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Wisting L, Stice E, Ghaderi A, Dahlgren CL. Effectiveness of virtually delivered Body Project groups to prevent eating disorders in young women at risk: a protocol for a randomized controlled trial. J Eat Disord 2023; 11:209. [PMID: 38001544 PMCID: PMC10668509 DOI: 10.1186/s40337-023-00932-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are a group of mental illnesses associated with significant psychological and physiological consequences. Overall, only about one-fifth of individuals with EDs receive treatment and treatment is effective for only about one-third for those who receive care. The development and implementation of effective prevention approaches for those at risk is therefore pivotal. The Body Project is the most effective ED prevention program for at-risk women according to several meta-analyses, but reach is limited since delivery, traditionally, has been in-person. Moreover, peer-led Body Project groups have been reported to produce stronger effects than clinician-led Body Project groups when delivered in-person. This has not yet been examined for virtually delivered Body Project groups. This study therefore seeks to investigate the effect of virtual Body Project groups delivered by peers versus clinicians on ED risk factors, ED symptoms, and prospective ED onset. METHODS Young women with body image concerns aged 16-25 years (N = 441) will be included in the study and randomized to three conditions: (i) virtually delivered Body Project groups led by clinicians; (ii) virtually delivered Body Project groups led by peers; and (iii) psychoeducational control group. Participants will complete assessments at five timepoints over two years (pretest, posttest, 6-months, 1-year, and 2-years). DISCUSSION Further research is needed to examine approaches to increase the potential for broad implementation of prevention of EDs. The virtual modality of the Body Project could markedly expand the reach for young women at risk. If findings confirm that peers can deliver virtual Body Project groups as effectively as clinicians, this will further enhance the implementation potential. TRIAL REGISTRATION The present study has been registered on clinicaltrials.gov (NCT05993728).
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, Oslo, 0424, Norway.
| | - Eric Stice
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, USA
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Carrard I, Cekic S, Bucher Della Torre S. A randomized controlled trial to evaluate the acceptability and effectiveness of two eating disorders prevention interventions: the HEIDI BP-HW project. BMC Womens Health 2023; 23:446. [PMID: 37612687 PMCID: PMC10463671 DOI: 10.1186/s12905-023-02607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023] Open
Abstract
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).
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Affiliation(s)
- Isabelle Carrard
- Department of Nutrition and dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.
| | - Sezen Cekic
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Sophie Bucher Della Torre
- Department of Nutrition and dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
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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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Matheson EL, Smith HG, Amaral ACS, Meireles JFF, Almeida MC, Linardon J, Fuller-Tyszkiewicz M, Diedrichs PC. Using Chatbot Technology to Improve Brazilian Adolescents' Body Image and Mental Health at Scale: Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e39934. [PMID: 37335604 DOI: 10.2196/39934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/21/2022] [Accepted: 04/10/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Accessible, cost-effective, and scalable mental health interventions are limited, particularly in low- and middle-income countries, where disparities between mental health needs and services are greatest. Microinterventions (ie, brief, stand-alone, or digital approaches) aim to provide immediate reprieve and enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments. Body image is a global public health issue that increases young peoples' risk of developing more severe mental and physical health issues. Embedding body image microinterventions into digital environments is one avenue for providing young people with immediate and short-term reprieve and protection from the negative exposure effects associated with social media. OBJECTIVE This 2-armed, fully remote, and preregistered randomized controlled trial assessed the impact of a body image chatbot containing microinterventions on Brazilian adolescents' state and trait body image and associated well-being outcomes. METHODS Geographically diverse Brazilian adolescents aged 13-18 years (901/1715, 52.54% girls) were randomized into the chatbot or an assessment-only control condition and completed web-based self-assessments at baseline, immediately after the intervention time frame, and at 1-week and 1-month follow-ups. The primary outcomes were mean change in state (at chatbot entry and at the completion of a microintervention technique) and trait body image (before and after the intervention), with the secondary outcomes being mean change in affect (state