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McClure Z, Fuller-Tyszkiewicz M, Messer M, Linardon J. Predictors, mediators, and moderators of response to digital interventions for eating disorders: A systematic review. Int J Eat Disord 2024; 57:1034-1048. [PMID: 37886906 DOI: 10.1002/eat.24078] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE Digital interventions show promise as an effective prevention or self-management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs. METHOD Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop-out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention-focused) and samples with a formally diagnosed ED (typically treatment-focused). RESULTS Eighty-six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified. DISCUSSION It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality. PUBLIC SIGNIFICANCE Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions.
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Affiliation(s)
- Zoe McClure
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
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Mol T, Thompson JK, Fuller-Tyszkiewicz M. A meta-analytic review of impact of measurement choice on RCTs to reduce appearance internalization. Int J Eat Disord 2023; 56:1480-1501. [PMID: 37237436 DOI: 10.1002/eat.23990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Prior reviews have shown that interventions targeting internalization of appearance standards are generally efficacious, though there is considerable heterogeneity in estimates across studies. This updated review of the literature evaluates whether efficacy estimates from RCTs systematically vary as a function of three related outcome measures (internalization, awareness, and perceived pressure regarding appearance standards). METHODS Seven electronic databases were systematically searched from inception to February 8, 2023. The Cochrane Risk of Bias tool assessed each study's risk of bias. Studies included were randomized-controlled trials evaluating body image/eating disorder prevention or intervention programs targeting internalization as a focal point of treatment. Effect sizes were meta-analyzed and meta-regression analyses were conducted investigating the impact of outcome measure choice on study effect size at post-intervention and follow-up. RESULTS Thirty-seven studies (N = 4809 participants) were included. The meta-analytic findings as expected found interventions efficacious at reducing internalization post-intervention (d = -0.47, 95% CI [-0.60 to -0.34], k = 44), and at follow-up (d = -0.28, 95% CI [-0.39 to -0.17], k = 43), but also highly heterogenous (I2 = 52-67%). Operationalization of internalization moderated results at follow-up but not post-intervention timepoints, with awareness measures (compared with internalization measures) producing weaker effect sizes. Exploratory analyses found bigger effects when internalization was compared with all other measurement categories combined, suggesting possible issues with statistical power in main analyses. DISCUSSION Mixed present findings suggest need for further evaluation of measurement effects on efficacy, and possible caution in choice of outcome measure for internalization-based interventions. PUBLIC SIGNIFICANCE STATEMENT This review provides some preliminary evidence that choice of survey measures used in randomized controlled trials can impact our judgments about whether a trial reduces the extent to which participants endorse unrealistic appearance standards. Accuracy in measurement of this efficacy of trials is crucial, given the role that internalized appearance standards play in onset and maintenance of eating disorders.
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Affiliation(s)
- Tess Mol
- School of Psychology, Deakin University, Geelong, Victoria, Australia
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Virtual prevention of eating disorders in children, adolescents, and emerging adults: a scoping review. J Eat Disord 2022; 10:94. [PMID: 35794629 PMCID: PMC9258006 DOI: 10.1186/s40337-022-00616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, there was a necessity for eating disorder (ED) outpatient treatment to be delivered virtually. Given this transition, and the surge in new ED cases, there was an urgent need to investigate virtually delivered ED prevention programs. This review aimed to identify the available evidence on virtual ED prevention programs for children, adolescents, and emerging adults. METHOD Using scoping review methodology, seven databases were searched for studies published from January 2000 to April 2021 reporting on virtually delivered ED prevention interventions for children and adolescents (< 18 years) and emerging adults (18-25 years). Studies were excluded if they contained adults (> 25 years) and individuals with clinical ED diagnoses. Abstracts and full-text papers were reviewed independently by two reviewers. Data was extracted on study type, methodology, age, sample size, virtual intervention, outcomes, and results. In April 2022, we used a forward citation chaining process to identify any relevant articles from April 2021 to April 2022. RESULTS Of 5129 unique studies identified, 67 met eligibility criteria, which included asynchronous (n = 35) and synchronous (n = 18) internet-based programs, other e-technology including mobile apps (n = 3) and text messaging interventions (n = 1), computer-based programs (n = 6), and online caregiver interventions focused on child outcomes (n = 4). Few studies mainly included children and adolescents (n = 18), whereas the vast majority included emerging adults (n = 49). For children and adolescents, the most widely researched programs were Student Bodies and its adapted versions (n = 4), eBody Project (n = 2), and Parents Act Now (n = 2). For emerging adults, the most widely researched programs were Student Bodies and its adapted versions (n = 16), eBody Project (n = 6) and Expand Your Horizon (n = 4). These interventions were effective at reducing various symptoms and ED risk. Some studies demonstrated that virtual prevention intervention efficacy resembled in-person delivery. CONCLUSION Virtual prevention interventions for EDs can be effective, however more research is needed studying their impact on children and adolescents and on improving access for vulnerable groups. Additional efficacy studies are required, such as for text messaging and mobile app ED prevention interventions. Evidence-based recommendations for virtual ED prevention for children, adolescents, and emerging adults at-risk for EDs should be prioritized.
