A pilot feasibility and acceptability trial of an internet indicated prevention program for perfectionism to reduce eating disorder symptoms in adolescents.

PURPOSE: Perfectionism is a transdiagnostic risk factor for eating disorders. Treating perfectionism can reduce symptoms of eating disorders. No research has examined an indicated prevention trial using internet-based Cognitive-Behavioural Therapy for Perfectionism (ICBT-P) in adolescent girls at elevated risk for eating disorders. Our aim was to conduct a preliminary feasibility trial using a co-designed ICBT-P intervention. It was hypothesised that a higher proportion of participants in the ICBT-P condition would achieve reliable and clinically significant change on perfectionism, eating disorders, anxiety and depression, compared to waitlist control. METHODS: Twenty-one adolescent girls with elevated symptoms of eating disorders (M age = 16.14 years) were randomised to a 4-week online feasibility trial of a co-designed ICBT-P prevention program or waitlist control. Qualitative surveys were used to gain participant perspectives. RESULTS: The ICBT-P condition had a higher proportion of participants achieve reliable change and classified as recovered on perfectionism and symptoms of eating disorders and anxiety, compared to waitlist control. Qualitative findings indicated that 100% of participants found the program helpful. CONCLUSION: The results indicate ICBT-P is a feasible and acceptable program for adolescent girls with elevated eating disorder symptoms. Future research is required to examine outcomes in a randomised controlled trial. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort or case-control analytic studies. TRIAL REGISTRATION NUMBER: This trial was prospectively registered with Australian and New Zealand Clinical Trials Registry (ACTRN12620000951954P) on 23/09/2020.

Protective role of family mealtime frequency against disordered eating behaviors: Racial and ethnic differences.

Family mealtimes have been recognized for their positive effect on child and adolescent health outcomes. Frequent family meals have been shown to have protective effects in reducing disordered eating behaviors, but the variability of these effects across different racial and ethnic backgrounds has been less explored. To address the gap, the current study utilizes a sample of 33,417 families with children (ages 6-17) in the United States who participated in the 2022 National Surveys of Children's Health (NSCH). Logistic regressions were conducted to examine the association between family mealtime frequency and the manifestation of disordered eating across youth from diverse racial/ethnic backgrounds. Our findings revealed that frequent family mealtimes are associated with a lower risk of engaging in disordered eating behaviors in youth. However, there were disparities in the associations between family mealtime frequency and the prevalence of disordered eating behaviors among children from different racial/ethnic backgrounds. Youth who never participated in family mealtimes were at a greater risk of engaging in disordered eating behaviors among those identifying as non-Hispanic Black or of 'other' racial groups. In youth identifying with multiple races, the frequency of family was not associated with the odds of disordered eating behaviors. The results provide insights into the nuanced influence of family mealtime frequency on disordered eating based on diverse racial/ethnic groups. This highlights the need for future studies to identify factors associated with racial/ethnic identities that may contribute to disordered eating behaviors in youth to identify the unique needs and challenges faced by families in leveraging the protective effect of family mealtimes.

Your Body Is Your Home: The feasibility of an intuitive eating intervention for early adolescents.

OBJECTIVE: Intuitive eating (IE) is an emerging health promotion framework which has shown promise in the prevention and early intervention of disordered eating (DE) behavior in adults. This study sought to extend this work by assessing the feasibility and preliminary efficacy of a 5-week IE intervention, "Your Body is Your Home," delivered in school classrooms for early adolescents aged 11-13. METHODS: The present study utilized a quasi-experimental design. Eligibility criteria were defined a priori and published in a registered protocol. Four classrooms (n = 128 student participants) were recruited into two streams, and self-report questionnaires were administered at pre-test, post-test, and 4-week follow-up. The questionnaires included the Intuitive Eating Scale for Early Adolescents (IES-2-EA), the Body Appreciation Scale (BAS-2), and the WHO Wellbeing Index (WHO-5). Linear mixed models were used to conduct preliminary efficacy testing. RESULTS: The results indicate that a brief classroom-based IE intervention is feasible and acceptable for both students and teaching staff; retention, fidelity, and attendance targets were achieved. Students and teachers rated all five sessions of the intervention as a highly feasible method of health promotion. Further, preliminary efficacy data suggest IE interventions aimed at early adolescents may be a feasible way of improving certain aspects of IE (p < .001) in male and female participants, and body appreciation (p < .001) in male participants. DISCUSSION: The study provides preliminary support for the implementation and evaluation of an IE intervention as part of school-based health promotion and offers preliminary effect size estimates for a larger-scale randomized trial. PUBLIC SIGNIFICANCE: Existing evidence suggests that IE may be a useful framework through which relationships with food and the body can be improved. The present study seeks to extend this work by adapting the framework for early adolescents (among whom the framework is not well understood) and examining feasibility, acceptability, and preliminary changes to several health and well-being metrics following a 5-week school-based intervention.

