Further evidence of the association between social media use, eating disorder pathology and appearance ideals and pressure: a cross-sectional study in Norwegian adolescents.

BACKGROUND: Few studies have investigated how the plethora of contemporary social media (SM) platforms relate to, and influence eating disorder (ED) pathology, appearance ideals and pressure to conform to these ideals in youth. METHODS: In this study, 1558 girls (53%) and boys (47%), predominantly within the 16-19 age range, completed an online questionnaire assessing SM use and perceived influence on appearance, ED pathology, internalization of appearance ideals and perceived appearance pressure. RESULTS: Results showed that ED pathology was common, particularly in girls, and that internalization of body ideals was gender specific, a thin ideal being more prevalent in girls, and a muscular ideal being more common in boys. Results also showed a strong association between ED pathology and perceived pressure to conform to these appearance ideals. One fourth of the participants reported spending four hours or more on SM daily, and 80% of girls reported that SM, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media. CONCLUSION: A clear pattern of associations between photo- and video specific SM platforms, ED pathology, internalization of body ideals and perceived pressure was found in this study. Adolescent girls appeared to be particularly at risk. The results illustrate an imperative need to keep addressing the potential risks of SM use in adolescents, and to continue monitoring the effect of SM on young people's view of themselves, their appearance, and their eating habits. Future studies should attempt to identify aspects of SM use that may be particularly detrimental for girls and boys in their formative years, but also those that may enhance adolescents' satisfaction and appreciation of their body and appearance. TRIAL REGISTRATION: The study is registered in the Open Science Framework (Identifier: 10.17605/OSF.IO/5RB6P https://doi.org/10.17605/OSF.IO/5RB6P ).

Social Media (SM) has become an increasingly influential part of people's everyday life, and has transformed the patterns of communication, especially in teenagers. In this study, we investigated the relationship between eleven commonly used SM platforms in adolescents, eating disorder (ED) pathology, appearance ideals, and pressure to conform to these ideals. A little over 1500 adolescent girls and boys, predominantly within the 16-19 age range, participated in the study. Most girls who participated reported that SM use, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media. Future studies should attempt to identify aspects of SM use that are particularly harmful for girls and boys in their formative years, but also those who have the potential of strengthening the sense of self-worth and contribute to positive identity formation.

The "Young Athlete Body Project"-A pilot study evaluating the acceptability of and results from an eating disorder prevention program for adolescent athletes.

BACKGROUND: The high frequency of eating disorders (EDs) in sports speaks of a need for early-stage preventive measures. OBJECTIVES: This study evaluated the acceptability of an age, sex, and sports adapted version of the "Body Project" and changes in mental health symptoms. METHODS: This noncontrolled pilot study included a class of athletes from 18 sports (N = 73, 13-14 years) at a sport-specialized junior high school in six small-group workshops. We interviewed 34 athletes on program acceptability, and all athletes responded to questionnaires at pretest, posttest, and 6-month follow-up including the Body Appreciation Scale 2-Children, Social Attitudes towards Appearance Questionnaire-4 revised, Eating Disorder Examination Questionnaire Short form-12 modified, and questions about body appearance pressure (BAP). RESULTS: Athletes found the program acceptable and beneficial, but some missed physically oriented activities or did not identify with the focus, particularly boys. There were acceptable levels in mental health constructs before the workshops. There were temporary changes in the percentage of boys experiencing "BAP in society" by -14.8% points (95% CI: -.6 to .0, p = .04), % in total group experiencing "BAP at school" by +11% points (95% CI: .0-.2, p = .05), thinness idealization by girls (g = .6, p = .002) and total group (g = .4, p = .006), and muscularity idealization by boys (g = .3, p = .05) and total group (g = .23, p = .04). DISCUSSION: Athletes experienced benefits from the Young Athlete Body Project. Seeing stabilization in outcomes may mean a dampening of the otherwise expected worsening in body appreciation and ED symptoms over time. PUBLIC SIGNIFICANCE: Adolescent athletes are at risk for developing EDs. Due to lack of prevention programs for this group, we adapted and evaluated a well-documented effective program, the Body Project, to fit male and female athletes <15 years. The athletes accepted the program and experienced participation benefits, with stronger acceptance among girls. Our promising findings encourage larger scaled randomized controlled trials to further evaluate a refined version this program among very young athletes.