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Ahuja KK, Banerjee D. A Psychosocial Exploration of Body Dissatisfaction: A Narrative Review With a Focus on India During COVID-19. Front Glob Womens Health 2021; 2:669013. [PMID: 34816220 PMCID: PMC8593986 DOI: 10.3389/fgwh.2021.669013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/23/2021] [Indexed: 01/14/2023] Open
Abstract
COVID-19 has been an unprecedented global crisis. Besides the public health impact, the pandemic necessitated measures, such as quarantine, travel restrictions, and lockdown, that have had a huge effect on digital screen time, dietary habits, lifestyle measures, and exposure to food-related advertising. At the same time, a reduction in physical activity, an increase of social media consumption, and an increase in fitness tutorials during the lockdown have contributed to body image issues. Emerging evidence from India suggests that peer conversations about appearance as negative body talk (fat talk) is particularly salient in contributing to body dissatisfaction and body perception ideals, which are more prevalent in women. Even though there has been an increase in research on the psychosocial impact of COVID-19, its influence on body image perceptions and consequent distress have been stigmatized and classified as under-spoken areas. With this background, this article reviews research on the biopsychosocial factors that influence body dissatisfaction among women, particularly the role of media. It also highlights the development of body image concerns in India, one of the worst-hit countries in the pandemic, through liberalization, importing Western notions of body instrumentality, demographic shift, and resultant social changes. Finally, the psychosocial strategies for positive body image ideas to prevent and mitigate the adverse effects of body dissatisfaction are discussed, particularly those that focus on cognitive behavioral techniques (CBTs) from the perspectives of positive psychology, media literacy programs, and involvement of the media. Interventions and further research to address body dissatisfaction among women, especially in the post-COVID aftermath, need to be a recognized as a public health goal.
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Affiliation(s)
- Kanika K. Ahuja
- Department of Psychology, Lady Shri Ram College for Women, New Delhi, India
| | - Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India,*Correspondence: Debanjan Banerjee
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Barnett P, Arundell LL, Saunders R, Matthews H, Pilling S. The efficacy of psychological interventions for the prevention and treatment of mental health disorders in university students: A systematic review and meta-analysis. J Affect Disord 2021; 280:381-406. [PMID: 33227669 DOI: 10.1016/j.jad.2020.10.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/30/2020] [Accepted: 10/28/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mental health problems are becoming increasingly prevalent among students and adequate support should be provided to prevent and treat mental health disorders in those at risk. METHODS This systematic review and meta-analysis examined the efficacy of psychological interventions for students, with consideration of how adaptions to intervention content and delivery could improve outcomes. We searched for randomised controlled trials (RCTs) of interventions in students with or at risk of mental health problems and extracted data for study characteristics, symptom severity, wellbeing, educational outcomes, and attrition. Eighty-four studies were included. RESULTS Promising effects were found for indicated and selective interventions to treat anxiety disorders, depression and eating disorders. PTSD and self-harm data was limited, and did not demonstrate significant effects. Relatively few trials adapted intervention delivery to student-specific concerns, and overall adapted interventions showed no benefit over non-adapted interventions. There was some suggestion that adaptions based on empirical evidence and provision of additional sessions, and transdiagnostic models may yield some benefits. LIMITATIONS The review is limited by the often poor quality of the literature and exclusion of non-published data. CONCLUSIONS Interventions for students show benefit though uncertainty remains around how best to optimise treatment delivery and content for students. Additional research into content targeting specific underlying mechanisms of problems and transdiagnostic approaches to provision could be promising avenues for further research.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Laura-Louise Arundell
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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Cerea S, Ghisi M, Bottesi G, Manoli T, Carraro E, Doron G. Cognitive Behavioral Training Using a Mobile Application Reduces Body Image-Related Symptoms in High-Risk Female University Students: A Randomized Controlled Study. Behav Ther 2021; 52:170-182. [PMID: 33483115 DOI: 10.1016/j.beth.2020.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 12/12/2022]
Abstract
Body dissatisfaction is prevalent in young women, and is associated with symptoms of body dysmorphic disorder (BDD) and eating disorders (EDs). The aim of the study was to assess the efficacy of a mobile application, based on cognitive behavioral principles, in reducing body dissatisfaction and BDD/ED symptoms in female university students considered at high-risk of developing body image disorders (BIDs). Fifty university students at high-risk of developing BIDs (using self-report questionnaires assessing BIDs and the Structured Clinical Interview for DSM-5 Clinical Version) were randomized in two groups: immediate-use App group (iApp group; n = 25) and delayed-use App group (dApp group; n = 25). The iApp group started using the app at baseline for 16 days (T0 to T1). The dApp group waited for 16 days before starting to use the app (T1 to T2). Participants completed questionnaires at baseline (T0), 16 days from baseline (T1), and 32 days from baseline (T2). Repeated measure Analyses of Variance (ANOVAs) showed a Group (iApp vs. dApp) × Time (T0 vs. T1) interaction on BDD symptoms indicating medium effect size (partial eta squared) reductions in the iApp group compared to dApp group at T1; post-intervention means for BDD symptoms were under the cut-off for extreme body dissatisfaction/BDD symptoms in both groups. Pertaining to ED symptoms, no significant Group × Time interaction was detected. Training 3 minutes a day for 16 days with a CBT-based mobile application may lead to reductions in some forms of body dissatisfaction, including BDD symptoms in female university students at high-risk of developing BIDs. On the other hand, effects of the intervention on ED symptoms seem more limited.