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.

Media Literacy Practices to Prevent Obesity and Eating Disorders in Youth.

PURPOSE OF REVIEW: Obesity and eating disorders share common issues related to media use and effects, especially in the USA. Current research increasingly demonstrates that media literacy can address this problem. This narrative review highlights current media literacy-based research for obesity and eating disorder prevention among youth. RECENT FINDINGS: Current research using media literacy techniques to prevent obesity indicates that these interventions improve nutrition outcomes, improve family communication about food, improve critical thinking about food advertisements, reduce sugar and fat intake, and reduce screen use for parents and youth. In addition, eating disorder research reveals that media literacy techniques lead to higher scores of body satisfaction and self-esteem, with lower scores of perfectionism, thinness, and ideal masculinity. There is a need for media literacy-based interventions to focus on family communication to prevent obesity and eating disorders. Furthermore, there should be more focus on identified levels of prevention and specific clinical outcomes.

Effectiveness of an e-Health Quasi-Randomized Controlled Universal Prevention Program for Eating Disorders in Spanish Adolescents.

Eating disorders (EDs) and sub-threshold conditions are prevalent in the adolescent population. Unfortunately, most preventive interventions have been targeted at emerging adults and the effectiveness of online prevention programs has yet to be determined in adolescents. This study sought to examine the short-term effectiveness of a universal e-Health psychoeducational prevention program for EDs compared to a control (non-intervention) group in Spanish adolescents. Using a quasi-randomized trial design, a total of 161 [% girls: 45.96; Mage(SD) = 12.43 (0.43)] adolescents from 5 participating schools were allocated to two intervention arms: (1) psychoeducational intervention (n = 79) and (2) wait-list control (n = 82). The intervention was delivered over 3 months through 3 modules that were accessible 24/7 and 3 school sessions guided by the students´ tutors focusing on nutrition, promoting a healthy lifestyle, mitigating body concerns, and social pressures. Participants completed an online assessment battery including the Eating Attitudes Test (EAT-26) and measures of self-esteem, family disruption, compliance with the Mediterranean diet, and lifestyle. Correlational analysis showed small to moderate relationships between self-esteem and family function (rho = 0.413, p = 0.001), BMI (body mass index) and the EAT-26 dieting subscale (rho = 0.417, p = 0.001), physical activity and the bulimia subscale (rho = - 0.237, p = 0.003), and self-esteem and the dieting subscale (rho = - 0.223, p = 0.004). At the post-intervention assessment, the intervention group showed a statistically significant reduction in ED risk (EAT-26) (d = - 0.323, p = 0.040) and the oral control subscale (d = 0.327, p = 0.038). The e-health intervention including tutor-led digital components was effective for reducing ED risk in children. Results must be interpreted with caution due to the low statistical power and the limited sample size. Large scale randomized controlled trials with longer follow-ups will be needed to bolster the evidence.

Body dissatisfaction and disordered eating symptoms in children's daily life: Can parents protect against appearance comparison on social media?

