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.

The role of emotion regulation in the relationship between mindfulness and risk factors for disordered eating: A longitudinal mediation analysis.

OBJECTIVE: Evidence suggests mindfulness may reduce risk factors for disordered eating. However, mechanisms of change in this relationship are unclear. This longitudinal study tested whether emotion regulation mediates the prospective associations between mindfulness and two proximal risk factors for disordered eating: weight and shape concerns, and negative affect. METHOD: This study is a secondary analysis of data collected within an eating disorder prevention trial. Adolescent girls (N = 374, Mage  = 15.70, SD = 0.77) completed self-report measures of mindfulness, emotion regulation, weight and shape concerns, and negative affect at baseline, 2 months following baseline, and 7 months following baseline. Path analyses were computed to test hypothesized indirect effects using confidence intervals based on 5000 bootstrap samples. RESULTS: Higher baseline mindfulness predicted lower weight and shape concerns and negative affect at 7 months via a mediator of better emotion regulation at 2 months. This effect remained while controlling for earlier measurements of the mediator and outcome in the model of negative affect but not weight and shape concerns. DISCUSSION: Emotion regulation may be an important mechanism explaining how mindfulness influences negative affect. Efforts should be made to intervene on mindfulness and emotion regulation in prevention and early intervention programmes for eating disorders and other psychiatric conditions. PUBLIC SIGNIFICANCE: Research has shown that mindfulness can help to reduce some of the risk of developing an eating disorder. This study explored whether mindfulness reduces some of this risk by helping people to better manage their emotions. Understanding this process can help us to develop better mindfulness-based strategies to support people who are at risk of developing an eating disorder.

Feasibility and acceptability of video-based microinterventions for eating disorder prevention among adolescents in secondary schools.

OBJECTIVE: Eating disorders (EDs) often emerge in late adolescence. Schools are ideal settings for prevention programs; however, cost and time limit implementation. Microinterventions may overcome these challenges. This study adapted two microinterventions (cognitive dissonance, self-compassion) and assessed feasibility and acceptability among mid-adolescents to provide proof-of-concept for further investigation. METHOD: Feedback from staff (n = 5) and student (n = 15) focus groups contributed iteratively to the adaptation of intervention materials. Students in Grade 10 and 11 (N = 101, Mage  = 15.80, SD = 0.68) were then randomly allocated by class to a 20-min video-based cognitive-dissonance or self-compassion intervention, accessed on their school devices. ED risk and protective factors were assessed at baseline, immediate postintervention (state outcomes), and 1-week follow-up (trait outcomes). Acceptability items were included at both timepoints. RESULTS: Implementation was deemed feasible. Girls generally reported greater acceptability than boys. Among girls, the self-compassion intervention demonstrated greater acceptability. Among boys, some aspects of acceptability (e.g., lesson endorsement, utilization of techniques) were rated higher in the cognitive dissonance group whereas other aspects (e.g., understanding, interest) were greater in the self-compassion group. All groups exhibited favorable changes in most state outcomes, however trait outcome change was varied. DISCUSSION: Microinterventions provide a feasible way of implementing prevention strategies in a time-poor educational context. Future large-scale evaluation is warranted to determine efficacy, following modifications based on current findings. PUBLIC SIGNIFICANCE: This study shows promising feasibility and acceptability of two brief, self-guided video-based lessons (microinterventions) for adolescents in school classrooms, that use psychological techniques to target appearance pressures as a key risk factor for eating disorders. Such interventions are easier to implement in school settings than longer, facilitator-led interventions, to encourage greater uptake and ongoing use. Findings support further research to evaluate effectiveness, to ultimately provide accessible and gender-inclusive tools for busy schools.

One size does not fit all: Trajectories of body image development and their predictors in early adolescence.

Background: Negative body image predicts many adverse outcomes. The current study prospectively examined patterns of body esteem development in early adolescence and identified predictors of developmental subtypes. Methods: 328 girls and 429 boys reported annually across a 4-year period (Mage at baseline = 11.14, SD = 0.35) on body esteem, appearance ideal internalization, perceived sociocultural pressures, appearance comparisons, appearance-related teasing, self-esteem, positive and negative affect, and dietary restraint. We performed latent class growth analyses to identify the most common trajectories of body esteem development and examine risk and protective factors for body image development. Results: Three developmental subgroups were identified: (a) high body esteem (39.1%); (b) moderate body esteem (46.1%); and (c) low body esteem (14.8%). Body esteem was stable within the low trajectory and there were minor fluctuations in the high and moderate trajectories. Greater appearance-related teasing, lower self-esteem, less positive affect, and higher dietary restraint predicted the low trajectory, whereas higher self-esteem and lower dietary restraint best predicted the high trajectory. Conclusions: Low body esteem appears to be largely stable from age 11 years. Prevention programming may be enhanced by incorporating components to address transdiagnostic resilience factors such as self-esteem and positive affect.