and trait) and body image self-efficacy between the assessment time points. RESULTS Most participants who entered the chatbot (258/327, 78.9%) completed ≥1 microintervention technique, with participants completing an average of 5 techniques over the 72-hour intervention period. Chatbot users experienced small significant improvements in primary (state: P<.001, Cohen d=0.30, 95% CI 0.25-0.34; and trait body image: P=.02, Cohen d range=0.10, 95% CI 0.01-0.18, to 0.26, 95% CI 0.13-0.32) and secondary outcomes across various time points (state: P<.001, Cohen d=0.28, 95% CI 0.22-0.33; trait positive affect: P=.02, Cohen d range=0.15, 95% CI 0.03-0.27, to 0.23, 95% CI 0.08-0.37; negative affect: P=.03, Cohen d range=-0.16, 95% CI -0.30 to -0.02, to -0.18, 95% CI -0.33 to -0.03; and self-efficacy: P=.02, Cohen d range=0.14, 95% CI 0.03-0.25, to 0.19, 95% CI 0.08-0.32) relative to the control condition. Intervention benefits were moderated by baseline levels of concerns but not by gender. CONCLUSIONS This is the first large-scale randomized controlled trial assessing a body image chatbot among Brazilian adolescents. Intervention attrition was high (531/858, 61.9%) and reflected the broader digital intervention literature; barriers to engagement were discussed. Meanwhile, the findings support the emerging literature that indicates microinterventions and chatbot technology are acceptable and effective web-based service provisions. This study also offers a blueprint for accessible, cost-effective, and scalable digital approaches that address disparities between health care needs and provisions in low- and middle-income countries. TRIAL REGISTRATION Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-021-12129-1.
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Affiliation(s)
- Emily L Matheson
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Harriet G Smith
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Ana C S Amaral
- Federal Institute of Education, Science and Technology of Southeast of Minas Gerais, Barbacena, Brazil
| | - Juliana F F Meireles
- Department of Family and Community Medicine, School of Community Medicine, University of Oklahoma Health Science Center, Tulsa, OK, United States
| | - Mireille C Almeida
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | | | - Phillippa C Diedrichs
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stice E, Rohde P, Gau JM, Bearman SK, Shaw H. An experimental test of increasing implementation support for college peer educators delivering an evidence-based prevention program. J Consult Clin Psychol 2023; 91:208-220. [PMID: 36892885 PMCID: PMC10175139 DOI: 10.1037/ccp0000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE College students are at particularly high risk for mental health problems, such as eating disorders, which are associated with functional impairment, distress, and morbidity, but barriers limit implementation of evidence-based interventions at colleges. We evaluated the effectiveness and implementation quality of a peer educator (PE) delivered eating disorder prevention program (the Body Project [BP]), which has a broad evidence-based using a train-the-trainer (TTT) approach and experimentally evaluated three levels of implementation support. METHOD We recruited 63 colleges with peer educator programs and randomly assigned them to (a) receive a 2-day TTT training in which peer educators were trained to implement the Body Project and supervisors were taught how to train future peer educators (TTT), (b) TTT training plus a technical assistance (TA) workshop (TTT + TA), or (c) TTT plus the TA workshop and quality assurance (QA) consultations over 1-year (TTT + TA + QA). Colleges recruited undergraduates (N = 1,387, 98% female, 55% White) to complete Body Project groups. RESULTS There were no significant differences across condition for attendance, adherence, competence, and reach, though nonsignificant trends suggested some benefit of TTT + TA + QA relative to TTT for adherence and competence (ds = .40 and .30). Adding TA and QA to TTT was associated with significantly larger reductions in risk factors and eating disorder symptoms. CONCLUSIONS Results suggest that the Body Project can be effectively implemented at colleges using peer educators and a TTT approach and that adding TA and QA resulted in significantly larger improvements in outcomes for group participants, and marginally higher adherence and competence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Eric Stice
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | | | | | | | - Heather Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University
