The diabetes body project: Study protocol of a multi-site trial of a virtually delivered eating disorder prevention program for young women with type 1 diabetes.

AIM: Young women with type 1 diabetes are a high-risk population for eating disorders (ED). Prevention programs are lacking. In young women without diabetes, the Body Project has produced reductions in ED risk factors, ED symptoms and future ED onset. Therefore, the Body Project was adapted to type 1 diabetes, the Diabetes Body Project (DBP). In this protocol, we describe the multi-site randomized controlled trial (RCT) to evaluate efficacy of the DBP. METHODS: This is an ongoing RCT with four sites (Europe and US). In total 280, 14-35 year-old, women with type 1 diabetes ≥1 year and some level of body image concerns will be recruited in 2023. Participants are randomized to either virtual DBP groups or an educational control. The study constitutes 5 measurement points distributed over 2 years. The primary aim is to test if DBP will produce significantly greater reductions in ED behaviours, ED symptoms and future ED onset. The secondary aim is to test if DBP has significantly greater improvements in diabetes distress, quality of life and glycaemic outcomes. RESULTS: We expect that DBP will be more efficacious in reducing ED behaviours, ED symptoms and ED onset compared to the control condition. Additionally, we hope to gain new knowledge on how DBP may affect diabetes-related outcomes. CONCLUSIONS: If DBP proves efficacious, it has potential for immediate, clinical implementation at low-cost and may contribute to broad prevention of future ED onset among young women with type 1 diabetes. GOV IDENTIFIER: NCT05399446.

A pilot study of a virtually delivered dissonance-based eating disorder prevention program for young women with type 1 diabetes: within-subject changes over 6-month follow-up.

INTRODUCTION: In an uncontrolled study, we previously demonstrated the feasibility and preliminary efficacy of our virtual diabetes-specific version (Diabetes Body Project) of the eating disorder (ED) prevention program the Body Project. The aim of the current study was to evaluate further this program for women with type 1 diabetes (T1D) by assessing within-subject changes in outcomes from pretest over 6-month follow-up. METHODS: Young women with T1D aged 16-35 years were invited to participate in Diabetes Body Project groups. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks). Primary outcome measures included ED risk factors and symptoms, and secondary outcomes included three T1D-specific constructs previously found to be associated with ED pathology: glycemic control as measured by HbA1c level, diabetes distress, and illness perceptions. RESULTS: Within-subject reductions, with medium-to-large effect sizes, were observed for the primary (ED pathology, body dissatisfaction, thin-ideal internalization, and appearance ideals and pressures) and secondary outcomes (within-condition Cohen's ds ranged from .34 to 1.70). CONCLUSION: The virtual Diabetes Body Project appears to be a promising intervention worthy of more rigorous evaluation. A randomized controlled trial with at least a 1-year follow-up is warranted to determine its efficacy compared to a control condition.

Cost-effectiveness of Intervention Implementation Support for Reducing Eating Disorder Symptoms Among College Students.

Implementation support for prevention interventions is receiving increased attention, as many organizations receive training in evidence-based practices but do not deliver the interventions optimally. The Body Project, a four-session program, significantly reduces eating disorder symptoms and future disorder onset among group participants when delivered by peer educators at colleges/universities. Costs and cost-effectiveness of the program were examined using data from a randomized trial that compared three levels of implementation support at 63 colleges: (1) a train-the-trainer (TTT) workshop alone, (2) TTT plus a technical assistance (TA) workshop, or (3) TTT plus TA plus monthly quality assurance (QA) consultations. Effectiveness was measured by the production of reliable change in eating disorder symptoms from pretest to posttest. Costs and cost-effectiveness of two levels of implementation support are reported, comparing TTT-only with TTT + TA + QA (effectiveness of the TTT + TA condition did not differ from TTT-only) and using results from an earlier study as a proxy for a no-treatment control. Two perspectives are considered: a sponsoring organization providing the training at multiple sites and a college delivering the intervention to its eligible students. From the perspective of a sponsoring organization, adding both the TA training and QA support improves the cost-effectiveness per eligible student receiving the intervention. From the perspective of costs for a college to deliver the intervention, receiving TA training and QA support is also more cost-effective than the training workshop alone, whether the peer educators are paid or unpaid and whether costs of group supervision are included or excluded. Results converge with previous research showing that more intensive implementation support can be more cost-effective.

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.

Evaluation of a novel eating disorder prevention program for young women with type 1 diabetes: A preliminary randomized trial.

