Prevention of eating disorders: 2023 in review.

This review of 16 prevention-related publications in Eating Disorders during 2022 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; and (3) definitions of and links between disordered eating (DE) and eating disorders (EDs). Seven articles fell into the category of prevention rationale (including screening studies) and relevant reviews, while nine articles addressed correlates of/risk factors (RFs) for various aspects of DE and EDs. One implication of the 16 articles reviewed is that RF research toward construction of selective and indicated prevention programs for an expanding array of diverse at-risk groups needs to address, from a nuanced, intersectional framework, a broad range of factors beyond negative body image and internalization of beauty ideals. Another implication is that, to expand and improve current and forthcoming prevention programs, and to shape effective advocacy for prevention-oriented social policy, the field in general and Eating Disorders in particular need more scholarship in the form of critical reviews and meta-analyses; protective factor research; prevention program development and multi-stage evaluation; and case studies of multi-step activism at the local, state (province, region), and national levels.

The global prevalence of screen-based disordered eating and associated risk factors among high school students: systematic review, meta-analysis, and meta-regression.

OBJECTIVE: Estimate the prevalence, and associated risk factors, of high school students who are considered at risk for an eating disorder based on screening measures. METHODS: An electronic search of nine databases was completed from their inception until 1st September 2022. A random-effects meta-analysis was conducted, and confounder (moderator) analyses and meta-regressions examined whether the overall prevalence estimate for of screen-based disordered eating (SBDE) was moderated by student age, BMI, or gender, as well as culture and type of SBDE assessment. RESULTS: The mean estimate of the prevalence of SBDE among high school students (K = 42 (66 datapoints), N = 56282] in the sample of 25 countries was 13% ([95% CI] = 10.0-16.8%, I2 = 99.0%, Cochran's Q p = 0.001). This effect was not moderated by features of the samples such as gender, BMI, or age. Among cultures, non-Western countries had a higher prevalence of SBDE prevalence than Western countries, but the difference was not significant. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged. CONCLUSION: The estimated figure of 1 in 8 high school students with SBDE-unmoderated by gender and BMI-stands out as a problem in need of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, and educators. There is a great need for innovative, integrated policy and program development all along the spectrum of health promotion and universal, selective, and indicated prevention. Further research is also needed to validate and refine this estimate by (a) conducting basic research on the accuracy of eating disorder screening measurements in samples ages 14 through 17; (b) examining representative samples in more countries in general and Latin American countries in particular; (c) clarifying the relationships between SBDE and age throughout the different phases of late childhood, adolescence, and emerging adulthood; and (d) investigating whether there are meaningful forms of disordered eating and whether these are associated with variables such as gender, ethnicity, and BMI.

We searched nine databases to identify studies of high school students that yielded an estimate of disordered eating based on screening measures such as the Eating Attitudes Test. Forty-two 42 studies (N = 56282 students) from 25 countries met the selection criteria. A random effects meta-analysis indicated that across those countries the best estimate of the prevalence of screen-based disordered eating is 13%. This estimate was not significantly moderated by BMI, gender, age, and whether the country was Western or non-Western. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged. The estimated figure of 1 in 8 high school students with disordered eating is a problem deserving of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, educators, and leaders committed to prevention and early identification of eating disorders and referral for treatment. Further research in many more countries is also needed to validate this estimate and to explore its relationship with development throughout adolescence and with variables that can help us to refine prevention and effective early identification and treatment of eating disorders.

Prevention of eating disorders: 2022 in review.

This review of 17 prevention-related publications in Eating Disorders during 2022 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion ➔ types of prevention ➔ case identification/referral ➔ treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews ➔ clarifying risk and protective factors ➔ program innovation and feasibility studies ➔ efficacy and effectiveness research ➔ program dissemination; and (3) definitions of and links between disordered eating (DE) and eating disorders (EDs). Five articles fell into the category of prevention rationale, theory, and critical analyses, while seven articles addressed risk factors (RFs) for various aspects of DE. Eating Disorders also published two pilot studies, two prevention efficacy trials, and one effectiveness study in 2022. One implication of the 17 articles reviewed is that RF research toward construction of selective and indicated prevention programs for diverse at-risk groups should address a broad range of factors beyond negative body image and internalization of beauty ideals. Another implication is that, to expand and improve current and forthcoming prevention programs, and to shape effective advocacy for prevention-oriented social policy, the field in general and Eating Disorders in particular need more scholarship in the form of critical reviews and meta-analyses, protective factor research, and case studies of multi-step activism at the local, state (province, region), and national levels.