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Dunker KLL, Carvalho PHBD, Amaral ACS. Eating disorders prevention programs in Latin American countries: A systematic review. Int J Eat Disord 2023; 56:691-707. [PMID: 36789735 DOI: 10.1002/eat.23916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE This systematic review evaluates and summarizes existing eating disorder (ED) prevention programs in Latin American countries. METHODS A systematic literature search was conducted using the Cochrane Controlled Trial Register, PubMed, and Virtual Health Library databases up to and including July 31, 2022. All ED prevention studies published in English, Spanish or Portuguese were eligible, regardless of the study design, sample characteristics, and type of prevention programs. The Cochrane Collaboration Risk of Bias criteria were used to evaluate the quality of the included studies. RESULTS Twenty-two studies were included. Most were pilot studies that were nonrandomized, had a high risk of bias, were from Mexico and Brazil, and employed selective interventions. Dissonance-based programs and social cognitive theory were the commonly used approaches in interventions, and most of them were tested in adolescent girls and women. Short follow-ups were used, varying from 1 to 6 months. Many found significant decreases after the intervention and/or at follow-up in ED/disordered eating risk behaviors/symptoms, negative affect, body-ideal internalization, and body image disturbances. CONCLUSIONS This review highlights promising efforts to prevent EDs among Latin American countries. Some barriers in conducting research include funding restrictions, laws that do not allow remuneration or compensation for participants, and high costs of training. Nonetheless, the outcomes of the programs developed and evaluated so far are positive enough to merit further work on ED prevention. Efforts for future researchers should recruit samples with diverse characteristics, use robust designs and data analysis techniques, and expand the accessibility of prevention programs. PUBLIC SIGNIFICANCE STATEMENT The development of effective eating disorder (ED) prevention programs that can be broadly implemented is a public health priority. Nevertheless, there is limited evidence regarding the characteristics of ED prevention programs and their efficacy among Latin American countries. In the present study, we reviewed existing ED prevention programs adopted in Latin America, described their characteristics and outcomes, noted the limitations of available programs, and discussed the implications of these findings for efforts to prevent the development of EDs in Latin America. The outcomes of the programs developed and evaluated so far are positive enough to merit the development and rigorous evaluation of future programs and their broad dissemination in Latin American countries. PROSPERO registration number CRD42021275245.
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Affiliation(s)
- Karin Louise Lenz Dunker
- AMBULIM, Eating Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Pedro Henrique Berbert de Carvalho
- AMBULIM, Eating Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,NICTA, Body Image and Eating Disorder Research Group, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Ana Carolina Soares Amaral
- Federal Institute of Education, Science and Technology of Southeast of Minas Gerais, Barbacena, Minas Gerais, Brazil
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Rutsztein G, Scappatura ML, Elizathe L, Leonardelli E, Murawski B, Lievendag L, Sanday J, Falivelli MBB, Bidacovich G, Keegan E. Efficacy of an integrated program (PIA-2) to reduce the risk for problems related to eating, weight and body image in female adolescents from Argentina. Int J Eat Disord 2023; 56:758-769. [PMID: 36757140 DOI: 10.1002/eat.23900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE This study aimed to examine the efficacy of an integrated program (PIA-2) to reduce the risk for problems related to eating, weight and body image in female adolescents from Argentina. METHOD A quasi-experimental study was conducted by comparing an experimental group versus a control group. The final sample included 509 girls aged 13-18 (M = 15.39 and SD = 1.30) from nine schools located in three geographical regions. They provided data at three assessment time points: baseline, post-intervention and a 3-month follow-up. Dependent variables included skipping breakfast, physical activity, eating disorder risk and thin-ideal internalization. The program was carried out in three 90-minute sessions within usual school hours, at 1-week intervals. RESULTS Participants who received the intervention decreased more than the control group in skipping breakfast month by month. However, a significant effect of the intervention was not found on physical activity, eating disorder risk, and thin-ideal internalization. DISCUSSION The presence of mixed findings shows the need to adjust the intervention to enhance the results. The importance of working jointly with other Latin American countries is emphasized, in order to promote the growth of the field of prevention, regarding cultural particularities shared by our societies. PUBLIC SIGNIFICANCE Integrated programs aimed at reducing risk factors for the entire spectrum of problems related to eating, weight and body image could lead to beneficial and more efficient effects. However, their development is still incipient in Latin America. PIA-2 Program, designed for female adolescents, produced positive results in one of the four variables studied, decreasing the weekly frequency of skipping breakfast among adolescents. This is pioneering research in Argentina and the region since very few studies on integrated prevention have been published in Latin America. It is crucial to continue with efforts aimed at developing programs that are suited to the specific needs of the population of Latin American countries. In this aspect, our study is undoubtedly an important contribution.