OBJECTIVE: Evaluate whether the Body Project prevention program adapted for young women with type 1 diabetes (Diabetes Body Project) reduces eating disorder (ED) risk factors and symptoms. METHODS: Young women (aged 15-30) at high-risk for EDs due to having type 1 diabetes and body image concerns (N = 55) were randomized to virtually delivered Diabetes Body Project groups or an educational control condition, completing measures at pretest, posttest, and 3-month follow-up. RESULTS: Diabetes Body Project versus the control participants showed significantly greater reductions in thin-ideal internalization, body dissatisfaction, diabetes distress, diabetes eating pathology, and ED symptoms by posttest, and greater reductions in diabetes eating pathology and ED symptoms, and greater improvements in quality of life by 3-month follow-up, which were medium to large effects (d's ranged from -0.43 to -0.90). Although control participants showed a worsening of glycemic control (time in range) verses Diabetes Body Project participants, this difference was non-significant (d = 0.26). CONCLUSIONS: Virtually delivered Diabetes Body Project decreased ED risk factors and symptoms in young women with type 1 diabetes. A well powered randomized controlled trial is warranted to evaluate this intervention over longer follow-up.

A randomized trial of two group-delivered transdiagnostic eating disorder treatments: Dissonance-based treatment versus interpersonal psychotherapy.

OBJECTIVE: Test whether a group-delivered dissonance-based transdiagnostic eating disorder treatment, Body Project Treatment (BPT), produces greater reductions in eating disorder symptoms and higher abstinence from eating disorder behaviors and remittance from eating disorder diagnoses than group-delivered transdiagnostic interpersonal psychotherapy (IPT). METHOD: Women with a range of eating disorders (N = 73) were randomized to 8-week group-implemented BPT or IPT and completed surveys and masked diagnostic interviews at pretest, posttest, and 6-month follow-up. RESULTS: Participants randomized to BPT versus IPT showed significantly greater reductions in eating disorder symptoms (d = -.75), pursuit of the thin ideal (d = -.87), anxiety symptoms (d = -.76), and social impairment (d = -.59) through 6-month follow-up. By end of treatment, participants randomized to the BPT versus IPT did not significantly differ on abstinence from binge eating and purging (49% vs. 40%, respectively) or remittance from eating disorder diagnoses (54% vs. 40%, respectively). Participants randomized to BPT versus IPT did not differ significantly in average session attendance (5.8 vs. 6.9, respectively) or average homework assignments completed (4.6 vs. 5.6, respectively). The within-condition reductions in eating disorder symptoms for BPT did not significantly differ when implemented in person versus via synchronous video telepsychiatry (d = -1.39 vs. -1.09, respectively), though these effects should be considered preliminary because of the small cell sizes. CONCLUSIONS: The evidence that BPT produces greater reductions in eating disorder symptoms, pursuit of the thin ideal, anxiety symptoms, and social impairment than IPT is encouraging because it provides some assurance that the effects are present equating for the effects of expectancies, demand characteristics, and nonspecific factors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effectiveness of virtually delivered Body Project groups to prevent eating disorders in young women at risk: a protocol for a randomized controlled trial.

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).

Prospective reciprocal relations between social support and eating disorder symptoms.

Prospective studies have found inconsistent relations between social support deficits and future increases in eating disorder symptoms. Furthermore, no prospective study has tested whether elevated eating disorder symptoms predict a future erosion of social support. Accordingly, the current study investigated the prospective reciprocal relations between perceived social support from both parents and peers and eating disorder symptoms in adolescent girls. In this study, 496 adolescent girls reported perceived social support and completed an eating disorder diagnostic interview annually for 7 years. Deficits in perceived peer, but not parental, support predicted future increases in eating disorder symptoms (p = .019, partial r = -.10). Furthermore, initial eating disorder symptoms predicted future reductions in perceived peer support (p = .016, partial r = -.11) but not parental support. Interestingly, these relations became nonsignificant when we controlled for negative affect and body mass index, suggesting that comorbid mood disorders and elevated body weight might partially drive these relations. Although both relations were small in magnitude, these results suggest low perceived peer support is a risk factor for future escalations in eating disorder symptoms and that elevated symptoms may contribute to a further erosion of peer support, creating a cyclical relation that maintains eating pathology. Conversely, high levels of perceived peer support could serve as a protective factor against future increases in eating pathology. These findings should advance interpersonal theories of eating pathology and inform the design of more effective prevention programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sequencing of symptom emergence in anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder in adolescent girls and relations of prodromal symptoms to future onset of these eating disorders.