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Affiliation(s)
| | | | | | | | | | - Guy Doron
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya.
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7
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Harrer M, Adam SH, Messner EM, Baumeister H, Cuijpers P, Bruffaerts R, Auerbach RP, Kessler RC, Jacobi C, Taylor CB, Ebert DD. Prevention of eating disorders at universities: A systematic review and meta-analysis. Int J Eat Disord 2020; 53:813-833. [PMID: 31943298 DOI: 10.1002/eat.23224] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Eating problems are highly prevalent among young adults. Universities could be an optimal setting to prevent the onset of eating disorders through psychological intervention. As part of the World Mental Health-International College Student initiative, this systematic review and meta-analysis synthesizes data on the efficacy of eating disorder prevention programs targeting university students. METHOD A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, PsycINFO) for randomized trials comparing psychological preventive interventions for eating disorders targeting university students with psychoeducation or inactive controls was performed on October 22, 2019. RESULTS Twenty-seven studies were included. Thirteen (48.1%) were rated to have a low risk of bias. The relative risk of developing a subthreshold or full-blown eating disorder was incidence rate ratio = 0.62 (95% CI [0.44, 0.87], n c = 8, numbers-needed-to-treat [NNT] = 26.08; standardized clinical interviews only), indicating a 38% decrease in incidence in the intervention groups compared to controls. Small to moderate between-group effects at posttest were found on eating disorder symptoms (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, n c = 26), dieting (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, n c = 21), body dissatisfaction (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, n c = 25), drive for thinness (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, n c = 12), weight concerns (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, n c = 13), and affective symptoms (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, n c = 18). The effects on bulimia nervosa symptoms were not significant. Heterogeneity was moderate across comparisons. DISCUSSION Eating disorder prevention on campus can have significant, small-to-moderate effects on eating disorder symptoms and risk factors. Results also suggest that the prevention of subthreshold and full-syndrome eating disorders is feasible using such interventions. More research is needed to identify ways to motivate students to use preventive eating disorder interventions. ANTECEDENTES Los trastornos de la conducta alimentaria son altamente prevalentes entre los adultos jóvenes. Las universidades podrían ser un entorno óptimo para prevenir la aparición de trastornos alimentarios a través de la intervención psicológica. Como parte de la iniciativa World Mental Health-International College Student, esta revisión sistemática y meta-análisis sintetiza datos sobre la eficacia de los programas de prevención de trastornos alimentarios dirigidos a estudiantes universitarios. MÉTODO: Una búsqueda bibliográfica sistemática de datos bibliográficas (CENTRAL, MEDLINE, PsycINFO) para ensayos aleatorios que comparaban intervenciones preventivas psicológicas para trastornos alimentarios dirigidos a estudiantes universitarios con psicoeducación o controles inactivos fue realizada hasta el 22 de octubre de 2019. RESULTADOS Se incluyeron 27 estudios. Trece (48,1%) fueron calificados como de bajo riesgo de sesgo. El riesgo relativo de desarrollar un trastorno de la conducta alimentaria subclínico (parcial) o completo fue IRR = 0.62 (95% CI [0.44, 0.87], nc = 8, NNT = 26.08; sólo entrevistas clínicas estandarizadas), lo que indica una disminución del 38% en la incidencia en los grupos de intervención en comparación con los controles. Se encontraron efectos pequeños a moderados entre los grupos en la post-prueba en los síntomas del trastorno alimentario (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, nc = 26), dieta (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, nc = 21), insatisfacción corporal (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, nc = 25), impulso por delgadez (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, nc = 12), problemas de peso (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, nc = 13) y síntomas afectivos (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, nc = 18). Los efectos sobre los síntomas de la bulimia nervosa no fueron significativos. La heterogeneidad fue moderada en las comparaciones. DISCUSIÓN: La prevención de los trastornos de la conducta alimentaria en el campus universitario puede tener efectos significativos, de pequeños a moderados, sobre los síntomas del trastorno alimentario y los factores de riesgo. Los resultados también sugieren que la prevención de los trastornos alimentarios subclínicos o parciales y síndromes completos es factible utilizando tales intervenciones. Se necesita más investigación para identificar formas de motivar a los estudiantes a usar intervenciones preventivas para los trastornos de la conducta alimentaria.
