is the first to adapt dissonance-based prevention models to a semi-manualized, peer-led, prevention program integrated into high school settings.

Strength and Power Improvements in Athlete and Non-Athletes During Intensive Eating Disorder Treatment

Understanding the unique needs of athletes who undergo eating disorder (ED) treatment is sorely needed. This study explores changes of strength and power in athlete (n = 21) and non-athlete (n = 36) patients from intake to discharge. Maximal oxygen consumption, vertical jump, push-ups, hand grip strength, and body mass index (in anorexia nervosa; AN) were measured among treatment center patients. The number of push-ups and hand grip strength were significantly improved upon discharge in the full sample (ps < .005) and in AN only (ps < .001). Body mass index was also significantly higher in AN (p < .001). Maximal oxygen consumption and vertical jump did not significantly improve between admission and discharge in either group (ps > .40). This study is the first to investigate measures of strength in athletes engaged in intensive eating disorder treatment and indicates the need to address the psychological mindset around physical activity using exercise education as part of a comprehensive program. Recommendations for incorporating exercise into an intensive ED treatment center are also provided.

Improving body image and sexual health behaviors among college women

OBJECTIVE

To conduct a pilot test to determine if the Body Project, an eating disorder prevention program, was able to reduce risky sexual behaviors.

PARTICIPANTS

Twenty college-age women ages 18-21 (in March, 2015) who endorsed both body image dissatisfaction and previous or current sexual activity.

METHODS

Participants were randomized to the Body Project or psychoeducational control group, and completed baseline, post-test, and 6-month follow-up measures assessing body image concerns, eating behaviors, and sexual behaviors and attitudes.

RESULTS

An intervention manipulation check demonstrated that body image variables were in expected directions, though were not significant by group. There was a significant interaction across group and time for "unanticipated sexual encounters," which decreased in the Body Project group.

CONCLUSIONS

This pilot study supports the feasibility of using an eating disorder prevention program to reduce other risky behaviors, specifically risky sexual behaviors.

Factors that assist and hinder efforts towards recovery from eating disorders: A comparison of collegiate female athletes and non-athletes

This study compared female intercollegiate athletes' and non-athletes' experiences of working towards recovery from an eating disorder. Participants (55 athletes, 99 non-athletes) responded to open-ended questions about factors that influenced their progress towards recovery. Both subgroups reported that Supportive Relationships and Cognitive/Emotional Shifts were most helpful. The third most frequent helpful factor for athletes was Sport Performance Concerns, for non-athletes it was Treatment. Athletes' most frequent hindering factors were Negative Emotions/Cognitions, Sport Pressures, and Hurtful Modelling, while non-athletes reported Negative Emotions/Cognitions, Lack of Support, and Hurtful Modelling. Sport-specific factors were among the most common themes in athletes' responses; therefore, athletes' recovery experiences and treatment needs appear unique.

Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students

OBJECTIVE

Eating disorders (EDs) present a significant threat to the health of adolescents and young adults, yet remain under-diagnosed and under-treated at a population-level. EDs have historically been thought to afflict "skinny, white, affluent girls" (the SWAG stereotype). As such, higher-weight individuals, racial/ethnic minorities, those from socioeconomically disadvantaged backgrounds, and males may not recognize their need for treatment, may not be properly screened for EDs, and/or may not be referred to treatment.

METHOD

Using large-scale survey data from the healthy bodies study, we examined variations in prevalence of perceived need for ED treatment, ED diagnosis, past-year ED treatment, and treatment barriers according to weight status, race, socioeconomic background, and sex among undergraduate and graduate students with symptoms of an ED (N = 1,747).

RESULTS

Among students with symptoms of an ED, 30.7% perceived a need for treatment, 10.5% had received a diagnosis, and 13.6% had received treatment in the past year. Individual characteristics were highly associated with perceived need, diagnosis, and past-year treatment. Females were more likely than males to perceive a need for treatment (OR = 1.97), to be diagnosed (OR = 4.66), and to be treated (OR = 1.64) for their ED symptoms. Socioeconomic background was associated with perceived need for treatment and past-year treatment, with students from affluent backgrounds having higher odds of perceiving need (OR = 1.52) and of receiving treatment (OR = 1.89) compared with their non-affluent peers.