Research suggests that body dissatisfaction is common among children. However, it remains largely unknown how body dissatisfaction occurs on a daily basis and which environmental factors are linked to this. The purpose of this study was to examine (1) state body dissatisfaction, dietary restraint, compensatory exercise and loss of control eating among children and its association with upward comparisons via social media and (2) whether trust in parents may attenuate this association. Children from 10 to 12 years old (N = 50) were assessed three times a day during a two-week period. Trust was examined via a baseline questionnaire. State body dissatisfaction, dietary restraint, compensatory exercise, loss of control eating and upward comparisons were examined via Ecological Momentary Assessment (EMA). Multilevel analyses indicated that an a higher level of upward comparison is associated with a higher level of state body dissatisfaction, compensatory exercise and loss of control eating. Trust in father significantly moderated the association between appearance comparison and body dissatisfaction. No evidence was found for the protective role of trust in mother. Future research is necessary to enhance our understanding of state body dissatisfaction among children and of environmental factors that may protect children from the adverse effects of social media.

Task shifting eating disorders prevention: A pilot study of selective interventions adapted for teacher-led universal delivery in secondary schools.

OBJECTIVE: Increasing effectiveness and sustainability of universal school-based eating disorder prevention is needed. This study adapted two existing selective prevention programmes for universal delivery, investigating feasibility, acceptability, and preliminary effects when delivered by trained teachers to classes of mixed-gender adolescents. METHOD: A three-arm controlled pilot study with Year 9 students (N = 288; Mage = 13.61 SDage = .50). Three schools in south Wales and south-west England were allocated to mindfulness-based intervention (MBI), dissonance-based intervention (DBI), or classes-as-usual (CAU) control. Self-reported eating disorder risk factors were collected at baseline, 6-week post-intervention, and 2-month follow-up. Focus groups were conducted post-intervention. RESULTS: Delivery and evaluation were feasible, allowing for flexibility in scheduling, with good retention. Student and teacher ratings indicated moderate acceptability of both interventions, with recommendations for refinement. Mixed model analyses, controlling for baseline, showed significant effects of condition across post-intervention and follow-up for body esteem (DBI > CAU; Cohen's d = .34) and positive affect (MBI > CAU, d = .58). For girls only, both MBI and DBI improved body satisfaction and internalization, and the MBI additionally resulted in improved weight and shape concerns, negative affect, and life disengagement (d's = .39-1.12), across post-intervention and follow-up. DISCUSSION: Selective eating disorder prevention programmes based on cognitive dissonance and mindfulness can be delivered universally in schools, by teachers, allowing for appropriate flexibility necessary for real world implementation. Moderate acceptability indicates areas for improving content and delivery; positive effects on key outcomes are encouraging. These findings provide support for further robust evaluation. PUBLIC SIGNIFICANCE: Existing universal eating disorder prevention is limited by small effects and reliance on highly trained facilitators. This study is the first to adapt mindfulness- and dissonance-based interventions for delivery by teachers, to adolescents of all genders in a classroom setting. Delivery was largely feasible and acceptable, and both interventions showed significant effects across key risk factors for eating disorders, with larger effect sizes than found previously. This underpins further robust evaluation.

PRIORITY Trial: Results from a feasibility randomised controlled trial of a psychoeducational intervention for parents to prevent disordered eating in children and young people with type 1 diabetes.

AIMS: Children and young people (CYP) with type 1 diabetes (T1D) are at increased risk of disordered eating. This study aimed to determine the feasibility and acceptability of a novel, theoretically informed, two-session psychoeducational intervention for parents to prevent disordered eating in CYP with T1D. METHODS: Parents of CYP aged 11-14 years with T1D were randomly allocated to the intervention or wait-list control group. Self-reported measures including the Diabetes Eating Problem Survey-Revised (DEPS-R), Problem Areas in Diabetes Parent Revised (PAID-PR), Child Eating Behaviour Questionnaire subscales (CEBQ), Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), clinical outcomes (e.g. HbA1c, BMI, medication and healthcare utilisation) and process variables, were collected at baseline, 1-and 3-month assessments. Acceptability data were collected from intervention participants via questionnaire. RESULTS: Eighty-nine parents were recruited, which exceeded recruitment targets, with high intervention engagement and acceptability (<80% across domains). A signal of efficacy was observed across outcome measures with moderate improvements in the CEBQ subscale satiety responsiveness (d = 0.55, 95% CI 0.01, 1.08) and child's BMI (d = -0.56, 95% CI -1.09, 0.00) at 3 months compared with controls. Trends in the anticipated direction were also observed with reductions in disordered eating (DEPS-R) and diabetes distress (PAID-PR) and improvements in wellbeing (WEMWBS). CONCLUSIONS: This is the first study to have co-designed and evaluated a novel parenting intervention to prevent disordered eating in CYP with T1D. The intervention proved feasible and acceptable with encouraging effects. Preparatory work is required prior to definitive trial to ensure the most relevant primary outcome measure and ensure strategies for optimum outcome completion.