Examining the efficacy of video-based microinterventions for improving risk and protective factors for disordered eating among young adult women.

OBJECTIVE: Brief self-guided activities designed for focused and immediate benefits, termed microinterventions, have the potential to aid reach and engagement in mental health interventions; however further validation is needed. This study evaluated effects of two microinterventions for responding to appearance-ideal media on risk and protective factors for disordered eating. METHOD: Undergraduate women (N = 202, Mage = 19.90, SD = 2.75) were allocated quasi-randomly to one of three 15-min video-based microinterventions (mindfulness, cognitive dissonance, educational control) in the lab and assessed on state outcomes at baseline and immediate posttest. One week later, trait factors were assessed and participants underwent an appearance-ideal media exposure task. RESULTS: Both mindfulness and dissonance groups reported significant immediate benefits to state appearance-ideal internalization, perceived sociocultural pressures and related distress, and mood, compared to educational control (Glass's Δ effect sizes = .40-.94), but not state weight or appearance satisfaction. At 1-week follow-up, mindfulness and dissonance groups demonstrated improved trait appearance-ideal internalization (Δ = .40 and .42), weight and shape concerns (Δ = .27 [ns] and .44), and body appreciation (Δ = .39 and .46) compared to the educational control. There were no effects on trait perceived pressures, negative affect, or body image psychological flexibility, and no differential changes in state outcomes from premedia to postmedia exposure. DISCUSSION: Microinterventions using mindfulness and dissonance techniques show promise for improving some risk and potential protective factors for disordered eating in the immediate and short-term. Further research is required to substantiate their place within the spectrum of eating disorder prevention, early intervention and treatment techniques.

Mindfulness-based prevention for eating disorders: A school-based cluster randomized controlled study.

OBJECTIVE: Successful prevention of eating disorders represents an important goal due to damaging long-term impacts on health and well-being, modest treatment outcomes, and low treatment seeking among individuals at risk. Mindfulness-based approaches have received early support in the treatment of eating disorders, but have not been evaluated as a prevention strategy. This study aimed to assess the feasibility, acceptability, and efficacy of a novel mindfulness-based intervention for reducing the risk of eating disorders among adolescent females, under both optimal (trained facilitator) and task-shifted (non-expert facilitator) conditions. METHOD: A school-based cluster randomized controlled trial was conducted in which 19 classes of adolescent girls (N = 347) were allocated to a three-session mindfulness-based intervention, dissonance-based intervention, or classes as usual control. A subset of classes (N = 156) receiving expert facilitation were analyzed separately as a proxy for delivery under optimal conditions. RESULTS: Task-shifted facilitation showed no significant intervention effects across outcomes. Under optimal facilitation, students receiving mindfulness demonstrated significant reductions in weight and shape concern, dietary restraint, thin-ideal internalization, eating disorder symptoms, and psychosocial impairment relative to control by 6-month follow-up. Students receiving dissonance showed significant reductions in socio-cultural pressures. There were no statistically significant differences between the two interventions. Moderate intervention acceptability was reported by both students and teaching staff. DISCUSSION: Findings show promise for the application of mindfulness in the prevention of eating disorders; however, further work is required to increase both impact and acceptability, and to enable successful outcomes when delivered by less expert providers.

Examination of the difficulties in emotion regulation scale and its relation to disordered eating in a young female sample.