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Affiliation(s)
- Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sophia H Adam
- Psychotherapeutische Praxengemeinschaft Handschuhsheim, Heidelberg, Germany
| | - Eva-Maria Messner
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, New York
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Craig Barr Taylor
- Department of Psychiatry, Stanford University Medical Center, Stanford, California
| | - David D Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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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: 141] [Impact Index Per Article: 20.1] [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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My mother told me: the roles of maternal messages, body image, and disordered eating in maladaptive exercise. Eat Weight Disord 2016; 21:469-476. [PMID: 26545594 DOI: 10.1007/s40519-015-0238-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The current study examined the relevance of familial environment (negative maternal messages) to the phenomenon of maladaptive (obligatory) exercise, defined as exercise fixation. Weight/shape concerns and exercise frequency were examined as potential mediators, evaluated both with and without eating disorder symptoms as a covariate. METHOD Self-report data comprising sociodemographic details and measures of parental weight messages, body image, obligatory exercise, and disordered eating symptoms were completed by 298 young female attendees of health and fitness centres. RESULTS The frequency of negative maternal messages demonstrated significant associations with all of weight/shape concerns, exercise frequency, exercise fixation, and eating disorder symptoms. In the initial model, partial mediation of maternal messages to exercise fixation was evident as negative maternal messages continued to have a direct effect on exercise fixation. In the second model, with the inclusion of eating disorder symptoms as a covariate, this direct effect was maintained while mediation was no longer evident. CONCLUSIONS The data provide further support for the association between disordered eating symptoms and maladaptive exercise, as defined by exercise fixation. Nevertheless, the importance of negative maternal messages as a key environmental enabler of exercise fixation has been demonstrated, even after the effects of weight/shape concerns and exercise frequency were accounted for. Clinically, addressing weight-related talk in the family home may reduce the incidence of problematic cognitions and behaviours associated with both maladaptive exercise and disordered eating symptoms.
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Watson HJ, Joyce T, French E, Willan V, Kane RT, Tanner-Smith EE, McCormack J, Dawkins H, Hoiles KJ, Egan SJ. Prevention of eating disorders: A systematic review of randomized, controlled trials. Int J Eat Disord 2016; 49:833-62. [PMID: 27425572 DOI: 10.1002/eat.22577] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention. METHOD A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted. RESULTS Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up. DISCUSSION The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hunna J Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia. .,Department of Health in Western Australia, Centre for Clinical Interventions, Perth, Australia. .,Faculty of Medicine, Dentistry, and Health Sciences, School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia. .,Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
| | - Tara Joyce
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Elizabeth French
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Vivienne Willan
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Robert T Kane
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Emily E Tanner-Smith
- Department of Human and Organizational Development, Peabody Research Institute, Vanderbilt University, Nashville
| | - Julie McCormack
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Hayley Dawkins
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Kimberley J Hoiles
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Sarah J Egan
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Loucas CE, Fairburn CG, Whittington C, Pennant ME, Stockton S, Kendall T. E-therapy in the treatment and prevention of eating disorders: A systematic review and meta-analysis. Behav Res Ther 2014; 63:122-31. [PMID: 25461787 PMCID: PMC4271736 DOI: 10.1016/j.brat.2014.09.011] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022]
Abstract
The widespread availability of the Internet and mobile-device applications (apps) is changing the treatment of mental health problems. The aim of the present study was to review the research on the effectiveness of e-therapy for eating disorders, using the methodology employed by the UK's National Institute for Health and Care Excellence (NICE). Electronic databases were searched for published randomised controlled trials of e-therapies, designed to prevent or treat any eating disorder in all age groups. Studies were meta-analysed where possible, and effect sizes with confidence intervals were calculated. The GRADE approach was used to determine the confidence in the effect estimates. Twenty trials met the inclusion criteria. For prevention, a CBT-based e-intervention was associated with small reductions in eating disorder psychopathology, weight concern and drive for thinness, with moderate confidence in the effect estimates. For treatment and relapse prevention, various e-therapies showed some beneficial effects, but for most outcomes, evidence came from single studies and confidence in the effect estimates was low. Overall, although some positive findings were identified, the value of e-therapy for eating disorders must be viewed as uncertain. Further research, with improved methods, is needed to establish the effectiveness of e-therapy for people with eating disorders.
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Affiliation(s)
- Christina E Loucas
- National Collaborating Centre for Mental Health (NCCMH), 21 Prescot Street, London, E1 8BB, United Kingdom.
| | - Christopher G Fairburn
- Centre for Research on Eating Disorders at Oxford (CREDO), University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Craig Whittington
- National Collaborating Centre for Mental Health (NCCMH), 21 Prescot Street, London, E1 8BB, United Kingdom
| | - Mary E Pennant
- National Collaborating Centre for Mental Health (NCCMH), 21 Prescot Street, London, E1 8BB, United Kingdom
| | - Sarah Stockton
- National Collaborating Centre for Mental Health (NCCMH), 21 Prescot Street, London, E1 8BB, United Kingdom
| | - Tim Kendall
- National Collaborating Centre for Mental Health (NCCMH), 21 Prescot Street, London, E1 8BB, United Kingdom
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12
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Witcomb GL, Arcelus J, Chen J. Can cognitive dissonance methods developed in the West for combatting the 'thin ideal' help slow the rapidly increasing prevalence of eating disorders in non-Western cultures? SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 25:332-40. [PMID: 24991176 PMCID: PMC4054580 DOI: 10.3969/j.issn.1002-0829.2013.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/18/2013] [Indexed: 11/18/2022]
Abstract
SUMMARY Eating disorders are common, life-threatening conditions in Western countries, but until relatively recently they were regarded as uncommon in non-Western cultures. However, the prevalence of eating disorders in many of the more affluent non-Western countries is rising rapidly as community members, particularly young women, internalize the 'thin ideal' that has been widely promoted by the international media. This review discusses the factors involved in the development of eating disorders in non-Western settings with a particular emphasis on the influences of urbanization, modernization, Westernization, and the resulting changes in women's roles. The cognitive dissonance programs developed in Western countries that have proven successful in countering the negative effects of the thin idea are described and their potential application to East Asia and other non-Western countries are discussed.