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Affiliation(s)
| | | | - Luciana Elizathe
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Leonardelli
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina.,Pontificia Universidad Católica, Buenos Aires, Argentina.,Universidad Favaloro, Buenos Aires, Argentina
| | - Brenda Murawski
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Leonora Lievendag
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Julieta Sanday
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Germán Bidacovich
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Keegan
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
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da Silva SU, Gonçalves VSS, Barufaldi LA, de Carvalho KMB. Weight misperception and substance use: Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). BMC Public Health 2022; 22:1850. [PMID: 36192717 PMCID: PMC9531377 DOI: 10.1186/s12889-022-14267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescence is a crucial period for body image formation. Weight misperception is the discrepancy between individuals' body weight perception and their actual nutritional status. Both weight concerns and substance use are common among adolescents, and there is evidence of an associations between these two variables. Thus, the aim of this study was to assess the association between weight misperception and substance use (smoking and alcohol) in a national sample of normal weight Brazilian adolescents. METHODS Data were obtained from the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, multicenter, national, school-based survey, carried out in 124 municipalities with more than 100,000 inhabitants from Brazil. The sample included adolescents aged 12-17 years, classified as normal weight by nutritional status evaluation. The following measures were collected: weight underestimation and overestimation (exposure); having tried cigarette smoking, current smoking, current alcohol consumption, binge drinking and current smoking and alcohol consumption(outcomes); macro-region, sex, type of school, and excessive screen time (confounders). The frequency of variables was calculated with 95% confidence intervals (CI). Poisson regression models were used to estimate prevalence ratios (PR). RESULTS In total, data from 53,447 adolescents were analyzed. Weight misperception was present in a third of the adolescents, with similar prevalence of weight underestimation and overestimation. In adolescents aged 12-14 years, weight underestimation and overestimation were associated with having tried cigarette smoking (PR: 1.18 and 1.43, respectively), current alcohol consumption (PR: 1.33 for both weight misperception categories), and binge drinking (PR: 1.96 and 2.01, respectively). Weight underestimation was associated with both having tried cigarette smoking and current alcohol consumption in boys (PR: 1.14 and 1.16, respectively) and girls (PR: 1.32 and 1.15, respectively). In girls, weight overestimation was associated with all substance use variables (PR between 1.19 and 1.41). CONCLUSIONS Our results showed an association between weight misperception and having tried cigarette smoking, alcohol consumption, and binge drinking in younger adolescents. In addition, weight overestimation was associated with all substance use indicators in girls. Based on our findings, interventions aimed to improve weight perception in normal weight adolescents may contribute to the reduction of substance use in this population.
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Affiliation(s)
- Simoni Urbano da Silva
- Graduate Program of Public Health, Faculty of Health Sciences, University of Brasilia, Brasilia, DF, Brazil.