Preventing eating disorders and disordered eating in genetically vulnerable, high-risk families.

OBJECTIVE: To close the chasm between theory about families containing a parent with an eating disorders (EDs) history and lack of selective or indicated prevention programming for such families with an older child or adolescent who is, genetically, at high risk. METHOD: A search of four major databases for January 2000 through September 2022 yielded no publications that (a) identified genetically high-risk families with offspring ages 10 through 18; (b) devised a prevention program for the family; and (c) evaluated program effects on risk/protective factors. To rectify this gap, research on three lines of family-based prevention is reviewed: (1) programs for adolescents at genetic risk for depression or anxiety; (2) the Stanford-Dresden project for adolescents at high risk for anorexia nervosa; and (3) Sadeh-Sharvit et al.'s work concerning the Parent-Based Prevention program for mothers with an EDs history and a child under age 5. RESULTS: The significant challenges for innovative prevention programming should be addressed by experts in effective EDs, depression, and anxiety prevention, and in family-based treatment (FBT) for EDs, collaborating with people from genetically vulnerable families. Innovative programming should focus on robust risk factors for EDs, adaptive expression of non-specific risk factors (e.g., temperament), and strengthening family functioning. DISCUSSION: The field is overdue for development of prevention programs designed for older children or adolescents who are at risk because a parent has an ED. Evidence-based prevention programs for EDs and for depression and anxiety, as well as parent-based prevention informed by FBT, provide a springboard for addressing this gap. PUBLIC SIGNIFICANCE: The foundation of theory and research is available for stakeholders to develop prevention programming that closes the huge gap between theory and research about families that are genetically vulnerable for eating disorders versus the complete lack of prevention programming for such families that have an older child or adolescent at high risk.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression.

PURPOSE: The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world. METHODS: An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex. RESULTS: Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased. CONCLUSIONS: These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment. LEVEL OF EVIDENCE: I, systematic review and meta-analysis.

An open invitation to productive conversations about feminism and the spectrum of eating disorders (part 1): basic principles of feminist approaches.

Despite the long history of feminist research in the field and the clear relevance of questions of gender to this sphere, many continue to question the relevance of feminism for understanding and treating eating disorders in 2022. In this set of two papers, we explore some of the tensions, omissions and misconceptions which surround feminist approaches to eating disorders. At the core of these two papers is our assertion that such approaches can make significant contributions in the eating disorders field along six key lines: enriching the science of eating disorders, unpacking diagnostics, contextualizing treatment and prevention, attending to lived experiences, diversifying methodologies, and situating recoveries. In this first paper, we outline what feminist approaches are and dig into some key tensions that arise when feminist approaches come to the table. These include critiques of sociocultural approaches to understanding eating disorders, the relationship between feminist approaches and biological and genetic attributions for eating disorders, and the role of men. We then offer a key contribution that feminist approaches have made to eating disorders scholarship: an invitation to unpack diagnostic approaches and situate eating disorders within the landscape of food, weight, and shape concerns in the twenty-first century.

Feminist research has been contributing to the eating disorders field for decades; yet, there continue to be questions about its relevance in 2022. In this set of two papers, we explore some of the questions around and disagreements about feminist approaches to eating disorders. We argue that feminist approaches to eating disorders continue to matter because they enrich the science of eating disorders, help us to better understand and situate diagnoses, consider treatment and prevention in context, attend to lived experiences, broaden our approaches to doing research, and consider recovery in context. In this first paper, we outline what feminist approaches are and dig into some key tensions around them. These include how sociocultural approaches to understanding eating disorders have been critiqued, relationships between "biological" and "feminist" understandings of eating disorders, and the role of men. We then consider one of the key contributions feminist approaches has made in the field: an invitation to think about eating disorder diagnoses in relation to contemporary concerns about food, weight, and shape.

An open invitation to productive conversations about feminism and the spectrum of eating disorders (part 2): Potential contributions to the science of diagnosis, treatment, and prevention.

The role of feminism in eating disorders research, treatment, and advocacy continues to be debated, with little agreement in sight about the role-or lack thereof-of feminist eating disorders work. In these debates, the opportunity to open fruitful conversations about eating disorders that generate new possibilities for researching, treating, and preventing them is missed. This article is the second in a series of two papers that invite such a discussion. In this article, we focus on five key contributions that feminist eating disorder work has made and can make moving forward. These are contextualizing treatment, attending to lived experiences, expanding the meanings of "sociocultural influences," diversifying methodologies, and situating recoveries. We do not propose to offer a "final word" on feminisms and eating disorders, but instead to start conversations about how we understand, research, and treat eating disorders.