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Affiliation(s)
- Gemma L Witcomb
- Loughborough University Centre for Research into Eating Disorders, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK ; Leicester Eating Disorder Service, Bennion Centre, Leicester Glenfield Hospital, Leicester, UK
| | - Jon Arcelus
- Loughborough University Centre for Research into Eating Disorders, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK ; Leicester Eating Disorder Service, Bennion Centre, Leicester Glenfield Hospital, Leicester, UK ; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PRC
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PRC
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13
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Knightsmith P, Sharpe H, Breen O, Treasure J, Schmidt U. 'My teacher saved my life' versus 'Teachers don't have a clue': an online survey of pupils' experiences of eating disorders. Child Adolesc Ment Health 2014; 19:131-137. [PMID: 32878388 DOI: 10.1111/camh.12027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Eating disorders (ED) have a peak rate of onset in school-aged children. Little is known about pupils' experiences of ED within a school setting. METHOD Five hundred and eleven 11- to 19-year-old school pupils completed an online questionnaire exploring their experiences of ED (72% female, 28% male). Responses were analysed using content analysis principles. RESULTS Of the participants, 38% had a current or past ED, 49% of these had never received a formal diagnosis. Of the respondents, 59% saw a need to raise ED awareness. Only 7% would confide in a teacher about an ED. CONCLUSIONS Efforts are needed to break down barriers to disclosure and support teachers to play an effective role in the detection and early intervention for ED.
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Affiliation(s)
- Pooky Knightsmith
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 8AF, UK
| | - Helen Sharpe
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 8AF, UK
| | - Olivia Breen
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 8AF, UK
| | - Janet Treasure
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 8AF, UK
| | - Ulrike Schmidt
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 8AF, UK
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14
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Atkinson MJ, Wade TD. Enhancing dissemination in selective eating disorders prevention: An investigation of voluntary participation among female university students. Behav Res Ther 2013; 51:806-16. [DOI: 10.1016/j.brat.2013.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 11/28/2022]
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15
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Associated Factors of Unhealthy Eating Patterns among Spanish University Students by Gender. SPANISH JOURNAL OF PSYCHOLOGY 2013; 13:364-75. [DOI: 10.1017/s1138741600003929] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study has examined bio-socio-demographic and psychopathological factors probably associated with unhealthy eating patterns among university students and to estimate a multifactorial model following the associated factors by gender. Adjusted odds ratios were calculated to describe associations on basis of Eating Disorder Inventory (EDI) stratified by gender in a representative sample of Spanish university students (n = 2551). The high EDI scorers for both sexes presented higher prevalence of dieting, body dissatisfaction, levels of psychopathology and lower self-esteem than the low EDI scorers. The results suggest that older students and higher self-esteem scores present lower scores in the EDI. In the female population, depression, paranoid dimension, dieting and body dissatisfaction were associated with population with unhealthy eating patterns. In the male sample, dieting, body dissatisfaction and interpersonal sensibility were also associated with unhealthy eating patterns. The results corroborate that abnormal eating patterns tend to affect specific vulnerable groups. We do not know the precise mechanisms through which these risk behaviors and attitudes, such as dieting or body dissatisfaction, may facilitate the later development of an eating disorder.
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16
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Bucchianeri MM, Arikian AJ, Hannan PJ, Eisenberg ME, Neumark-Sztainer D. Body dissatisfaction from adolescence to young adulthood: findings from a 10-year longitudinal study. Body Image 2013; 10:1-7. [PMID: 23084464 PMCID: PMC3814026 DOI: 10.1016/j.bodyim.2012.09.001] [Citation(s) in RCA: 281] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 09/05/2012] [Accepted: 09/06/2012] [Indexed: 11/26/2022]
Abstract
Given mixed findings regarding the unique trajectories of female and male adolescents' body dissatisfaction over time, comprehensive longitudinal examinations are needed. This 10-year longitudinal, population-based study, with 1902 participants from diverse ethnic/racial and socioeconomic backgrounds in the Minneapolis/St. Paul metropolitan area, examined changes in body dissatisfaction from adolescence to young adulthood. Results revealed that: (a) female and male participants' body dissatisfaction increased between middle and high school, (b) body dissatisfaction increased further during the transition to young adulthood, and (c) this increase was associated with an increase in BMI over time, such that the upward trend in body dissatisfaction became nonsignificant when BMI was controlled. These results highlight a trend in which diverse female and male youth are increasingly dissatisfied with their bodies as their BMI increases from middle school to young adulthood, and emphasize the need for targeted prevention efforts to intervene in this trajectory and mitigate potential harm.
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Affiliation(s)
- Michaela M Bucchianeri
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA.