| | | | - Laura Augusta Barufaldi
- Population Research Division, Brazilian National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, RJ, Brazil
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Resende TRO, Almeida M, Dos Santos Alvarenga M, Brown TA, de Carvalho PHB. Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction. Eat Weight Disord 2022; 27:1099-1112. [PMID: 34143404 DOI: 10.1007/s40519-021-01245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Investigate the efficacy of a dissonance-based (DB) intervention (i.e., the Body Project), during which some examples of intuitive eating were provided by peer leaders, in improving intuitive eating and targeting risk and protective factors for eating disorders (ED) among Brazilian women with body dissatisfaction. METHODS Participants were randomized to a four-session DB intervention (n = 38) or assessment-only control (AOC) (n = 36), and completed validated measures assessing intuitive eating, body appreciation, self-esteem, body-ideal internalization, body dissatisfaction, negative affect, and disordered eating pre-intervention, post-intervention, and at 4- and 24-week follow-ups. RESULTS The DB condition demonstrated significantly greater increases in intuitive eating, body appreciation and self-esteem scores compared to AOC from pre-intervention to post-intervention (between-condition Cohen's d = 0.73-0.98), 4-week (between-condition Cohen's d = 1.25-1.87) and 24-week follow-up (between-condition Cohen's d = 0.82-1.38). Also, the DB condition showed significantly greater decreases in body-ideal internalization, body dissatisfaction and disordered eating scores from pre-intervention to post-intervention (between-condition Cohen's d = 0.76-1.04), 4-week (between-condition Cohen's d = 1.27-1.71) and 24-week follow-up (between-condition Cohen's d = 1.04-1.19). Regarding negative affect, DB condition showed significantly greater reduction only at 24-week follow-up (between-condition Cohen's d = 0.60). CONCLUSION Results reinforce the efficacy of DB interventions in reducing ED risk factors for young women and support the preliminary efficacy of these programs in improving intuitive eating, body appreciation, and self-esteem. LEVEL OF EVIDENCE Level I, randomized controlled trial. ReBEC (Brazilian Registry of Clinical Trials; available at http://www.ensaiosclinicos.gov.br/ ) number of registration: RBR-2f57cs. Date of registration: June 1, 2020.
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Affiliation(s)
- Thainá Richelli Oliveira Resende
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, 745, São Paulo Street, City Center, Governador Valadares, Brazil
| | - Maurício Almeida
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, 745, São Paulo Street, City Center, Governador Valadares, Brazil
| | - Marle Dos Santos Alvarenga
- School of Public Health, Nutrition in Public Health Post Graduation Program, University of São Paulo, São Paulo, Brazil
| | - Tiffany A Brown
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,San Diego State University Research Foundation, San Diego, CA, USA
| | - Pedro Henrique Berbert de Carvalho
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, 745, São Paulo Street, City Center, Governador Valadares, Brazil. .,AMBULIM, Eating Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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Feasibility and effect of adding a concurrent parental component to a school-based wellness program using two modes of mobile-based technology - mixed methods evaluation of RCT. BMC Public Health 2022; 22:297. [PMID: 35164721 PMCID: PMC8842894 DOI: 10.1186/s12889-022-12581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed the feasibility and effect of two mobile modes (WhatsApp vs. a specially designed app) in their delivery of updates and assignments to parents. METHODS Two three-armed, randomized, controlled feasibility studies were conducted. In each trial, four schools with a total of 418 students in grade 5th, mean age 10.1 years, were randomly allocated to the control arm, youth-only arm, or youth & parental component arm. Only the data of those that completed all three assessments (pre, post and 3 months post program) were analyzed: 133 in the first trial and 137 in the second. In the youth-only arm, students participated in an interactive age-tailored prevention program delivered in 10 weekly, 90-min sessions on self-care behaviors, media literacy, self-esteem, and positive body image. The control groups in both studies received three health- and nutrition-related sessions. In the parental arm, in addition to the 'Favoring-Myself-Young's ten sessions program, parents received updates and were requested to complete shared assignments with their children. In the first year, the assignments were sent via WhatsApp, and in the following year via "Favoring Myself" smartphone application. Facilitators were third year undergraduate students. They used a detailed semi-structured guide and received 4-weekly hours of didactic and group dynamic supervision. Mixed-methods assessments were performed using semi-structured interviews with ten parents and five school staff members each year, as well as a computerized self-report questionnaire. RESULTS Feasibility of parent-adolescent shared assignments in both digital modes was lower than expected. The use of WhatsApp had higher feasibility and uptake than the use of the special application. The addition of the concurrent parental component via WhatsApp was associated with superior improvement in self-esteem and identification of advertisement strategies, compared with the youth-only program. However, adolescents in the youth-only program delivered via the smartphone application demonstrated superior improvement compared to those in the youth and parental component arm. CONCLUSIONS Although the addition of the concurrent parenting component was praised by the actively participating parents, overall, under the chosen structure and population, it did not prove to add statistically significant value to the youth-only arm. TRIAL REGISTRATIONS NCT03216018 (12.7.2017) and NCT03540277 (26.4.2018).
