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

OBJECTIVE: To evaluate the efficacy of the Female Athlete Body project (FAB) in reducing eating disorder (ED) symptoms and risk factors. METHOD: This study was a community participatory three-site, two-arm, cluster randomized controlled trial (RCT). Female collegiate athletes (N = 481) were randomly assigned by team to the FAB intervention, a behavioral ED risk factor reduction program, or a waitlist control condition. Primary analyses examined 18-month effects for ED pathology. Secondary analyses examined risk factors and correlates (e.g., thin-ideal internalization, negative mood, Female Athlete Triad knowledge, and body mass index [BMI]). RESULTS: Linear mixed effects models with team as a cluster level variable and study condition as a between-subjects variable revealed significantly reduced dietary restraint in FAB teams relative to control teams. FAB teams also reported significantly fewer objective and subjective binge episodes than control teams. Finally, FAB teams showed significantly lower thin-ideal internalization and increased BMI at 18-months. No other significant differences were found. DISCUSSION: This RCT examined the effects of a short intervention on ED pathology and risk factors in female collegiate athletes through 18-month follow-up. This trial is one of only three trials with female athletes that have shown long-term reductions in any ED symptoms or produced positive effects on ED risk factors. The present study is the first to find such effects with athletes using a brief (i.e., 4 hr) intervention at 18-month follow-up. Although small effects were found, the current trial provides valuable lessons about future design and implementation of similar trials with athletes. TRIAL REGISTRATION: Clinical trials NCT01735994.

The Athletes' Relationships with Training scale (ART): A self-report measure of unhealthy training behaviors associated with eating disorders.

OBJECTIVE: Several studies indicate that eating-disorder (ED) psychopathology is elevated in athletes compared to non-athletes. The assessment of excessive exercise among athletes is a challenge because, compared to non-athletes, athletes are required to train at higher intensities and for longer periods of time. However, individuals participating in competitive sports are still susceptible to unhealthy physical-activity patterns. Most ED assessments were developed and normed in non-athlete samples and, therefore, do not capture the nuances of athletes' training experiences. The purpose of the current study was to develop and validate a clinically useful, self-report measure of unhealthy training behaviors and beliefs in athletes, the Athletes' Relationships with Training Scale (ART). METHOD: The initial item pool was administered to N = 267 women collegiate athletes who were participating in an ED prevention program study and N = 65 women athletes who were in ED treatment. RESULTS: Factor analyses indicated the ART had a four-factor structure. Factorial and construct validity of the ART were demonstrated. ART scores significantly predicted health care utilization and differed between athletes with an ED versus athletes without an ED. For athletes in ED treatment, ART scores significantly decreased from treatment admission to discharge. DISCUSSION: The ART showed evidence of strong psychometric properties and clinical utility. The ART could be helpful for clinicians and athletic trainers to help gauge whether athletes are engaging in unhealthy training practices that may warrant clinical attention and for tracking clinical outcomes in athletes with EDs who are receiving treatment.

Effectiveness of a peer-delivered dissonance-based program in reducing eating disorder risk factors in high school girls.

OBJECTIVE: This pilot study investigated the feasibility, acceptability, and effectiveness of a peer-led dissonance-based eating disorders (ED) prevention/risk factor reduction program with high school girls. METHOD: Ninth grade girls (n = 50) received the peer-led program within the school curriculum. A quasi-experimental design was used to assess changes in ED risk factors preintervention and postintervention compared with waitlist control. Participants were followed through 3-month follow-up. RESULTS: Peer-leader adherence to an intervention manual tailored for this age group was high. The intervention was rated as highly acceptable, with a large proportion of participants reporting that they enjoyed the program and learned and applied new information. Intervention participants exhibited significantly greater pre-post reductions in a majority of risk-factor outcomes compared to waitlist controls. When groups were combined to assess program effects over time there were significant pre-post reductions in a majority of outcomes that were sustained through 3-month follow-up. DISCUSSION: This pilot study provides tentative support for the effectiveness of using peer leaders to implement an empirically supported ED risk factor reduction program in a high school setting. Additional research is needed to replicate results in larger, better-controlled trials with longer follow-up.