Internet-based cognitive behaviour therapy for the prevention, treatment and relapse prevention of eating disorders: A systematic review and meta-analysis.

Eating disorders (EDs) are undertreated worldwide. In the UK the lag between recognition of symptoms and treatment ranges from about 15 months to in excess of 2 years. Internet-based cognitive behaviour therapy (ICBT) could be a viable alternative to face-to-face cognitive behaviour therapy (CBT) that avoids the negative impacts of delayed interventions. Based on evidence from randomised controlled trials (RCTs), this systematic review investigated the efficacy of minimally guided self-help ICBT, without face-to-face therapy, for the prevention, treatment and relapse prevention of all types of EDs in adults. The electronic databases MEDLINE, PsychINFO, CENTRAL, Scopus, and Web of Science were searched between 1991 and 2021. Inclusion criteria specified RCTs with ICBT versus inactive comparison groups. The Cochrane Risk of Bias Tool-2 was used for quality assessments. Qualitative synthesis and meta-analyses were conducted. Findings typically showed medium significant beneficial effect sizes for prevention studies ranging from (-0.31 [95% CI: -0.57, -0.06] to -0.47 [95% CI: -0.82, -0.11]) and generally large effect sizes for the treatment studies ranging from (-0.30 [95% CI: -0.57, -0.03] to -1.11 [95% CI: -1.47, -0.75]). Relapse prevention studies yielded mainly small non-significant beneficial effects with significant effect sizes of (-0.29 [95% CI: -0.56, -0.03] and -0.43 [95% CI: -0.70, -0.16]). Only the treatment studies reached clinical significance and cognitive symptoms improved more than behavioural symptoms. ICBT appears to be efficacious for the prevention, treatment and relapse prevention of eating disorders with treatment interventions being the most beneficial. However, the evidence base is very small, particularly for treatment and relapse prevention, indicating the need for more high-quality RCTs.

Orthorexia nervosa versus healthy orthorexia: Anxiety, perfectionism, and mindfulness as risk and preventative factors of distress.

BACKGROUND: Orthorexia nervosa is a recently conceptualised pathological entity presenting as an obsessive focus on healthy eating with associated psychosocial impairment. AIMS: The present study investigated the differential associations between orthorexia nervosa and healthy orthorexia with distress and impairment. MATERIALS & METHODS: With a community sample (N = 268) multiple measures of orthorexia nervosa and health orthorexia were compared as explanatory variables in mediation structural equation modelling (SEM). Outcome variables assessed and investigated were psychological distress while demographic variables were controlled. The mediating roles of perfectionism and health anxiety on orthorexia nervosa were examined with further preventative mediation role of mindfulness on distress. RESULTS: Distinctive to other eating disorders, gender showed no significant effects on orthorexia nervosa and healthy orthorexia. Signalling measurement issues for this disorder, the different measures of orthorexia nervosa resulted in mixed findings regarding body mass index and age. Findings supported perfectionism and health anxiety as risk factors, as well as mindfulness acceptance as a preventative factor in both orthorexia nervosa and healthy orthorexia. Orthorexia nervosa and healthy orthorexia assessed by most measures, contrary to the expectations, had significant positive associations with psychological distress indicated by stress, anxiety, and depression. DISCUSSION & CONCLUSION: The complexity in differentiating orthorexia nervosa from healthy orthorexia calls for further investigation. This research effort should serve to substantiate the status of orthorexia nervosa as a distinct clinical disorder.

A review of the nutritional guidance for athletes to prevent eating disorders.