BACKGROUND: To advance knowledge regarding the etiology of eating disorders, we characterized the sequencing of eating disorder symptom emergence for adolescent girls who subsequently developed anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) for community-recruited adolescents and tested whether prodromal symptoms increased risk for future onset of each eating disorder. METHODS: Data collected from adolescent girls (N = 496; M age = 13.02, s.d.= 0.73) who completed a diagnostic interview annually over an 8-year period were used to address these aims. RESULTS: For all four eating disorders, compensatory weight-control behaviors were the first behavioral symptom to emerge and weight/shape overvaluation was the first cognitive symptom to emerge. Moreover, lower-than-expected BMI predicted future AN onset, binge eating and all cognitive symptoms predicted future BN onset, weight/shape overvaluation predicted future BED onset, and compensatory behavior and all cognitive symptoms predicted future PD onset. These predictive effects were small-to-large in magnitude. Collectively, prodromal symptoms predicted an eating disorder onset with 83-87% accuracy. CONCLUSIONS: Results suggest that compensatory weight-control behaviors and weight/shape overvaluation typically emerge before other prodromal symptoms in all eating disorders during adolescence. Moreover, different prodromal symptoms seem to predict future onset of different eating disorders. Screening adolescent girls for these prodromal symptoms and implementing indicated prevention programs designed to reduce these symptoms may prove effective in preventing future onset of eating disorders.

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: study protocol for a hybrid type 2 effectiveness-implementation cluster-randomized trial using train-the-trainer.

BACKGROUND: Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction-the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)-delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes and (b) providers' perceptions of fit. METHODS: TTT will be implemented in nine CMHCs in California, USA (N = 60 providers; N = 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers' perceptions of fit. Aim 3 will evaluate whether Generation 2 providers' perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality), and (3) evaluate other possible moderators. DISCUSSION: This trial has potential to (a) inform the process of embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) add to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advance our understanding of providers' perceptions of EBPT "fit" across TTT generations. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT05805657 . Registered on April 10, 2023.

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: Study protocol for a hybrid type 2 effectiveness-implementation cluster- randomized trial using train-the-trainer.

Background: Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction-the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)-delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes (b) providers' perceptions of fit. Methods: TTT will be implemented in nine CMHCs in California, United States (N= 60 providers; N= 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers' perceptions of fit. Aim 3 will evaluate whether Generation 2 providers' perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will: (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality); and (3) evaluate other possible moderators. Discussion: This trial has potential to inform the process of (a) embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) adding to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advancing our understanding of providers' perceptions of EBPT 'fit' across TTT generations. Trial registration: Clinicaltrials.gov identifier: NCT05805657. Registered on April 10, 2023. https://clinicaltrials.gov/ct2/show/NCT05805657.

Setting and Provider Predictors of Implementation Success for an Eating Disorder Prevention Program Delivered by College Peer Educators.

INTRODUCTION: College students face increased risk for a variety of mental health problems but experience barriers to treatment access. Prevention programs, including those implemented by peer educators, may decrease treatment needs and increase service access. We examined the implementation of an evidence-based eating disorder prevention program, Body Project, delivered by college peer educators at 63 colleges/universities, comparing three levels of implementation support: (1) Train-the-Trainer (TTT) training; (2) TTT plus a technical assistance workshop (TTT + TA); and (3) TTT + TA with one year of quality assurance calls (TTT + TA + QA). The present study tested the degree to which indicators proposed by the Consolidated Framework for Implementation Research (CFIR) were associated with core implementation outcomes. METHOD: We tested whether indices of CFIR domains (i.e., perceived intervention characteristics, outer and inner setting factors, provider characteristics, and implementation process) were correlated with three implementation outcomes (program reach, fidelity, effectiveness) during a 1-year implementation period. RESULTS: Greater program reach was associated with implementation process, specifically the completion of more implementation activities (ß = 0.46). Greater program fidelity was associated with higher positive (ß = 0.44) and lower negative (ß = - 0.43) perceptions of the Body Project characteristics, and greater reported general support for evidence-based practices (ß = 0.41). Greater effectiveness was associated with lower negative perceptions of Body Project characteristics (d = 0.49). CONCLUSIONS: Several implementation determinants proposed by the CFIR model predicted outcomes, especially intervention fidelity. Across the outcomes of interest, implementation determinants related to peer educator and supervisor perceived characteristics of the specific intervention and general attitudes towards evidence-based practices emerged as robust predictors to inform future work investigating ongoing implementation and sustainability of programs in university settings.

Elevated reward, emotion, and memory region response to thin models predicts eating disorder symptom persistence: A prospective functional magnetic resonance imaging study.