Associations of adherence to physical activity and dietary recommendations with weight recurrence 1-5 years after metabolic and bariatric surgery.

BACKGROUND: Little is known about longer-term adherence to recommended physical activity (PA) and dietary behaviors after metabolic and bariatric surgery (MBS) and whether adherence is associated with weight recurrence. OBJECTIVES: To explore (1) changes in and associations between adherence to PA and general dietary recommendations after MBS and (2) whether PA and dietary behaviors interact to predict weight recurrence. SETTING: University hospital; public practice. METHODS: Participants completed ActiGraph PA monitoring, dietary questionnaire, and weighing 1 and 5 years after surgery. Parametric and non-parametric tests evaluated changes in and associations between adherence to PA and dietary recommendations. Multiple linear regression explored associations of adherence and weight recurrence 5 years post-surgery. RESULTS: A total of 73 participants (66% loss to follow-up, 80.8% females) were included. From 1 to 5 years after surgery, adherence to PA recommendations did not change (23.5% versus 20.5%, P = .824), whereas adherence to dietary recommendations decreased (P = <.001). Adherence to PA recommendations is positively associated with eating fruits and vegetables and limiting intake of sugar and fat at 1 year (P < .05) and negatively associated with choosing meat with less fat at 5 years (P = .018). Adherence to PA and dietary behaviors did not independently contribute or interact to predict weight recurrence. CONCLUSIONS: Adherence to recommendations was poor. Dietary adherence decreased from 1 to 5 years post-surgery, whereas PA adherence remained stable. PA adherence was positively associated with adherence to some dietary recommendations at 1 year but not at 5 years. Neither behavioral adherences were associated with weight recurrence. Additional research is needed to understand how to improve adherence and its relationship with other health outcomes after MBS.

Siblings, shopping, and sustainability: Birth-order differences in green consumption.

Several studies have examined the role of birth order in shaping human personality, but fewer have tested this variable in relation to other pressing issues. We conducted a birth-order study on green consumption, which enabled us to detect a small-to-moderate effect size equivalent to r = 0.15 or d = 0.30 with sufficient statistical power (N = 335). To capture green consumption, participants indicated their tendency to express the value of environmental protection through purchases and consumption behaviors. Firstborns (vs. laterborns) consistently expressed lower concerns linked to environmental protection in their purchase patterns. While the effect size of this finding was small-to-moderate by conventional standards and in direct contrast to the findings from a recent article on the same topic, these results could still be informative to address challenges associated with climate change considering the number of individuals with siblings in the world and the ease with which birth-order data can be collected.

Hiking, indoor biking, and body liking: a cross-sectional study examining the link between physical activity arenas and adults' body appreciation.

BACKGROUND: Body appreciation might serve as a protective factor for developing eating disorders and is associated with participation in physical activity. Less is known about whether various arenas for physical activity may be linked to body appreciation. Therefore, the current study sought to (1) identify potential associations between physical activity level and arenas for physical activity, connectedness with nature, self-compassion, and body appreciation in adults, and (2) explore physical activity level and arenas, connectedness with nature, and self-compassion as explanatory factors for body appreciation. METHODS: A total of 360 adult Norwegian inhabitants (75% women, mean (SD) age 42.58 (12.30) yrs) responded to an online questionnaire. Instruments included the Body Appreciation Scale, the Connectedness with Nature Scale, and the Self-Compassion Scale. RESULTS: The percentage of participants who engaged in various physical activity arenas were 98.5% for nature, 57.5% for fitness centers, and 43.0% for organized sports. Small, positive associations were found between body appreciation and the frequency of using fitness centers and nature as physical activity arenas. Self-compassion, connectedness with nature, and frequency of using fitness centers and nature as physical activity arenas explained 39% of the variance in body appreciation. DISCUSSION: The importance of both fitness centers and nature as arenas for physical activity to explain body appreciation was surprising and might reflect different use of fitness centers among adults compared to younger age groups. CONCLUSION: Physical activity at fitness centers and in nature were positively associated with body appreciation in adults. Self-compassion, connectedness with nature, and using fitness centers and nature as arenas for physical activity, were found to explain variation in body appreciation in adults.