OBJECTIVE: Difficulties with emotion regulation is considered an important maintaining factor of disordered eating. One of the most commonly used measures of this construct is the Difficulties in Emotion Regulation Scale (DERS). The aim of this study was to explore the factor structure of this measure in young females and to examine its reliability and validity with respect to disordered eating. METHOD: Females aged 17-25 years (M age = 19.6 years, N = 486) were examined in the analyses. Confirmatory factor analyses were conducted followed by regression analyses examining the DERS subscales as predictors of eating disorder severity and disordered eating behaviors. RESULTS: The original 6-factor 36-item model did not fit well and analyses indicated a 6-factor 30-item solution was a more suitable fit for our population. Validity and reliability of the 30-item solution were found to be acceptable. Regression analyses also indicated the 36- and 30-item models were able to adequately predict eating disorder severity and disordered eating behaviors with the "Awareness" and "Goals" subscales being predictors of the former, and the "Impulsivity" subscale being a significant predictor of the latter. DISCUSSION: The overall findings suggest that an abbreviated version of the DERS might be more appropriate than the original version with young females and that this measure exhibits stronger relationships with eating disorder severity and disordered eating behaviors than the longer version. Further examinations of the psychometric properties of the DERS with clinical populations are indicated.

Pilot implementation of an evidence-based online cognitive behavioural therapy for perfectionism in university students: Lessons learnt.

Higher Education Institutes (HEIs) have been met with an unprecedented demand on their student counselling and wellbeing services in recent years with the impacts of COVID-19 and high rates of mental health concerns amongst student populations. Online mental health programs offer one solution by providing students with quick and easy access to effective therapeutic content. The Focused Minds Program is an evidence-based eight-module online self-guided cognitive behavioural intervention that targets the transdiagnostic risk factor of perfectionism and has been shown to decrease depression, anxiety, and disordered eating. The program was implemented at a UK university between 2021 and 2023. Recruitment occurred via departmental emails, academic staff, and the university's counselling staff and website. Participants were provided with access to the intervention for 6-weeks and completed weekly surveys of psychosocial measures. The trial's implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework: reach (uptake via the recruitment channels), effectiveness (outcomes on psychometric measures of mental wellbeing), adoption (staff and organisational support), implementation (intervention engagement and attrition), and maintenance (continued implementation across the trial period). Key barriers to successful implementation, as well as proposed solutions, are discussed to guide future online mental health interventions provided in HEIs.

Beyond Body Size: Focusing on Body Functionality to Improve Body Image Among Women Who Have Undergone Bariatric Surgery.

This study investigated a novel technique to improve body image among women who have undergone bariatric surgery-namely, by having them focus on their body functionality (everything the body can do, rather than how it looks). Participants were 103 women (Mage = 46.61) who had undergone bariatric surgery 5-7 months prior to the study. They were randomized to the 1-week online intervention, comprising three functionality-focused writing exercises (Expand Your Horizon; Alleva et al., 2015), or to a wait-list control group. Body appreciation, appearance and functionality satisfaction, body awareness, self-objectification, self-esteem, and self-kindness were assessed at pretest, posttest, and at 1-week and 3-month follow-up. Multilevel modeling analyses showed that, compared to the control, the intervention group experienced improved body appreciation at posttest, and these improvements persisted at both follow-ups. These findings were nonsignificant when intent-to-treat analyses were performed. Both available case and intent-to-treat analyses showed that all participants experienced improvements in facets of body image across time. Qualitative analyses of participants' responses to the intervention writing exercises provided more insight. Via coding reliability thematic analysis, we identified 11 themes that together provide evidence that intervention participants experienced facets of a more positive body image, while also facing challenges to their body image and well-being. Together, findings suggest that focusing on body functionality may contribute to improved body image among women who have undergone bariatric surgery, but effects may be nuanced compared to prior functionality research among general samples of women. The study was registered retrospectively (ClinicalTrials.gov; identifier NCT04883268).

Understanding university student priorities for mental health and well-being support: A mixed-methods exploration using the person-based approach.

Poor student well-being at UK universities is overstretching institutional support services, highlighting a need for effective new resources. Despite extensive literature on mental health and well-being interventions, students' engagement with support remains unexplored. The study aimed to understand students' experience of engagement with well-being support, identify their well-being needs and form concrete recommendations for future intervention design and delivery. The Person-Based Approach to intervention design was followed to centralise users' experience, in turn maximising acceptability and effectiveness of resources. An online survey (N = 52) was followed by three focus groups (N = 14). Survey data were analysed descriptively, and reflexive thematic analysis was performed on qualitative data. Mixed-methods data integration produced four key student priorities for well-being resources - ease of access, inclusive and preventative approach, sense of community and a safe space, and applying skills to real-life contexts. Five actionable guiding principles for intervention design were produced through consultation with expert stakeholders. This work helps understand why and how students engage with support at university. The resulting recommendations can inform future intervention development, leading to more acceptable, engaging and effective student well-being resources.