Since the 1980s eating disorders (ED) have gained increasing prevalence, with athletes proving to be at a higher risk compared to non-athletes. Eating disorders can significantly impact the health and performance of an athlete, however, certain guidelines are in place for prevention, treatment and management. NICE and UK Sport were two guidelines that were identified as being referenced within the UK. This paper aimed to evaluate their utility and establish whether modifications are required to prevent ED within athletic populations. A checklist was created based on peer-reviewed recommendations and used in conjunction with conceptualised case studies based on information sourced from proposed key informant interviews. Whilst both guidelines are extensive in the identification of symptoms associated with ED, they lack recognised recommended screening methods. Furthermore, although both contain some form of validated treatment, NICE recommends cognitive behavioural therapy despite acknowledging the lack of evidence supporting its beneficial application. In contrast to recommendations regarding physical therapy, NICE also states to avoid certain treatments, such as yoga, despite beneficial evidence of its treatment/rehabilitation for ED. When applied to case studies, both guidelines demonstrated the need for refinement and improvement in recommendations relating to weight loss and screening methods. To form an accurate critique of the guidelines, an assessment of their applicability and suitability in the prevention, treatment and management of ED in a practical sporting environment involving consenting participants is required.

Economic evidence for prevention and treatment of eating disorders: An updated systematic review.

OBJECTIVE: This systematic review updates an existing review examining the cost-effectiveness of interventions to prevent and treat eating disorders (EDs). METHOD: Literature search was conducted in Academic Search Complete, MEDLINE, CINAHL, PsycINFO, EconLit, Global Health, ERIC, Health Business Elite, and Health Policy Reference Center electronic databases, capturing studies published between March 2017 to April 2023. Hand-searching was conducted as supplementary including gray literature search. Included articles were (1) full economic evaluations or return-on-investment studies, (2) in English and (3) aimed at prevention and treatment of any ED. Included studies were added and synthesized with previously reviewed studies. Screening and extraction followed PRISMA guidelines. Quality assessment was conducted using the Drummond checklist. PROSPERO registration CRD42021287464. RESULTS: A total of 28 studies were identified, including 15 published after the previous review. There were nine prevention, seven anorexia nervosa (AN) treatment, five bulimia nervosa (BN) treatment, four binge-eating disorder (BED), and three non-specific ED treatment studies. Findings indicate value-for-money evidence supporting all interventions. Quality assessment showed studies were fair-to-good quality. DISCUSSION: There has been significant growth in cost-effectiveness studies over the last 5 years. Findings suggest that interventions to prevent and treat ED offer value for money. Interventions such as Featback (ED prevention and non-specific ED treatment); focal psychodynamic therapy, enhanced cognitive behavioral therapy, and high-calorie refeeding (AN treatment); stepped-care with assisted self-help and internet-based cognitive behavioral therapy (BN treatment); and cognitive behavioral therapy guided self-help intervention (BED treatment) have good quality economic evidence. Further research in implementation of interventions is required. PUBLIC SIGNIFICANCE STATEMENT: The increasing prevalence of ED globally has significant impact on healthcare systems, families, and society. This review is showcasing the value for money of interventions of eating disorders prevention and treatment. This review found that existing interventions offers positive economic benefit for the healthcare system.

OBJETIVO: Esta revisión sistemática actualiza una revisión existente que examina la rentabilidad de las intervenciones para prevenir y tratar los trastornos de la conducta alimentaria (TCA). MÉTODO: Se realizó una búsqueda bibliográfica en las bases de datos electrónicas Academic Search Complete, MEDLINE, CINAHL, PsycINFO, EconLit, Global Health, ERIC, Health Business Elite y Health Policy Reference Center, abarcando estudios publicados entre marzo de 2017 y abril de 2023. Se realizó una búsqueda manual como complemento, incluyendo la búsqueda de literatura gris. Los artículos incluidos eran (1) evaluaciones económicas completas o estudios de retorno de inversión, (2) en inglés y (3) dirigidos a la prevención y tratamiento de cualquier TCA. Los estudios incluidos se añadieron y sintetizaron con estudios previamente revisados. El cribado y la extracción siguieron las pautas PRISMA. La evaluación de la calidad se realizó utilizando la lista de verificación de Drummond. Registro en PROSPERO CRD42021287464. RESULTADOS: Se identificaron 28 estudios, incluyendo 15 publicados después de la revisión anterior. Hubo nueve estudios de prevención, siete de tratamiento de anorexia nerviosa (AN), cinco de tratamiento de bulimia nerviosa (BN), cuatro de trastorno por atracón (TpA) y tres de tratamiento de TCA no especificados. Los hallazgos indican evidencia de valor por dinero que respalda todas las intervenciones. La evaluación de la calidad mostró que los estudios eran de calidad aceptable a buena. DISCUSIÓN: Ha habido un crecimiento significativo en los estudios de rentabilidad en los últimos cinco años. Los hallazgos sugieren que las intervenciones para prevenir y tratar los TCA ofrecen valor por dinero. Intervenciones como Featback (prevención de TCA y tratamiento de TCA no específicos); terapia psicodinámica focal, terapia cognitivo-conductual mejorada y rehabilitación nutricional con alto contenido calórico (tratamiento de AN); atención escalonada con autoayuda asistida y terapia cognitivo-conductual en línea (tratamiento de BN); y terapia cognitivo-conductual guiada de autoayuda (tratamiento de TpA) tienen una buena evidencia económica de calidad. Se requiere más investigación en la implementación de intervenciones.