Physical activity helps us feel good about ourselves and appreciate our bodies. However, less is known about the extent to which different arenas for physical activity are related to body appreciation. Therefore, 360 adults from Norway completed a survey with questions about their physical activity level, use of nature, fitness centers, and organized sports as arenas for physical activity, and measures linked to connectedness with nature, self-compassion, and body appreciation. We found an association between body appreciation and performing physical activity at fitness centers and in nature. Physical activity at these two arenas together with self-compassion and connectedness with nature explained body appreciation in these adults. Future studies should focus on the adolescent population, where the level of body appreciation tend to be lower and where organized sports, in addition to fitness centers, constitute an even more commonly used physical activity arena.

Intervention in professional dance students to increase mental health- and nutrition literacy: A controlled trial with follow up.

Introduction: There is a need to change the culture within the art of dance, as it has been associated with injuries and mental health consequences. This study evaluates an intervention designed to increase mental health literacy, enhance nutritional knowledge, reduce symptoms and effects of low energy availability, and strengthen understanding of sports nutrition and recovery strategies, in dance students of mixed genders. Material and methods: A total of 125 dance students received three workshops, with 39 arts and crafts students serving as references. The results were evaluated by the Eating Disorder Examination questionnaire, the Low Energy Availability in Females questionnaire, the Hopkins Symptom Check List, and questions on mental health literacy, sports nutrition, and recovery knowledge. Results: Dance students achieved sustained improvements in mental health and nutrition knowledge and temporary improvements in driven exercise (i.e., performing exercise because of a compulsive drive). No other benefits were identified from the intervention. Conclusion: Our findings indicate the need for an ongoing education program to reduce the occurrence and development of negative mental health outcomes and low energy availability in professional dance students. Such approaches may not only improve the mental health of dance students but also potentially prevent the high frequency of injuries.

The Healthy Body Image Intervention and Reduction in Eating Disorder Symptomatology and Muscle Building Supplement Use in High School Students: A Study of Mediating Factors.

Background: Mediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image (HBI) intervention's effect on eating disorder (ED) symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use. Methods: This study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development including 30 schools in Norway. A total of 1,713 (37% boys) participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators. Results: In girls, the reduction in ED symptomatology was mediated by positive changes in protective factors (self-esteem and body image flexibility) and reductions in risk factor scores (perceived media pressure and thin appearance internalization). Comparable changes in protective and risk factors among boys played no mediating role. Conclusion: Interventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys.

Explanations for use of dietary- and muscle enhancing dietary supplements among university students: a national cross-sectional study.