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17
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Franko DL, Jenkins A, Rodgers RF. Toward Reducing Risk for Eating Disorders and Obesity in Latina College Women. JOURNAL OF COUNSELING AND DEVELOPMENT 2012. [DOI: 10.1002/j.1556-6676.2012.00038.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Franko DL, Coen EJ, Roehrig JP, Rodgers RF, Jenkins A, Lovering ME, Dela Cruz S. Considering J.Lo and Ugly Betty: a qualitative examination of risk factors and prevention targets for body dissatisfaction, eating disorders, and obesity in young Latina women. Body Image 2012; 9:381-7. [PMID: 22609033 DOI: 10.1016/j.bodyim.2012.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 04/04/2012] [Accepted: 04/13/2012] [Indexed: 02/01/2023]
Abstract
Latina women are vulnerable to poor body image, eating disorders, and obesity, particularly during the college years. This study sought to identify common cultural antecedents of these concerns in order to inform the development of prevention programs for this population. Six groups of university students who identified as Latina (N=27) discussed cultural aspects of body image, eating disorders, and obesity. Thematic analysis identified four main themes: (a) cultural disparities in body-ideal, including the influence of the media and acculturation issues; (b) messages about body shape and weight received by family, peers, and society; (c) difficulties making healthy eating and physical activity choices as a function of college life; and (d) the influence of peers and potential male partners on body satisfaction and body-ideals. These results have implications for the development of programs targeting body dissatisfaction and risk for eating disorders and obesity in Latina college women.
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Affiliation(s)
- Debra L Franko
- Department of Counseling and Applied Educational Psychology, Northeastern University, Boston, MA 02115, USA.
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19
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Wilfley DE, Kolko RP, Kass AE. Cognitive-behavioral therapy for weight management and eating disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am 2011; 20:271-85. [PMID: 21440855 PMCID: PMC3065663 DOI: 10.1016/j.chc.2011.01.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Eating disorders and obesity in children and adolescents involve harmful behavior and attitude patterns that infiltrate daily functioning. Cognitive-behavioral therapy (CBT) is well suited to treating these conditions, given the emphasis on breaking negative behavior cycles. This article reviews the current empirically supported treatments and the considerations for youth with weight control issues. New therapeutic modalities (ie, enhanced CBT and the socioecologic model) are discussed. Rationale is provided for extending therapy beyond the individual treatment milieu to include the family, peer network, and community domains to promote behavior change, minimize relapse, and support healthy long-term behavior maintenance.
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, St Louis, MO 63110, USA.
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20
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Promoting positive body image among university students: A collaborative pilot study. Body Image 2010; 7:200-4. [PMID: 20227934 DOI: 10.1016/j.bodyim.2010.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 01/28/2010] [Accepted: 02/04/2010] [Indexed: 11/21/2022]
Abstract
The purpose of the present study was to pilot a prevention program designed to promote positive body image among university students. Thirty-seven undergraduate students from three Canadian universities were recruited to participate in the study. They were selected from a pool of students enrolled in a peer health education program facilitated by the university-based health promotion staff. Borrowing from the tenets of the non-specific vulnerability stressor model and the disease-specific social cognitive theory, the intervention focused on media literacy, self-esteem enhancement strategies, stress management skills and ways to recognize healthy versus unhealthy relationships. Separate ANOVAs revealed that participants reported significant improvements in body satisfaction and reductions in the internalization of media stereotypes between the baseline and post-program period. The program received a favorable response from the participating students, who appreciated the face-to-face format of the intervention, and from the university staff who expressed interest in embedding the strategies into their routine peer mentoring training activities. Limitations of the study and suggestions for future research are discussed.
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21
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George JBE, Franko DL. Cultural issues in eating pathology and body image among children and adolescents. J Pediatr Psychol 2009; 35:231-42. [PMID: 19703916 DOI: 10.1093/jpepsy/jsp064] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Eating pathology and body image issues are now recognized as affecting all racial and ethnic groups. This article reviews eating pathology and body image concerns in four diverse groups in the U.S. (African Americans, Latino/as, Asians, and Native Americans). The major conclusion based on this review is that eating disturbances and body dissatisfaction occur to some degree in children and adolescents from all four major ethnic groups in the U.S; however, there is substantial variability across studies. Future directions include the need for studies of prevalence, prevention and treatment research, and investigations of neurobiological and genetic variables.
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Affiliation(s)
- Jessica B Edwards George
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655-0002, USA.
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23
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Ranby KW, Aiken LS, Mackinnon DP, Elliot DL, Moe EL, McGinnis W, Goldberg L. A mediation analysis of the ATHENA intervention for female athletes: prevention of athletic-enhancing substance use and unhealthy weight loss behaviors. J Pediatr Psychol 2009; 34:1069-83. [PMID: 19386771 DOI: 10.1093/jpepsy/jsp025] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explain, through mediation analyses, the mechanisms by which ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives), a primary prevention and health promotion intervention designed to deter unhealthy body shaping behaviors among female high school athletes, produced immediate changes in intentions for unhealthy weight loss and steroid/creatine use, and to examine the link to long-term follow-up intentions and behaviors. METHODS In a randomized trial of 1668 athletes, intervention participants completed coach-led peer-facilitated sessions during their sport season. Participants provided pre-test, immediate post-test, and 9-month follow-up assessments. RESULTS ATHENA decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors at post-test. These effects were most strongly mediated by social norms and self-efficacy for healthy eating. Low post-test intentions were maintained 9 months later and predicted subsequent behavior. CONCLUSIONS ATHENA successfully modified mediators that in turn related to athletic-enhancing substance use and unhealthy weight loss practices. Mediation analyses aid in the understanding of health promotion interventions and inform program development.