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Ahuvia I, Jans L, Schleider J. Secondary effects of body dissatisfaction interventions on adolescent depressive symptoms: A meta-analysis. Int J Eat Disord 2022; 55:231-246. [PMID: 34951477 DOI: 10.1002/eat.23659] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/17/2021] [Accepted: 12/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Depression is a leading cause of disability among adolescents, yet existing treatments are variably effective, suggesting needs to identify novel intervention targets. Body dissatisfaction (BD) may be a promising, but understudied, target: BD is common among adolescents; prospectively associated with future depression; and modifiable through intervention. BD interventions are typically evaluated in terms of impacts on eating disorders, but many trials also measure depression-related secondary outcomes. However, BD intervention effects on depression have not been systematically examined. We, therefore, conducted a meta-analysis to estimate secondary effects of BD interventions on depression symptoms and related outcomes in adolescents (ages 12-19). METHOD Our systematic review included randomized controlled trials (RCTs) published between January 2006 and December 2020. Across-group effect sizes were analyzed using robust variance estimation. Preregistered methods, data, and analytic code are available at https://osf.io/734n8/. RESULTS The meta-analysis included 13 RCTs, 50 effect sizes, and 6,962 participants. BD interventions led to significant postintervention reductions in depression-related outcomes versus control conditions (g = -0.19 at postintervention, 95% confidence interval: -0.07, -0.31, p = .005). No evidence emerged for moderators of this meta-analytic effect. DISCUSSION Overall, BD-focused interventions significantly reduced adolescent depression, with mean postintervention effect sizes comparable to those observed for interventions targeting depression explicitly. Results are bolstered by preregistered methods and robustness checks. Limitations include a lack of data on participants' sexual and gender identities and a significant risk of bias in the underlying literature. Future research on BD interventions should measure depression symptom severity as a secondary outcome.
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Affiliation(s)
- Isaac Ahuvia
- Stony Brook University, Stony Brook, New York, USA
| | - Laura Jans
- Stony Brook University, Stony Brook, New York, USA
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12
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Matheson EL, Smith HG, Amaral ACS, Meireles JFF, Almeida MC, Mora G, Leon C, Gertner G, Ferrario N, Suarez Battan L, Linardon J, Fuller-Tyszkiewicz M, Diedrichs PC. Improving body image at scale among Brazilian adolescents: study protocol for the co-creation and randomised trial evaluation of a chatbot intervention. BMC Public Health 2021; 21:2135. [PMID: 34801002 PMCID: PMC8605542 DOI: 10.1186/s12889-021-12129-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Body image concerns are prevalent among Brazilian adolescents and can lead to poor psychological and physical health. Yet, there is a scarcity of culturally-appropriate, evidence-based interventions that have been evaluated and made widely available. Chatbot technology (i.e., software that mimics written or spoken human speech) offers an innovative method to increase the scalability of mental health interventions for adolescents. The present protocol outlines the co-creation and evaluation of a body image chatbot for Brazilian adolescents via a partnership between academics, industry organisations and the United Nations Children's Fund (UNICEF). METHODS A two-armed fully remote randomised controlled trial will evaluate the chatbot's effectiveness at improving body image and well-being. Adolescent girls and boys (N = 2800) aged 13-18 years recruited online will be randomly allocated (1:1) into either: 1) a body image chatbot or 2) an assessment-only control condition. Adolescents will engage with the chatbot over a 72-hour period on Facebook Messenger. Primary outcomes will assess the immediate and short-term impact of the chatbot on state- and trait-based body image, respectively. Secondary outcomes will include state- and trait-based affect, trait self-efficacy and treatment adherence. DISCUSSION This research is the first to develop an evidence-informed body image chatbot for Brazilian adolescents, with the proposed efficacy trial aiming to provide support for accessible, scalable and cost-effective interventions that address disparities in body image prevalence and readily available resources. TRIAL REGISTRATION NUMBER NCT04825184 , registered 30th March 2021.