Food insecurity, weight-based discrimination, weight self-stigma, and mental health in post-bariatric surgery patients.

The United States Department of Agriculture defines food insecurity (FI) as reduced quality and variety of diet or overall reduced food intake. To date, limited research has investigated the relationship between FI, weight stigma, and bariatric surgery. The existing literature suggests that FI in bariatric surgery patients is significantly associated with being a person of color, depression, receiving Medicare or Medicaid, and higher eating disorder (ED) pathology. Research also suggests that weight stigma in bariatric surgery patients is associated with worsened weight loss outcomes. No research to our knowledge has investigated FI, internalized weight stigma, weight-based discrimination, and history of bariatric surgery in one sample. Bariatric surgery patients in this study (N = 266) reported elevated rates of FI relative to the general population, via an online questionnaire. Those with FI also reported higher rates of depression, anxiety, ED pathology, internalized weight stigma, and experiences of weight-based discrimination compared to those who were food secure. Given these findings, bariatric surgical centers should evaluate all potential patients for FI before surgery and, at the bare minimum, provide additional support before and post-surgery. The ethics of conducting bariatric surgery in those with FI who lack significant medical comorbidity also must be considered.

Posttraumatic stress disorder and other mental health correlates in a predominantly Latino/Hispanic sample living with food insecurity.

OBJECTIVE: Food insecurity (FI) is a global public health concern that is associated with psychopathology, including depression and anxiety. Individuals living with social disadvantages, such as experiencing low SES or being part of minoritized populations, are at higher risk of developing lifetime posttraumatic stress disorder (PTSD) following trauma exposure. Yet relatively little is known about PTSD prevalence rates and the potential mental health burden in populations with FI. The primary aim of this study was to investigate the prevalence rates and characteristics of PTSD and associated mental health burdens in a low SES, predominantly Latino/Hispanic sample with FI in the United States. METHOD: The study utilized self-report surveys in a cross-sectional design. Participants included 891 clients of a local urban food bank. RESULTS: In this sample, 45.8% reported experiencing one or more traumatic events and 17.4% met the clinical cutoff for PTSD. These results indicate that, while rates of traumatic event exposure are comparable to the general population, those experiencing FI report higher rates of PTSD. Of those with PTSD, 72.3% met the clinical cutoff for generalized anxiety disorder, 69% for depression, and 25.8% for an eating disorder (ED). Furthermore, PTSD symptom severity accounted for 43.6%, 29.6%, and 18.7% of the variance in linear regression models for depressive symptoms, anxiety symptoms, and ED pathology, respectively. CONCLUSIONS: The compounding mental health consequences of experiencing FI, PTSD, and other psychopathology needs further investigation. Moreover, affordable and accessible treatment models are imperative to address the needs of this low-SES population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mental health and quality of life in postmenopausal women as a function of retrospective menopause symptom severity.

OBJECTIVES: Perimenopause is commonly viewed as a window of vulnerability for developing psychiatric and eating disorders, especially for women who experience severe symptoms. However, menopausal symptoms may have a lasting effect on older women's mental health and quality of life (QOL) into postmenopause. The current study examined older (60+) postmenopausal women's mental health and QOL as a function of retrospective menopausal symptom severity. METHODS: Participants were recruited via public online postings and included 227 postmenopausal women, ages 60 to 94 years old (M = 68.84, SD = 6.53). Participants completed an online questionnaire to assess past menopausal symptoms as well as current depression, anxiety, sleep difficulties, binge eating, QOL, and demographics. The relation between the retrospective severity of menopausal symptoms and mental health/QOL was evaluated using linear regressions, while controlling for demographic covariates. RESULTS: Retrospective menopause symptom severity was significantly associated with depression, sleep difficulties, binge eating severity, and most QOL measures. Regarding covariates, having a psychiatric history was significantly associated with all outcome variables, except for anxiety. Time since menopause and body mass index were significantly associated with binge eating severity. Regarding specific symptom subgroups, psychological and somato-vegetative symptoms were most associated with mental health and QOL. CONCLUSION: The menopausal transition is a significant change in a woman's life and the challenges of menopausal symptoms can have lasting impacts on women's health. It is imperative that future research seeks to further understand the lasting impacts of this transition on the lives of older women to ensure proper interventions are implemented for successful aging.