BACKGROUND: Use of dietary supplements (DS) and muscle enhancing dietary supplements (MEDS) is frequent among students despite the lack of evidence of effects and health risks related to consumption. We need to increase our understanding of students' motivation, examine potential gender differences, and explore explanatory factors, to address preventive measures related to use. Therefore, this study aimed to explore the frequency of, and the reasons for, DS use among university students, as well as explanatory factors for use of MEDS. METHOD: Male and female students from nine Norwegian universities participated in this cross-sectional study. Participants responded to questions about demographics, DS and MEDS use, internalization of body ideals, physical activity- and exercise level, motives for exercise, and exercise context. Independent t-test, Chi-square test, Pearson's correlation, and logistic regression were used to investigate between group differences, associations, and explanatory factors for use, respectively. P-values ≤ 0.05 were defined as significant. RESULTS: A total of 1001 males (34%) and females, with a mean(sd) age of 24.21(4.76) years, participated. The frequency of DS use was 42% and 40% (p = .414) in males and females, respectively, in which more males than females used DS to improve physical or mental performance (p = < .001), increase muscle mass (p = < .001) and weight for health (p = .014), and improve appearance (p = < .001). In males and females, respectively, 25% and 10% used MEDS (p = < .001). In males, being a fitness center member (OR:3.80), exercising to improve muscle mass (OR:1.96), and a higher physical activity level (OR:1.09) positively explained MEDS use, while exercising to increase endurance (OR:0.49) and being an exercise science student (OR:0.47) negatively explained MEDS use. In females, internalizing the athletic body ideal (OR:1.78) and exercising to improve muscle mass (OR:1.74) positively explained MEDS use. CONCLUSIONS: Our main findings indicate that a surprisingly high percentage of male and female Norwegian students use DS and MEDS, and that reasons for use, and variables explaining the variability in frequency of use, differ between genders. Longitudinal studies to investigate direction of associations are needed in future research.

Protein, Creatine, and Dieting Supplements Among Adolescents: Use and Associations With Eating Disorder Risk Factors, Exercise-, and Sports Participation, and Immigrant Status.

Objective: This study aimed to estimate the number of weekly users of protein, creatine, and dieting supplements and to explore whether weekly use was related to eating disorder (ED) risk factors, exercise, sports participation, and immigrant status. Methods: In total, 629 and 1,060 high school boys and girls, respectively, self-reported weekly frequency of protein, creatine, and dieting supplement use, and weight and shape concerns, appearance internalization and pressure, self-esteem, mental distress, physical activity level, exercise context, and the type and weekly frequency of sport played. Multiple hierarchical regression analyses were performed to investigate explanatory factors for supplement use. Results: More boys than girls used protein and creatine supplements. Immigrant boys had more frequent use of all supplements than non-immigrant boys, and immigrant girls used creatine supplements more frequently than non-immigrant girls. In total, 23-40 and 5-6% of the variation in the weekly frequency of supplement use in boys and girls, respectively, was explained by immigrant status, ED risk factors, and exercise and sports participation. More frequent use of protein, creatine and dieting supplements in boys was significantly explained by more weight and shape concerns, fitness center exercise, and weight-sensitive sports participation. Depending on the type of supplement, more frequent use of supplements in girls was significantly explained by lower self-esteem, more engagement in weight-sensitive sports, and less engagement in general sport and exercise activities. Conclusion: Weekly supplement use was common and more frequent among boys than girls. The weekly use of protein, creatine, and dieting supplements was related to ED risk factors, exercise and sports participation, and immigrant status in boys but not in girls.

Sexual Harassment in Fitness Instructors: Prevalence, Perpetrators, and Mental Health Correlates.

Introduction: This paper explores frequency of experiences of sexual harassment (SH) among fitness instructors, outlines the typical perpetrator, and explores associated mental health symptoms. Design: Cross-sectional survey. Materials and Methods: A total of 270 Norwegian fitness instructors, recruited in social media, responded to an electronic questionnaire in 2019/2020 on experiences of body appearance pressure, SH, and mental health symptoms. Outcomes included in this publication are experiences of SH, and symptoms of mental health issues based on the Hopkins symptom checklist, SCL-10; Beck Depression Inventory, BDI-1a; and Eating Disorder Examination Questionnaire, EDE-q. Results: The frequencies of SH experiences were 30% among 211 women and 22% among 59 men, respectively, with customers being the most frequent source of such approaches and personal trainers (PTs) more often reporting such experiences compared to group instructors (GIs) and to those operating as both PT and GI. Women having experienced SH had significantly higher scores in symptoms of depression, anxiety, and eating disorders compared to women with no such experience. Conclusion: The high frequency of SH experiences among fitness instructors, with customers emerging as perpetrators and typically in the context of personal training, necessitates increased awareness of SH in the fitness industry. To reduce the occurrence of SH, the fitness centers need to communicate countermeasures with high level of compliance.