There continue to be debates about what role, if any, feminism has to play in eating disorders research, treatment, and advocacy. In these debates, we sometimes miss the chance to engage in productive dialogue about what the past and present of feminist eating disorders research, treatment, and prevention can offer­and where it might grow. This article, the second in a series of two papers that invite such a discussion, focuses on five key contributions that feminist eating disorder work has made and can make moving forward. These are: considering treatment in context, attending to lived experiences, thinking about the meaning of "sociocultural influences," broadening our approaches to doing research, and considering recovery in context. We do not intend this work to offer a "final word" on the role of feminisms for eating disorders. Instead, we want to spark and continue conversations about how we understand, research, and treat eating disorders.

Prevention of eating disorders: 2021 in review.

This review of 19 prevention-related publications in Eating Disorders during 2021 is framed by four models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; (3) links between disordered eating (DE) and eating disorders (EDs); and (4) Kraemer and Jacobi's criteria for variable, causal risk factors (RFs). Twelve articles demonstrated the strengths and limitations of cross-sectional investigations of RFs for DE and EDs: five explored the role of trauma in activating genetic and psychological RFs (e.g., anxiety and experiential avoidance), while five suggest other variables meriting further evaluation: ergogenic supplement use, "feeling fat," internalized weight bias, food insecurity, and compulsive exercising. One article presents a pilot program that reduced risk factors in a high-risk group: professional ballerinas. Implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies, along with the need to develop tailored programs for various high-risk groups, are discussed.

Prevention of eating disorders: 2020 in review.

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

Prevention of eating disorders: 2019 in review.

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

Development and validation of the Physical Activity Body Experiences Questionnaire.

Embodiment is defined as a state in which one experiences one's physical body as an essential aspect of one's lived experiences, a potential protective factor against body image and eating disturbance. The Physical Activity Body Experiences Questionnaire (PABEQ) was rationally derived as a measure of embodiment based on focus groups, literature reviews, and expert review. The PABEQ and measures of body image, self-objectification, and disordered eating were administered to two samples randomly selected from a pool of 606 female undergraduate students at least 18 years of age and a third test-retest sample of 58 female undergraduates. Exploratory factor analyses and reliability estimates supported a two-factor scale: Mind-Body Connection and Body Acceptance. Results indicated the utility of the subscales in predicting body awareness, body responsiveness, positive body image, body satisfaction, self-objectification, disordered eating, and positive body image.

Prevention of eating disorders: 2018 in review.

This article reviews the 10 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2018. Two models frame this analysis. This first is the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment (recovery). The second parses the phases of prevention into rationale, theory, and methodology → clarification of risk factors, including very high risk, shading into warning signs → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. Collectively, the articles illustrate how complex and demanding the field of prevention is, with respect to, for example, phases of program development, the multidimensional ecology of interventions, and methodological requirements for demonstrating that a program deserves to be designated "evidence-based." A subset of the articles also illustrates how far the increasingly broad and dynamic field of prevention has advanced. Examples include models of eating disorder development in high-risk populations such as people with type 1 diabetes; prevention programming for young children; and after-school preventive interventions that combine dissonance-based lessons with empowering participation in community advocacy and activism.

The relationship between risk of eating disorders, age, gender and body mass index in medical students: a meta-regression.

PURPOSE: Age, gender and body mass index (BMI) are commonly described risk factors for the development of eating disorders. However, the magnitude of these factors (individually and together) is still not well-defined in some populations. METHODS: A systematic search was performed for studies that reported the prevalence of eating disorder risk among medical students using the Eating Attitudes Test-26 (EAT-26) and age, gender and BMI as risk factors. We included studies published in English peer-reviewed journals between 1982 and 2017. A total of 14 studies were included in the analyses, and the meta-regression analyses were performed using mean age (years), gender (proportion of female subjects), and mean BMI (kg/m2) as moderators with the risk of eating disorders measured using EAT-26 as an outcome variable. Four interaction terms were created (1) age × gender (2) age × BMI (3) gender × BMI and (4) age × gender × BMI to assess if two or more independent variables simultaneously influence the outcome variable. RESULTS: Utilizing the EAT-26, the pooled prevalence of at risk for eating disorders among medical students (k = 14, N = 3520) was 10.5% (95% CI 7.3-13.7%). Meta-regression model of age, gender and BMI alone revealed poor predictive capabilities. Meta-regression model of age × gender × BMI interaction revealed statistically significant results with a covariate coefficient of 0.001 and p value of 0.044. CONCLUSION: Results from this sample of medical students provided evidence for the role of interactions between risk factors (e.g., age × gender × BMI) in predicting individuals at risk for eating disorders, whereas these variables individually failed to predict eating disorders. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis.