Because few studies have identified biological factors that predict the persistence of eating pathology, we tested the hypotheses that elevated responsivity of brain regions implicated in reward valuation to thin models and high-calorie binge foods would predict the persistence of eating pathology. We analyzed data from 146 women (Mage = 21.87 ± 3.81) with threshold or subthreshold anorexia nervosa, bulimia nervosa, binge eating disorder, or purging disorder who completed functional magnetic resonance imaging scans assessing neural response to thin models and binge foods at baseline, were randomized to two eating disorder treatments or a waitlist control condition and completed diagnostic interviews that assessed change in symptoms over 2.5-month follow-up. Elevated activation in regions associated with memory (parahippocampal gyrus r = .38; hippocampus r = .25) and with reward valuation and emotional salience (amygdala r = .35) in response to thin versus average-weight models predicted future persistence of an eating disorder symptom composite (all analyses controlled for treatment condition). Neural response to high-calorie binge foods did not predict the persistence of eating disorder symptoms. There was no evidence that either treatment moderated the relation of baseline neural responsivity to thin models to future persistence of eating disorder symptoms, though power for these post hoc analyses was limited. Results suggest that overvaluation of the thin ideal increases the risk for the persistence of eating disorder symptoms but provided no support for the hypothesis that overvaluation of high-calorie foods would predict symptom persistence. Results imply that treatments should seek to reduce the overvaluation of the thin ideal. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Contextualizing the Neural Vulnerabilities Model of Obesity.

In recent years, investigators have focused on neural vulnerability factors that increase the risk of unhealthy weight gain, which has provided a useful organizing structure for obesity neuroscience research. However, this framework, and much of the research it has informed, has given limited attention to contextual factors that may interact with key vulnerabilities to impact eating behaviors and weight gain. To fill this gap, we propose a Contextualized Neural Vulnerabilities Model of Obesity, extending the existing theory to more intentionally incorporate contextual factors that are hypothesized to interact with neural vulnerabilities in shaping eating behaviors and weight trajectories. We begin by providing an overview of the Neural Vulnerabilities Model of Obesity, and briefly review supporting evidence. Next, we suggest opportunities to add contextual considerations to the model, including incorporating environmental and developmental context, emphasizing how contextual factors may interact with neural vulnerabilities to impact eating and weight. We then synthesize earlier models and new extensions to describe a Contextualized Neural Vulnerabilities Model of Obesity with three interacting components-food reward sensitivity, top-down regulation, and environmental factors-all within a developmental framework that highlights adolescence as a key period. Finally, we propose critical research questions arising from the framework, as well as opportunities to inform novel interventions.

Relation of Overweight/Obesity to Reward Region Response to Food Reward and the Moderating Effects of Parental History of Eating Pathology in Adolescent Females.

OBJECTIVE: To test whether overweight/obesity is associated with an elevated reward region response to milkshake cues and a low reward region response to milkshake receipt. To test whether the risk for eating pathology moderates the effects of weight status on the neural response to milkshake cues and milkshake receipt. METHOD: The current study used functional magnetic resonance imaging (fMRI) to examine the neuronal responses of female adolescents (n = 80; M age = 14.6 ± 0.9; M BMI = 21.9 ± 3.6; 41% with a biological parental history of eating pathology) during a food receipt paradigm. RESULTS: Females with overweight/obesity showed a greater ventromedial prefrontal cortex (vmPFC), and ventral anterior cingulate (ACC) response to milkshake cues and a greater ventral striatum, subgenual ACC, and dorsomedial prefrontal cortex response to milkshake receipt than those with a healthy weight. Females with overweight/obesity plus a parental history of eating pathology showed a greater vmPFC/medial orbitofrontal cortex response to milkshake cues than those without a parental history of eating pathology and those with a healthy weight. Females with overweight/obesity and without a parental history of eating pathology showed a greater thalamus and striatum response to milkshake receipt. CONCLUSIONS: Overweight/obesity is associated with an elevated reward region response to palatable food cues and food receipt. A risk for eating pathology enhances the reward region response to food cues in those with excess weight.

Automatic pro-thin/anti-fat biases can develop without previous visual exposure to body shapes.

Endorsement of the thin beauty ideal increases risk for future body dissatisfaction and eating disorders among women. Visual-based media is theorized to be a central pathway through which the thin ideal is internalized. This internalization process results in formation of automatic pro-thin and anti-fat attitudes. However, it is often difficult to separate the contribution of visual-based media and other forms of communication in the creation of such attitudes. Using a novel auditory implicit association test, we show that women with congenital blindness with no previous exposure to body shapes develop automatic pro-thin and anti-fat attitudes to the same extent as sighted women. This result was replicated in studies conducted in two countries involving a combined total of 62 women with blindness and 80 sighted women. Results suggest that internalization of the thin ideal can occur without visual exposure to images of the thin beauty ideal or visual exposure to one's own body.