Body image in adult women: Associations with health behaviors, quality of life, and functional impairment.

This study examined body image in adult women along with probable correlates including health behaviors, negative affect, quality of life, and functional impairment. Adult women (N = 738, age = 25-86 years) completed an online survey assessing these domains. Women across all ages reported similar body image concerns. Negative body image significantly correlated with poorer wellness behaviors, negative affect, quality of life, and functional impairment. The inverse held for positive body image. The majority of correlations remained even when controlling for negative affect. Further research is warranted to investigate nature of the correlational relationships identified in this study.

From Efficacy to Global Impact: Lessons Learned About What Not to Do in Translating Our Research to Reach.

Although members of the Association for Behavioral and Cognitive Therapies have made significant strides toward the collective goals outlined in our mission statement, we routinely acknowledge that our ability to develop empirically supported treatments exceeds our success in improving dissemination and implementation of said interventions. Further, as noted by Kazdin and Blase (2011), even if we succeeded in having every clinician worldwide administer our best treatments with excellent competency, we still would be unsuccessful in markedly impacting the worldwide burden of mental illness because most treatments require intensive labor by expensive providers. To this end, Kazdin and Blase and others call for increased use of alternative strategies. Examples include increased attention toward prevention; use of lower-cost, simplified interventions; task shifting; train-the-trainer models; community participatory research methodology; and identification of novel funding sources. The Body Project is an empirically supported, cognitive dissonance-based prevention intervention that targets body image, a well-established risk factor for eating disorders, negative affect, unhealthy weight control behaviors, smoking behavior, and decreased physical activity. Supported by a global village of researchers, community activists, and organizational partners, the Body Project is currently being implemented in 125 countries. The aim of this paper is to share lessons our team has learned in taking a prevention intervention from early testing to widespread implementation and connect these back to broader conversations occurring in our field regarding the importance of scalability and new directions in improving global mental health.

From efficacy to effectiveness to broad implementation: Evolution of the Body Project.

OBJECTIVE: At the turn of the millennium, eating disorders (EDs) prevention was largely nonexistent. No program had reduced future onset of EDs in even a single trial, and most had not reduced ED symptoms. Sixteen years later, the ED prevention field has translated basic risk factor research into interventions, with demonstrated efficacy and effectiveness in reducing ED risk factors and symptoms, as well as future ED onset in some trials. This article reviews the aforementioned progress focusing on a model intervention (i.e., the Body Project [BP]). METHOD: The article is a qualitative review of the existing BP literature. RESULTS: Although clinical psychology has struggled with bridging the research practice gap and translating efficacy and effectiveness research into clinical implementation, researchers, clinicians, and community stakeholders working with the BP have made significant progress in addressing barriers to scalability, large-scale implementation, and sustainability, reaching 3.5 million girls and young women in 125 countries. CONCLUSION: The successful evolution of the BP from basic research to traversing the efficacy-to-effectiveness-to-dissemination/implementation continuum has yielded significant public health impact and is thus a fitting case for this special issue commemorating the 125th anniversary of the American Psychological Association. The BP example may help others broadly implement efficacious interventions for other mental health problems. (PsycINFO Database Record

Mechanisms of action during a dissonance-based intervention through 14-month follow-up: The roles of body shame and body surveillance.