What is needed for eating disorder prevention for transgender and gender diverse young adults? Findings from asynchronous online focus groups.

Transgender and gender diverse (TGD) young adults face higher risk of eating disorder (ED) symptoms than cisgender peers. Evidence-based ED prevention programs exist but must be adapted to meet the needs of diverse TGD populations. We conducted eight asynchronous online focus groups in 2019 with 66 ethnically and gender diverse TGD young adults (18-30 years) living in the United States. Participants were recruited online; groups took place over four consecutive days. We conducted inductive thematic analysis of participant responses to three prompts about ED prevention needs and advice for program developers. Findings fell into three domains. In Domain 1: Developing Program Content, themes included (1.1) need to address multiple dimensions of gender; (1.2) intersectional representation matters; (1.3) limitations of ED research; (1.4) being responsive to trauma. Domain 2: Program Delivery Considerations, included preferences for (2.1) group composition, (2.2) intervention modality, and (2.3) program leadership. Domain 3: Cultivating Affirming Spaces included themes addressing the need for programs to (3.1) create judgment-free environments and (3.2) center lived experience. TGD young adults in this study described a range of needs and recommendations for ED prevention content and delivery, with relevance to clinicians, program designers, and ED prevention advocates.

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.

How effective are psychosocial interventions at improving body image and reducing disordered eating in adult men? A systematic review.

Disordered eating and body image concerns significantly impact a growing number of men. This systematic review assessed the evidence of the effectiveness of psychosocial interventions to improve body image and eating pathology in men. Searches were conducted in December 2022 in 13 databases (PsycINFO, MEDLINE, CINAHL Plus, AMED, PubMed, Scopus, Cochrane, EMBASE, ASSIA, British Nursing Index, Wiley and OpenGrey). Studies that quantitatively evaluated psychosocial interventions and reported pre-post body image or disordered eating outcomes in men aged 18 years and over were eligible. Articles including boys, uncontrolled designs, or not in English were excluded. Findings were narratively synthesised and presented according to intervention approach. Quality was assessed using EPHPP. Eight studies including six RCTs were reviewed. Five were assessed as being moderate quality and three as weak. Evidence from moderate quality studies suggested that dissonance-based interventions showed promising improvements in body image and disordered eating for up to six months post-intervention in men with and without body dissatisfaction. Evidence for media literacy and psychoeducational interventions was limited. Findings were limited by heterogeneity in outcome measures and homogeneity of participants preventing generalisability. Robust research with longer follow-ups is needed to confirm effectiveness.

A randomized controlled trial to evaluate the acceptability and effectiveness of two eating disorders prevention interventions: the HEIDI BP-HW project.