Relation of BOLD response to food-specific and generic motor response inhibition tasks to body fat gain in adults with overweight and obesity.

BACKGROUND: Low inhibitory control has been theorized to contribute to the development and maintenance of obesity. Knowledge on the neurobiological indicators of inhibitory control deficits predicting future weight gain is limited. The current study examined if individual differences in blood-oxygenation-level-dependent (BOLD) activity associated with food-specific and general motor response inhibition predict future body fat change in adults with overweight or obesity. METHODS: BOLD activity and behavioral responses of adults with overweight or obesity (N = 160) were recorded while performing a food-specific stop signal task (n = 92) or a generic stop signal task (n = 68). Percent body fat was measured at baseline, posttest, 3-month, and 6-month follow-up. RESULTS: Elevated BOLD activity in somatosensory (postcentral gyrus), and attention (precuneus) regions during successful inhibition in the food-specific stop signal task and elevated BOLD activity in a motor region (anterior cerebellar lobe) in the generic stop signal task predicted greater body fat gain over 6-month follow-up. Elevated BOLD activity in inhibitory control regions (inferior-, middle-, superior frontal gyri) and error monitoring regions (anterior cingulate cortex, insula) during erroneous responses in the generic stop signal task predicted body fat loss. CONCLUSIONS: Results suggest that improving motor response inhibition and error monitoring may facilitate weight loss in adults with overweight and obesity.

Evaluating whether a peer-led dissonance-based eating disorder prevention program prevents onset of each eating disorder type.

BACKGROUND: This study tested whether the dissonance-based Body Project eating disorder prevention program reduced onset of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) over long-term follow-up. METHODS: Data were combined from three prevention trials that targeted young women at high-risk for eating disorders (N = 1092; M age = 19.3). Participants were randomized to Body Project groups led by peer educators or expressive writing/educational controls and completed masked diagnostic interviews over 2- to 4-year follow-ups. Logistic regressions tested whether onset of each eating disorder over follow-up differed between Body Project and control participants. RESULTS: Peer-led Body Project groups produced a 46% reduction in onset of subthreshold/threshold BN and a 62% reduction in onset of PD relative to controls over follow-up. Rates of onset of subthreshold/threshold AN and BED did not significantly differ between peer-led Body Project participants and control participants. CONCLUSIONS: Results support the dissemination of the peer-led Body Project for reducing future onset of BN and PD. This study and recent research suggest that thin-ideal internalization, the risk factor for eating disorders targeted in the Body Project, may be more relevant for predicting onset of BN and PD compared to AN and BED. Findings support the development of a version of the Body Project aimed to reduce risk factors that have predicted future onset of all four types of eating disorders (e.g. overvaluation of weight/shape, fear of weight gain), which may more effectively prevent all eating disorder types.

An experimental test of increasing implementation support for college peer educators delivering an evidence-based prevention program.

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).

Enhancing Efficacy of a Brief Obesity and Eating Disorder Prevention Program: Long-Term Results from an Experimental Therapeutics Trial.

Objective: Test whether the efficacy of Project Health, an obesity/eating disorder prevention program, is improved by delivering it in single-sex groups and adding food response inhibition and attention training. Method: High-risk young adults (N = 261; M age = 19.3, 74% female) were randomized to (1) single-sex or (2) mixed-sex groups that completed food response inhibition and attention training or (3) single-sex or (4) mixed-sex groups that completed sham training with nonfood images in a 2 × 2 factorial design. Results: There was a significant sex-composition by training-type by time interaction; participants who completed single- or mixed-sex Project Health groups plus food response and attention training showed significant reductions in body fat over a 2-year follow-up, though this effect was more rapid and persistent in single-sex groups, whereas those who completed single- or mixed-sex Project Health groups plus sham training did not show body fat change. However, there were no differences in overweight/obesity onset over the follow-up. The manipulated factors did not affect eating disorder symptoms or eating disorder onset, but there was a significant reduction in symptoms across the conditions (within-condition d = -0.58), converging with prior evidence that Project Health produced larger reductions in symptoms (within-condition d = -0.48) than educational control participants. Average eating disorder onset over the 2-year follow-up (6.4%) was similar to that observed in Project Health in a past trial (4.5%). Conclusions: Given that Project Health significantly reduced future onset of overweight/obesity in a prior trial and the present trial found that body fat loss effects were significantly greater when implemented in single-sex groups and paired with food response and attention training, there might be value in broadly implementing this combined intervention.