DISCUSSION

At a population-level, the unmet need for ED treatment disproportionately affects certain groups. Stereotypes about who develops EDs could contribute to disparities in ED treatment and outcomes.

A pilot controlled trial of a cognitive dissonance-based body dissatisfaction intervention with young British men

This pilot study evaluated a body image intervention for men, Body Project M. Seventy-four British undergraduate men took part in two 90-min intervention sessions, and completed standardised assessments of body image, bulimic pathology, and related outcomes at baseline, post-intervention, and 3-month follow-up. Fifty-three other men completed the questionnaires as an assessment-only control group. Per-protocol analysis showed that Body Project M improved men's dissatisfaction with body fat and muscularity, body appreciation, muscularity enhancing behaviours, appearance comparisons, and internalization (ds=0.46-0.80) at post-intervention. All except dissatisfaction with muscularity and internalization were sustained at 3-month follow-up. No effects were found for bulimic pathology. Post-intervention effects for dissatisfaction with muscularity and internalization only were retained under intention-to-treat analysis. Participants were favourable towards the intervention. This study provides preliminary evidence for the acceptability and post-intervention efficacy of Body Project M. Further development of the intervention is required to improve and sustain effects.

Bulimic Symptomatology Among Male Collegiate Athletes: A Test of an Etiological Model

We tested Petrie and Greenleaf's psychosocial model in relation to male athletes' bulimic symptomatology. Through structural equation modeling, we cross-sectionally examined the direct and indirect effects of general and sport-specific appearance pressures, internalization, body satisfaction, drive for muscularity, negative affect, and dietary restraint on bulimic symptomatology. Participants were U.S. male collegiate athletes (N = 698; M_age = 19.87 years) representing 17 sports. With minor respecifications, the model had acceptable fit, and the psychosocial variables explained 48% of the bulimic symptomatology variance. Although all variable paths were significant, sport pressures, such as from coaches and teammates about weight, importance of appearance, and looking good in a uniform, were the most salient latent variable. Athletes' engagement in muscle-building behaviors added uniquely and substantively as well. Our analysis begins to clarify the complex interactions among these psychosocial variables in understanding male athletes' bulimic symptomatology and provides a base from which to develop prevention programming.

Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Acute effectiveness of these delivery modalities

OBJECTIVE

Because independent trials have provided evidence for the efficacy and effectiveness of the dissonance-based Body Project eating disorder prevention program, the present trial tested whether clinicians produce the largest intervention effects, or whether delivery can be task-shifted to less expensive undergraduate peer educators or to Internet delivery without effect size attenuation, focusing on acute effects.

METHOD

In this study, 680 young women (Mage = 22.2 years, SD = 7.1) recruited at colleges in 2 states were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or an educational video control condition.

RESULTS

Participants in all 3 variants of the Body Project intervention showed significantly greater reductions in eating disorder risk factors and symptoms than did educational video controls. Participants in clinician-led and peer-led Body Project groups showed significantly greater reductions in risk factors than did eBody Project participants, but effects for the 2 types of groups were similar. Eating disorder onset over 7-month follow-up was significantly lower for peer-led Body Project group participants versus eBody Project participants (2.2% vs. 8.4%) but did not differ significantly between other conditions.

CONCLUSIONS

The evidence that all 3 dissonance-based prevention programs outperformed an educational video condition, that both group-based interventions outperformed the Internet-based intervention in risk factor reductions, and that the peer-led groups showed lower eating disorder onset over follow-up than did the Internet-based intervention is novel. These acute-effects data suggest that both group-based interventions produce superior eating disorder prevention effects than does the Internet-based intervention and that delivery can be task-shifted to peer leaders. (PsycINFO Database Record