Body appreciation and body appearance pressure in Norwegian university students comparing exercise science students and other students.

BACKGROUND: Body image is considered a core issue for public health and associates with university students' overall health. Due to positive associations between exercise and body image, it has been suggested that students within an exercise science program might be more body appreciative compared to other students. On the other hand, the strong societal idealization of the athletic body may expose them to a pressure of having a specific body appearance, which may result in unfavorable health consequences. Nevertheless, studies investigating these hypotheses are lacking. We therefore aimed to explore the level and associations of body appreciation, body appearance pressure, body image related mental health constructs, physical activity, and exercise, in Norwegian university exercise science and non-health reference students. METHOD: Male and female exercise science students (n = 517) and reference students (n = 476), from nine large universities in Norway took part in this cross-sectional study. Participants responded to the Body appreciation scale-2, a self-developed questionnaire on body appearance pressure, Physical Appearance Comparison Scale-Revised, Sociocultural attitudes towards appearance questionnaire-4R, Rosenberg Self-Esteem Scale, Satisfaction with Life Scale, and questions about physical activity and exercise. Between group differences were analyzed using student independent t-test and ANCOVA for parametric data and Chi-square test for categorical data, and associations were evaluated by Person's correlation. P-values ≤0.05 were defined as significant. RESULTS: Female exercise science students had higher scores on body appreciation compared to reference students. No group difference was found in males. A high percentage of students reported experiencing body appearance pressure, with 69 and 85% among male and female exercise science students, and 57 and 83% among male and female reference students. Fitness centers were the settings where most respondents experienced body appearance pressure. Body appreciation was strongly associated with favorable scores on body image related mental health constructs, while personally experienced body appearance pressure associated with destructive scores on the same constructs. CONCLUSION: Body appearance pressure is an issue among university students regardless of study program. Actions to promote body appreciation and prevent body appearance pressure may include an implementation of media literacy, body functionality, and exercise as topics within the education program to safeguard students' health and well-being. CLINICAL TRIAL REGISTRY: No. NCT04256967 .

The Impact of Covid-19 Pandemic Lockdown During Spring 2020 on Personal Trainers' Working and Living Conditions.

Purpose: The aim of this study was to map changes in working and living conditions of Norwegian personal trainers (PTs) during the Covid-19 lockdown spring 2020. Methods: A total of 150 PTs (mean (SD) age 35.5 (8.4) years, with 6.5 (5.3) years of experience as PT, and 61% female) in Norway responded to an online survey. Results: Number of PT sessions per week was reduced during the lockdown and the majority of the respondents reported loss of clients and negative impact on their working conditions. The official restrictions and guidelines were considered difficult to interpret and somewhat discriminatory compared to restrictions and guidelines for other comparable exercise occupational groups. The lockdown period provided more PTs to offer online and outdoor training. Living conditions were also affected with reported impairments in private economy and reduced vitality (p < 0.05), and with vitality being lower in female compared to male respondents during, but not before, the lockdown period. Discussion: The reported negative impact of the Covid-19 lockdown period on PTs' working and living conditions are discussed with focus on the reported gender differences and considering the previously reported poor reputation of the fitness industry.

The Norwegian healthy body image intervention promotes positive embodiment through improved self-esteem.