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24
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Franko DL, George JBE. A pilot intervention to reduce eating disorder risk in Latina women. EUROPEAN EATING DISORDERS REVIEW 2008; 16:436-41. [PMID: 18683899 DOI: 10.1002/erv.891] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The current study tested the effects of an eating disorder risk reduction programme (Food, Mood and Attitude (FMA)) with Latina women. METHOD Fifty-two female Latina college students were screened. Of these, 28 eligible women were administered a questionnaire packet prior to and approximately 2 months and again 1 year after completing a 2-hour computer-based risk reduction programme called FMA and participating in two 2-hour discussion groups about risk factors for eating disorders. RESULTS Paired sample t-tests indicated significant changes from pre- to post-assessment on the Eating Disorder Examination Questionnaire (EDEQ)-shape concerns subscale (p = .002), Eating Disorder Inventory-2 (EDI-2)-body dissatisfaction (BD) subscale (p < .001) and the Body Shape Questionnaire (BSQ; p = .006). Significant changes in binge frequency also occurred (p = .006). Changes on three of these measures were maintained at the 1-year follow-up assessment. CONCLUSIONS This small-scale study suggests that FMA may reduce some risk factors for eating disorders in Latina college women.
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Affiliation(s)
- Debra L Franko
- Department of Counseling and Applied Educational Psychology, Northeastern University, 203 Lake Hall, Boston, MA 02115, USA.
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25
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Stice E, Marti N, Shaw H, O'Neil K. General and program-specific moderators of two eating disorder prevention programs. Int J Eat Disord 2008; 41:611-7. [PMID: 18528875 DOI: 10.1002/eat.20524] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate general and program-specific factors hypothesized to moderate the effects of two eating disorder prevention programs. METHOD High-risk adolescent girls (N = 481; M age = 17) were randomized to a dissonance-based thin-ideal internalization reduction program, a healthy weight management program, an expressive-writing control condition, or an assessment-only control condition. Participants completed diagnostic interviews and surveys at pretest, post-test, 6-month follow-up, and 12-month follow-up. RESULTS Dissonance program effects on bulimic symptoms were stronger for participants with initial elevations in body image distress, bulimic symptoms, and thin-ideal internalization. Healthy weight program effects on bulimic symptoms were stronger for adolescents with initial elevations in body image distress, bulimic symptoms, readiness to change, body mass, and emotional eating. CONCLUSION Overall, intervention effects tended to be amplified for high-risk versus low-risk adolescents. However, certain moderator effects appeared to be specific to the two different prevention programs.
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Affiliation(s)
- Eric Stice
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA.
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26
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Portnoy DB, Scott-Sheldon LAJ, Johnson BT, Carey MP. Computer-delivered interventions for health promotion and behavioral risk reduction: a meta-analysis of 75 randomized controlled trials, 1988-2007. Prev Med 2008; 47:3-16. [PMID: 18403003 PMCID: PMC2572996 DOI: 10.1016/j.ypmed.2008.02.014] [Citation(s) in RCA: 344] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 01/31/2008] [Accepted: 02/10/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The use of computers to promote healthy behavior is increasing. To evaluate the efficacy of these computer-delivered interventions, we conducted a meta-analysis of the published literature. METHOD Studies examining health domains related to the leading health indicators outlined in Healthy People 2010 were selected. Data from 75 randomized controlled trials, published between 1988 and 2007, with 35,685 participants and 82 separate interventions were included. All studies were coded independently by two raters for study and participant characteristics, design and methodology, and intervention content. We calculated weighted mean effect sizes for theoretically-meaningful psychosocial and behavioral outcomes; moderator analyses determined the relation between study characteristics and the magnitude of effect sizes for heterogeneous outcomes. RESULTS Compared with controls, participants who received a computer-delivered intervention improved several hypothesized antecedents of health behavior (knowledge, attitudes, intentions); intervention recipients also improved health behaviors (nutrition, tobacco use, substance use, safer sexual behavior, binge/purge behaviors) and general health maintenance. Several sample, study and intervention characteristics moderated the psychosocial and behavioral outcomes. CONCLUSION Computer-delivered interventions can lead to improved behavioral health outcomes at first post-intervention assessment. Interventions evaluating outcomes at extended assessment periods are needed to evaluate the longer-term efficacy of computer-delivered interventions.
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Affiliation(s)
- David B. Portnoy
- Center for Health, Intervention, and Prevention, University of Connecticut
| | | | - Blair T. Johnson
- Center for Health, Intervention, and Prevention, University of Connecticut
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27
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Becker CB, Ciao AC, Smith LM. Moving From Efficacy to Effectiveness in Eating Disorders Prevention: The Sorority Body Image Program. COGNITIVE AND BEHAVIORAL PRACTICE 2008. [DOI: 10.1016/j.cbpra.2006.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Paxton SJ, McLean SA, Gollings EK, Faulkner C, Wertheim EH. Comparison of face-to-face and internet interventions for body image and eating problems in adult women: an RCT. Int J Eat Disord 2007; 40:692-704. [PMID: 17702020 DOI: 10.1002/eat.20446] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcomes following an eight-session, small group, therapist-led, intervention for body dissatisfaction, and disordered eating in adult women, delivered either in face-to-face or synchronous, internet mode. METHOD Community women with high body dissatisfaction and internet access were randomly assigned to either face-to-face delivery (N = 42), internet delivery (N = 37), or delayed treatment control (N = 37). All groups were assessed at baseline and 8-9 weeks later. The intervention groups were reassessed at 6-months follow-up. RESULTS Both intervention groups showed large improvements in body dissatisfaction compared with the delayed treatment control and these improvements were maintained at follow-up. However, posttreatment improvements were greater in the face-to-face than internet intervention. CONCLUSION In adult women, it is desirable to deliver the body image intervention in a face-to-face mode, but the internet mode is effective and has the potential to increase access to therapy.