BACKGROUND: Eating disorders (ED) are common in Switzerland, as in other Western countries, with a prevalence of any ED of 3.5%. However, no specific prevention intervention has been evaluated in the French-speaking part of the country. In this study, we assessed the acceptability and effectiveness of two well-validated eating disorders prevention interventions: the Body Project intervention (BP), based on cognitive dissonance techniques, and the Healthy Weight intervention (HW), based on the implementation of a healthy lifestyle. METHODS: Forty female students, aged 18-28, with body dissatisfaction, were randomized into three arms: a BP group, an HW group, and a waiting-list control group (WLCG). The primary outcome measure was body dissatisfaction. Secondary outcomes were thin-ideal internalization, dietary restraint, negative affect, and ED psychopathology. Thirty-three participants completed the assessments before and after the one-month interventions or waiting period. A follow-up measurement was conducted one month after the interventions to assess the stability of the results. RESULTS: Both interventions, delivered via a virtual web platform, were considered acceptable. The reduction in body dissatisfaction was greater in the BP group (r = 0.7; p < 0.01) or the HW group (r = 0.6; p < 0.01) than in the WLCG, with large effect sizes. Dietary restraint and shape concern were also significantly reduced in the BP group (r = 0.6 and r = 0.7, respectively; p < 0.01) and HW group (r = 0.5 and r = 0.5, respectively; p < 0.05) compared to the WLCG, with moderate to large effect sizes. The results obtained in each intervention group were stable at the one-month follow-up. CONCLUSIONS: This study showed encouraging results in young women with body dissatisfaction, arguing in favor of the French adaptations of the BP and HW interventions. However, the feasibility of recruitment was difficult, partly due to the pandemic situation at the time of the study, and should be further considered to improve dissemination. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04558073, 22/09/2020 and Swiss National Clinical Trial Portal (SNCTP000003978).

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.

The cost-effectiveness of a virtual intervention to prevent eating disorders in young women in Sweden.

OBJECTIVE: To determine the cost-effectiveness of a virtual version of the Body Project (vBP), a cognitive dissonance-based program, to prevent eating disorders (ED) among young women with a subjective sense of body dissatisfaction in the Swedish context. METHOD: A decision tree combined with a Markov model was developed to estimate the cost-effectiveness of the vBP in a clinical trial population of 149 young women (mean age 17 years) with body image concerns. Treatment effect was modeled using data from a trial investigating the effects of vBP compared to expressive writing (EW) and a do-nothing alternative. Population characteristics and intervention costs were sourced from the trial. Other parameters, including utilities, treatment costs for ED, and mortality were sourced from the literature. The model predicted the costs and quality-adjusted life years (QALYs) related to the prevention of incidence of ED in the modeled population until they reached 25 years of age. The study used both a cost-utility and return on investment (ROI) framework. RESULTS: In total, vBP yielded lower costs and larger QALYs than the alternatives. The ROI analysis denoted a return of US $152 for every USD invested in vBP over 8 years against the do-nothing alternative and US $105 against EW. DISCUSSION: vBP is likely to be cost-effective compared to both EW and a do-nothing alternative. The ROI from vBP is substantial and could be attractive information for decision makers for implementation of this intervention for young females at risk of developing ED. PUBLIC SIGNIFICANCE: This study estimates that the vBP is cost-effective for the prevention of eating disorders among young women in the Swedish setting, and thus is a good investment of public resources.

Preventing Disordered Eating in Teenage Ballet Students: Evaluation of DancExcellent, a Combined CBT and Nutrition Education Intervention.

BACKGROUND: Disordered eating (DE) behaviors are relatively common among high-level dancers, especially in classical ballet. At the same time, interventions aimed at reducing DE behaviors in this population are scarce. METHODS: An 8-week exploratory preventive intervention for DE behaviors was carried out in a high-level ballet school for 40 teenagers aged 12-15 years (77.5% female). Both risk factors (perfectionism) and potentially protective factors (self-esteem, self-compassion) for the development of DE behaviors were considered. The intervention was created specifically for this study and consisted of five cognitive behavior therapy (CBT) workshops and four nutrition workshops. Additional components included newsletters for pupils and educational sessions and social media interactions with staff and parents. The intervention comprised two phases (control and intervention periods), with students acting as their own controls. Standardized questionnaires were completed before and after both phases. RESULTS: Questionnaire results did not indicate any changes in reported perfectionism, self-esteem, or self-compassion, nor were symptoms of DE affected during either the control or intervention periods. CONCLUSIONS: The intervention did not yield any discernible impact. However, it was affected by the onset of the COVID-19 pandemic, which limits our ability to draw conclusions about intervention effectiveness. Evaluations with pupils offer several considerations for future improvements.