Objectification theory posits that internalization of societal perspectives about the female body leads to increased body surveillance, which can result in body-related shame and subsequent eating disorder (ED) behaviors. Preliminary research indicates that these associations may be complex in nature. This study examined temporal relations among body surveillance, body shame, and eating disorder symptoms in the context of a dissonance-based body image intervention and through 14-month follow-up. College women (N=285) completed assessments at baseline, post-intervention, and at 8-week, 8-month, and 14-month follow-up. Cross-lag panel analyses revealed that changes in body surveillance significantly mediated the association between body shame and ED symptoms over time. Alternatively, body shame did not change over time and was not a significant mediator of associations between body surveillance and ED symptoms longitudinally. Results indicate that the ameliorative effects of dissonance-based interventions may be due to reductions in body surveillance, rather than decreased body shame.

Long-term follow-up of patients with hypoparathyroidism.

CONTEXT: Despite tremendous interest in hypoparathyroidism, large cohort studies describing typical treatment patterns, laboratory parameters, and rates of complications are lacking. OBJECTIVE: Our objective was to characterize the course of disease in a large cohort of hypoparathyroid patients. DESIGN AND SETTING: We conducted a chart review of patients with permanent hypoparathyroidism identified via a clinical patient data registry. Patients were seen at a Boston tertiary-care hospital system between 1988 and 2009. PATIENTS: We identified 120 patients. Diagnosis was confirmed by documented hypocalcemia with a simultaneous low or inappropriately normal PTH level for at least 1 yr. Mean age at the end of the observation period was 52 ± 19 (range 2-87) yr, and the cohort was 73% female. MAIN OUTCOME MEASURE: We evaluated serum and urine laboratory results and renal and brain imaging. RESULTS: We calculated time-weighted average serum calcium measurements for all patients. The time-weighted average for calcium was between 7.5 and 9.5 mg/dl for the majority (88%) of patients. Using linear interpolation, we estimated the proportion of time within the target calcium range for each patient with a median of 86% (interquartile range 67-98%). Of those with a 24-h urine collection for calcium (n = 53), 38% had at least one measurement over 300 mg/d. Of those with renal imaging (n = 54), 31% had renal calcifications, and 52% of those with head imaging (n = 31) had basal ganglia calcifications. Rates of chronic kidney disease stage 3 or higher were 2- to 17-fold greater than age-appropriate norms. CONCLUSIONS: Hypoparathyroidism and its treatment carry a large burden of disease. Renal abnormalities are particularly common.

Exposure utilization and completion of cognitive behavioral therapy for PTSD in a "real world" clinical practice.

This study assessed rates of imaginal exposure therapy (ET) utilization and completion of cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) in a clinical setting and examined variables associated with CBT completion. Using a clinical definition, the completion rate of CBT was markedly lower than rates reported in randomized trials. CBT completion was inversely related to severity of overall pretreatment measures of PTSD, avoidance, hyperarousal, depression, impaired social functioning, and borderline personality disorder. Regression yielded avoidance and depression as unique predictors of completion. Most dropouts occurred before starting imaginal ET, although initiating ET was associated with greater likelihood of completion. Results highlight methodological differences between research and practice notions of treatment completion and the need for further study of variables influencing CBT completion in practice settings.

Comorbid anxiety disorders in civilians seeking treatment for posttraumatic stress disorder.

Research indicates that posttraumatic stress disorder (PTSD) is associated with high rates of comorbid psychiatric diagnoses. Yet, it remains unknown whether PTSD is associated with greater comorbidity relative to patients with other anxiety disorders. This study examined prevalence of comorbid anxiety disorders with PTSD relative to other disorders among a treatment-seeking population. Patients with PTSD (n = 83) evidenced greater overall comorbidity as compared to patients with other anxiety (n = 151) or Axis I (n = 73) disorders. Compared to patients with panic disorder, patients with PTSD were more likely to be diagnosed with depression and social phobia, but not other anxiety disorders. Extent of anxiety disorder comorbidity was not related to PTSD severity. These findings are discussed in terms of their relevance for treatment of PTSD.