Universal prevention of eating disorders: A concept analysis.

The definition of universal prevention is important for theoretical, research, and policy-related reasons. The present article provides an etymological and historical look at the concept of universal prevention, in and of itself and in terms of its position on the mental health intervention spectrum involving mental health promotion, selective prevention, indicated prevention, case identification, and treatment. Following a summary of the features commonly associated with universal prevention, these characteristics are fashioned into a family resemblance model for defining the construct. This model is applied to four of the articles constituting the journal Eating Behaviors' special issue on the universal prevention of eating disorders. It is argued that this family resemblance approach captures the diversity of current universal approaches to reducing risk factors and/or preventing eating disorders. This type of definition, coupled with Foxcroft's (2014) tripartite functional analysis of universal prevention, has the potential to improve evaluations of universal prevention, as well as large-scale collaborative projects that seek to integrate programs across the mental health intervention spectrum.

V.I.K. (Very Important Kids): a school-based program designed to reduce teasing and unhealthy weight-control behaviors.

The purpose of this study was to evaluate the feasibility and effectiveness of V.I.K. (Very Important Kids), a school-based, multi-component intervention designed to prevent teasing and unhealthy weight-control behaviors among fourth through sixth grade students. The effectiveness of the V.I.K. intervention was evaluated using a pre-post quasi-experimental design with one school assigned to each condition: intervention and assessment-only control. Data were collected at baseline and at 8-month post-test among 63 students at the intervention school and 57 students at the control school. The V.I.K. intervention included an after-school program, a theater program, school environment components and a family component. Process data suggest that the V.I.K. program can feasibly be implemented within a school setting and can effectively engage students, school staff and parents. Analysis of impact data revealed that the percentage of students reporting being teased decreased significantly in the intervention school relative to the control school, after controlling for baseline levels of teasing, body mass index z score and demographic factors (odds ratio = 0.22; 95% confidence interval = 0.06, 0.88; P = 0.03). These findings provide promising evidence that multi-component, school-based interventions may effectively reduce teasing in elementary schools. Future research of interventions aimed at preventing teasing using a larger sample of schools is warranted.

Prevention of body dissatisfaction and disordered eating: What next?

Eating disorder prevention is a young field that has made significant strides in the past two decades. It is timely to take a look back at what we have learned during this period in order to begin to address the question, "What next?" This paper considers several key issues based upon a review of the literature and the authors' perspectives. Topics discussed include: (1) environmental approaches; (2) global mental health versus eating disorder specific interventions; (3) participatory approaches; (4) the integration of obesity and eating disorder prevention; (5) boys; (6) program evaluation; and (7) whether we know enough to move ahead.

The role of body image in the prevention of eating disorders.

This article reviews theory and research pertaining to prevention of negative body image and eating disorders. Research derived from the social cognitive model (SCM) and non-specific vulnerability-stressor (NSVS) model indicates that sustained prevention effects for attitudes and behaviors are possible, but not easy to achieve or explain. These limitations are considered in the context of promising research derived from a third model, critical social perspectives (CSP). We conclude that (1) research on practice should aim beyond the examination of efficacy in order to clarify the active ingredients contributing to prevention; and (2) research informed by each of the divergent perspectives can be used to enrich theory and practice in the field of eating disorders prevention.

The effect of experimental presentation of thin media images on body satisfaction: a meta-analytic review.

OBJECTIVE: The effect of experimental manipulations of the thin beauty ideal, as portrayed in the mass media, on female body image was evaluated using meta-analysis. METHOD: Data from 25 studies (43 effect sizes) were used to examine the main effect of mass media images of the slender ideal, as well as the moderating effects of pre-existing body image problems, the age of the participants, the number of stimulus presentations, and the type of research design. RESULTS: Body image was significantly more negative after viewing thin media images than after viewing images of either average size models, plus size models, or inanimate objects. This effect was stronger for between-subjects designs, participants less than 19 years of age, and for participants who are vulnerable to activation of a thinness schema. CONCLUSION: Results support the sociocultural perspective that mass media promulgate a slender ideal that elicits body dissatisfaction. Implications for prevention and research on social comparison processes are considered.