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Affiliation(s)
- E L Matheson
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - H G Smith
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - A C S Amaral
- Federal Institute of Education, Science and Technology of Southeast of Minas Gerais, 204 Monsenhor José Augusto, Barbacena, 36205018, Brazil
| | - J F F Meireles
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, USA
| | - M C Almeida
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - G Mora
- UNICEF Brasília, Office of the Representative of UNICEF in Brazil, SEPN 510, Block A - 2nd floor, Brasília, DF, 70750-521, Brazil
| | - C Leon
- UNICEF Brasília, Office of the Representative of UNICEF in Brazil, SEPN 510, Block A - 2nd floor, Brasília, DF, 70750-521, Brazil
| | - G Gertner
- Talk2U LLC, 777 Brickell Ave Ste 1210, Miami, Florida, 33131, USA
| | - N Ferrario
- Talk2U LLC, 777 Brickell Ave Ste 1210, Miami, Florida, 33131, USA
| | - L Suarez Battan
- Talk2U LLC, 777 Brickell Ave Ste 1210, Miami, Florida, 33131, USA
| | - J Linardon
- School of Psychology, Deakin University, Geelong, Australia
| | | | - P C Diedrichs
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
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Carrard I, Bucher Della Torre S. 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. PLoS One 2021; 16:e0259796. [PMID: 34780528 PMCID: PMC8592424 DOI: 10.1371/journal.pone.0259796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Isabelle Carrard
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- * E-mail:
| | - Sophie Bucher Della Torre
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
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14
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Junqueira ACP, Tylka TL, Almeida SDS, Costa TMB, Laus MF. Translation and Validation of the Brazilian Portuguese Version of the Broad Conceptualization of Beauty Scale With Brazilian Women. PSYCHOLOGY OF WOMEN QUARTERLY 2021. [DOI: 10.1177/03616843211013459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In many countries, women are socialized to adopt a narrow definition of beauty. Research has revealed that, in the United States and China, the ability to broadly conceptualize beauty (perceive beauty in diverse body sizes, shapes, and appearances) is linked to women’s lower anti-fat attitudes, higher body appreciation, and higher well-being. In this study, we translated an existing measure of this construct, the Broad Conceptualization of Beauty Scale (BCBS), into Brazilian Portuguese and evaluated the factor structure and reliability and validity of its scores with a diverse sample of 563 Portuguese women. Findings revealed that the Brazilian Portuguese BCBS contains two factors—external/appearance features of beauty (BCBS-E) and internal features of beauty (BCBS-I)—contrary to the unidimensional factor structure found in previous studies. Support for internal consistency and 3-week test–retest reliability was garnered. Total BCBS and BCBS-E scores evidenced convergent, discriminant, and incremental validity, whereas the BCBS-I did not accrue substantial convergent or incremental validity support beyond its inverse bivariate association with anti-fat attitudes. We recommend the use of the Brazilian Portuguese BCBS in body image research programs as well as clinical practice and prevention programs with Brazilian women seeking support for body dissatisfaction and disordered eating.
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Affiliation(s)
- Alessandra Costa Pereira Junqueira
- Department of Psychology, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Nutrition, University of Ribeirão Preto, São Paulo, Brazil
| | - Tracy L. Tylka
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | | | | | - Maria Fernanda Laus
- Department of Psychology, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Nutrition, University of Ribeirão Preto, São Paulo, Brazil
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Stice E, Marti CN, Shaw H, Rohde P. Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects. Clin Psychol Rev 2019; 70:91-107. [PMID: 31004832 PMCID: PMC6536334 DOI: 10.1016/j.cpr.2019.04.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Eric Stice
- Oregon Research Institute, United States.
| | | | | | - Paul Rohde
- Oregon Research Institute, United States
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