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Affiliation(s)
- Susan J Paxton
- School of Psychological Science, Faculty of Science, Technology and Engineering, La Trobe University, Melbourne, Australia.
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30
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Stice E, Shaw H, Marti CN. A Meta-Analytic Review of Eating Disorder Prevention Programs: Encouraging Findings. Annu Rev Clin Psychol 2007; 3:207-31. [PMID: 17716054 DOI: 10.1146/annurev.clinpsy.3.022806.091447] [Citation(s) in RCA: 373] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This meta-analytic review found that 51% of eating disorder prevention programs reduced eating disorder risk factors and 29% reduced current or future eating pathology. Larger effects occurred for programs that were selected (versus universal), interactive (versus didactic), multisession (versus single session), solely offered to females (versus both sexes), offered to participants over 15 years of age (versus younger ones), and delivered by professional interventionists (versus endogenous providers). Programs with body acceptance and dissonance-induction content and without psychoeducational content and programs evaluated in trials using validated measures and a shorter follow-up period also produced larger effects. Results identify promising programs and delineate sample, format, and design features associated with larger effects, which may inform the design of more effective prevention programs in the future.
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Affiliation(s)
- Eric Stice
- Oregon Research Institute, Eugene, OR 97403, USA.
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31
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Heinicke BE, Paxton SJ, McLean SA, Wertheim EH. Internet-Delivered Targeted Group Intervention for Body Dissatisfaction and Disordered Eating in Adolescent Girls: A randomized controlled trial. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2007; 35:379-91. [PMID: 17243014 DOI: 10.1007/s10802-006-9097-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 12/28/2006] [Indexed: 10/23/2022]
Abstract
This study evaluated a targeted intervention designed to alleviate body image and eating problems in adolescent girls that was delivered over the internet so as to increase access to the program. The program consisted of six, 90-minute weekly small group, synchronous on-line sessions and was facilitated by a therapist and manual. Participants were 73 girls (mean age=14.4 years, SD=1.48) who self-identified as having body image or eating problems and were randomly assigned to an intervention group (n=36) (assessed at baseline, post-intervention and at 2- and 6-months follow-up) or a delayed treatment control group (n=37) (assessed at baseline and 6-7 weeks later). Clinically significant improvements in body dissatisfaction, disordered eating, and depression were observed at post-intervention and maintained at follow-up. Internet delivery was enthusiastically endorsed. The program offers a promising approach to improve body image and eating problems that also addresses geographic access problems.
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Affiliation(s)
- Brooke E Heinicke
- School of Psychological Science, La Trobe University, Bundoora, Melbourne 3086, Australia
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32
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Cousineau TM, Franko DL, Ciccazzo M, Goldstein M, Rosenthal E. Web-based nutrition education for college students: Is it feasible? EVALUATION AND PROGRAM PLANNING 2006; 29:23-33. [PMID: 21494421 PMCID: PMC3074521 DOI: 10.1016/j.evalprogplan.2005.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
College students have poor nutrition habits and often exhibit at-risk weight control behaviors; yet, health promotion efforts on campuses often target other risk behaviors such as alcohol and tobacco use. The goal of this study was to determine program content and examine the feasibility of a web-based nutrition education program for college students using innovative applications of tailoring, targeting and personalization of information. Comprehensive program planning entailed three phases: focus groups and use of concept mapping methodology, prototype web program development, and feasibility testing of the prototype. Results of concept mapping suggested that students and experts agreed on the relative importance of the major content areas unique to the college audience. A prototype web program, informed by health promotion theories, was developed and evaluated. Students and college health professionals participated in the feasibility evaluation, which included acceptance and usability testing of the prototype. Mean scores were computed for the acceptance ratings that indicated that the prototype web program was not only feasible, but also compelling and relevant for the college audience. In conclusion, a tailored, web-based interactive nutrition program could potentially be used to provide individualized nutrition information to encourage college students to adopt healthy eating behaviors.
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Affiliation(s)
- Tara M. Cousineau
- Inflexxion, Inc., 320 Needham Street, Ste 100, Newton, MA 02464-1594, USA
- *Corresponding author. Tel.: +1 617 332 6028; fax: +1 617 332 1820. E-mail address: (T.M. Cousineau)
| | - Debra L. Franko
- Department of Counseling and Applied Educational Psychology, Northeastern University, Boston, MA 02115, USA
| | - Michele Ciccazzo
- College of Health and Urban Affairs, Florida International University Miami, FLA 33199, USA
| | - Marion Goldstein
- Steinhardt School of Education, New York University, NY 10003, USA
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