We examined both direct and indirect effects of the Healthy Body Image (HBI) intervention on positive embodiment among Norwegian high school students. In total, 2446 12th grade boys (43 %) and girls (mean age 16.8 years) from 30 schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. We tested mediation models using path analysis and found that among several hypothesized mediators, only self-esteem mediated a positive intervention effect on positive embodiment for both boys and girls. A direct effect of the intervention on positive embodiment was only found in girls. The study provides novel findings indicating that health promotion interventions to address a positive embodiment should focus on enhancing adolescent's self-esteem. Serial mediation modeling might reveal more complex explanations of change mechanisms and could further evolve current knowledge.

Body Figure Idealization and Body Appearance Pressure in Fitness Instructors.

PURPOSE: The fitness centers are settings for health promotion, yet may serve as a stage for counterproductive figure idealization. Such idealization may take the form of a drive toward the thin, the muscular, or lean body figure ideal, which all hold the potential to impel an experience of body appearance pressure (BAP) and body dissatisfaction. The aim of this study was to explore figure idealization, body dissatisfaction, and experience of BAP in fitness instructors. MATERIALS AND METHODS: Fitness instructors, 70 (23%) males and 236 (77%) females, were recruited through their facility chief executive officer and social media for a digital survey on mental health. Results are presented for body appreciation (BAS-2), body dissatisfaction (EDI-BD), drive for muscularity (DM), drive for leanness (DLS), questions on BAP, symptoms of eating disorders (EDE-q), and history of weight regulation and eating disorders (EDs). RESULTS: Attempts to gain body weight were reported by 17% of females and 53% of males, whereas ∼76% of males and females, respectively, reported to have attempted weight reduction. Reasons for body weight manipulation were predominantly appearance related, and 10-20% reported disordered eating behavior. Mean BAS-2 and EDI-BD were acceptable, but 28% of females were above clinical cutoff in EDI-BD, and mean DLS were high in both sexes. In total, 8% of females were above clinical cutoff in EDE-q, which corresponded well with the self-reported ED. Approximately 90% of the sample perceived BAP to be a societal issue and reported predominantly customers and colleagues to be the cause of their personal experience of BAP. Fewer than 50% knew of any actions taken by their employer to reduce BAP. There were few differences according to profession or educational level. CONCLUSION: Fitness instructors report BAP to affect them negatively, which may put them at risk of impaired mental health. Educational level did not protect against figure idealization and BAP. To care for their employees and to optimize their position as a public health promoter, the fitness industry should target BAP in health promotion programs.

Does the Healthy Body Image program improve lifestyle habits among high school students? A randomized controlled trial with 12-month follow-up.

OBJECTIVES: Positive embodiment and healthy lifestyle habits seem to be related; therefore, stimulating positive embodiment should promote healthy lifestyle habits. In the current study, we delivered the Healthy Body Image (HBI) intervention among Norwegian high school students and examined the effects on healthy lifestyle habits. METHODS: The HBI intervention comprises three interactive workshops, with three overarching themes related to body image, social media literacy, and lifestyle. A total of 2446 boys (43%) and girls in grade 12 (mean age 16.8 years) from 30 high schools participated in this cluster-randomized controlled study. Schools were randomized to the HBI intervention or control study arm. Data on physical activity, eating habits, and sleep were collected at baseline, post intervention, and 3- and 12-month follow-up and analyzed using linear mixed regression models. RESULTS: The intervention had a minor negative effect on physical activity levels in boys at 12-month follow-up and short-term small-to-moderate positive effects on consumption of breakfast and fruit and vegetables, and sleep duration on school days. CONCLUSIONS: In future, the lack of satisfactorily long-term effects might be better addressed using a combination of cognitive and behavioral approaches to more optimally integrate positive embodiment and lifestyle changes in the daily life of adolescents.Trial registration: ClinicalTrials.gov ID: PRSNCT02901457. Approved by the Regional Committee for Medical and Health Research Ethics.

Elite athletes get pregnant, have healthy babies and return to sport early postpartum.

OBJECTIVES: To enhance knowledge on pregnancy and return to sport in the postpartum period in elite female athletes. METHODS: 34 Norwegian elite athletes (33.1 years) and 34 active controls (31.5 years) were asked about training and competitive history, pregnancy-related issues, injuries, body dissatisfaction (BD), drive for thinness (DT), eating disorders (ED) and practical experiences, through a questionnaire and interview. Independent samples T-tests or χ² tests for between-group differences and paired-samples T-tests and repeated measures analysis of variance for within group differences were used. RESULTS: No group differences in fertility problems, miscarriage, preterm birth or low birth weight were found. Both groups decreased training volume all trimesters and the first two postpartum periods compared with prepregnancy, and more athletes returned to sport/exercise at week 0-6 postpartum. We found no group differences in complications during pregnancy and delivery, but athletes reported fewer common complaints. Four athletes experienced stress fracture postpartum. Athletes had higher BD and DT postpartum, while controls reduced DT score. Number of athletes with clinical ED was reduced postpartum, while constant in controls. Athletes were not satisfied with advice related to strength training and nutrition during pregnancy. CONCLUSION: Elite athletes and active controls get pregnant easily, deliver healthy babies and decrease training during pregnancy and the first postpartum periods compared with prepregnancy. Most athletes and every third control returned to sport or exercise at week 0-6 postpartum. Athletes report stress fractures and increased BD and DT, but decreased ED postpartum. However, since relatively few athletes were included these findings need further investigation.

The healthy body image (HBI) intervention: Effects of a school-based cluster-randomized controlled trial with 12-months follow-up.

We examined the effects of the Healthy Body Image (HBI) intervention on positive embodiment and health-related quality of life among Norwegian high school students. The intervention comprised three interactive workshops, with body image, media literacy, and lifestyle as main themes. In total, 2,446 12th grade boys (43%) and girls (mean age 16.8 years) from 30 high schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. Data were collected at baseline, post-intervention, 3- and 12-months follow-up, and analysed using linear mixed regression models. The HBI intervention caused a favourable immediate change in positive embodiment and health-related quality of life among intervention girls, which was maintained at follow-up. Among intervention boys, however, weak post-intervention effects on embodiment and health-related quality of life vanished at the follow-ups. Future studies should address steps to make the HBI intervention more relevant for boys as well as determine whether the number of workshops or themes may be shortened to ease implementation and to enhance intervention effects.

The Norwegian healthy body image programme: study protocol for a randomized controlled school-based intervention to promote positive body image and prevent disordered eating among Norwegian high school students.

BACKGROUND: Body dissatisfaction and disordered eating raise the risk for eating disorders. In the prevention of eating disorders, many programmes have proved partly successful in using cognitive techniques to combat such risk factors. However, specific strategies to actively promote a positive body image are rarely used. The present paper outlines a protocol for a programme integrating the promotion of a positive body image and the prevention of disordered eating. METHODS AND DESIGN: Using a cluster randomized controlled mixed methods design, 30 high schools and 2481 12th grade students were allocated to the Healthy Body Image programme or to a control condition. The intervention comprised three workshops, each of 90 min with the main themes body image, media literacy, and lifestyle. The intervention was interactive in nature, and were led by trained scientists. The outcome measures include standardized instruments administered pre-post intervention, and at 3 and 12 months follow-ups, respectively. Survey data cover feasibility and implementation issues. Qualitative interviews covers experiential data about students' benefits and satisfaction with the programme. DISCUSSION: The present study is one of the first in the body image and disordered eating literature that integrates a health promotion and a disease prevention approach, as well as integrating standardized outcome measures and experiential findings. Along with mediator and moderator analyses it is expected that the Healthy Body Image programme may prove its efficacy. If so, plans are made with respect to further dissemination as well as communicating the findings to regional and national decision makers in the education and health care services. TRIAL REGISTRATION: The study was registered and released at ClinicalTrials.gov 21th August 2016 with the Clinical Trial.gov ID: PRSNCT02901457 . In addition, the study is approved by the Regional Committee for Medical and Health Research Ethics.