Assessing the impact of body image concerns on functioning across life domains: Development and validation of the Body Image Life Disengagement Questionnaire (BILD-Q) among British adolescents.

Assessing the impact of body image on engagement in a range of life domains is important; however, there is a lack of validated measures for adolescents. The current research developed the Body Image Life Disengagement Questionnaire (BILD-Q) and validated it among four samples of British adolescents. Study 1 (N = 1707; 11-13 years) indicated a 9-item unidimensional scale based on Exploratory Factory Analysis. In Study 2 (N = 1403; 11-13 years), Confirmatory Factor Analysis (CFA) showed an acceptable fit overall, but better among girls than boys. Further exploration with CFA in Study 3 (N = 2034; 13-14 years) showed a good to excellent fit overall, and acceptable among both boys and girls. The scale showed good internal consistency and test-retest reliability, and gender invariance indicated the scale can be used comparatively. In Study 4 (N = 288; 13-14 years), convergent validity was supported via expected relationships with body image and related constructs. Concurrent and predictive incremental validity were also evidenced via explaining significant unique variance in well-being. These studies provide support for the BILD-Q as a reliable and valid measure of broader impacts of body image among adolescents, which may benefit intervention evaluation and policy change efforts.

Evaluating the "Dove Confident Me" Five-Session Body Image Intervention Delivered by Teachers in Schools: A Cluster Randomized Controlled Effectiveness Trial.

PURPOSE: Body dissatisfaction is common during adolescence and predicts poor psychological and physical health. Interventions have traditionally overrelied on delivery by external providers (e.g., researchers and psychologists), preventing scalability. This study evaluated the acceptability and effectiveness of a school-based body image intervention delivered by schoolteachers. METHODS: Six British schools participated in a pragmatic cluster randomized controlled trial. Girls and boys aged 11-13 years received the five-session intervention delivered by their teachers (n = 848) or lessons-as-usual control (n = 647) and were assessed at baseline, postintervention, and 2-, 6-, 12-, 24- and 36-month follow-up. The primary outcome was body image (body esteem), secondary outcomes included risk factors for body image (internalization of appearance ideals, sociocultural pressures, social comparisons, appearance-related teasing, and conversations), and tertiary outcomes included psychosocial well-being (negative affect, self-esteem, dietary restraint, and life engagement). RESULTS: Compared with the control group, intervention students demonstrated improvements in the primary outcome of body esteem at postintervention (Cohen's d = .15), 2-month (d = .26), and 6-month follow-up (d = .15). For girls, there was also a significant reduction in experienced appearance-related teasing at 6-month (d = .24) and 12-month (d = .30) follow-up. No other significant intervention effects were observed. The intervention was acceptable to students. CONCLUSIONS: These findings present the longest sustained improvements in a cognitive-affective body image outcome observed among girls and boys during a teacher-led universal body image program to date. Intervention refinement and improved teacher training may further improve outcomes. Task-shifting intervention delivery to community providers to scale up interventions is a promising strategy.

"What can her body do?" Reducing weight stigma by appreciating another person's body functionality.

OBJECTIVE: Weight stigma is prevalent across multiple life domains, and negatively affects both psychological and physical health. Yet, research into weight stigma reduction techniques is limited, and rarely results in reduced antipathy toward higher-weight individuals. The current pre-registered study investigated a novel weight stigma reduction intervention. We tested whether a writing exercise focusing on body functionality (i.e., everything the body can do, rather than how it looks) of another person leads to reductions in weight stigma. METHOD: Participants were 98 women (Mage = 23.17, Range = 16-63) who viewed a photograph of a higher-weight woman, "Anne," and were randomised to complete a writing exercise either describing what "Anne's" body could do (experimental group) or describing her home (active control group). Facets of weight stigma were assessed at pretest and posttest. RESULTS: At posttest, the experimental group evidenced higher fat acceptance and social closeness to "Anne" compared with the active control group. However, no group differences were found in attribution complexity, responsibility, and likeability of "Anne". CONCLUSIONS: A brief body functionality intervention effectively reduced some, but not all, facets of weight stigma in women. This study provides evidence that functionality-focused interventions may hold promise as a means to reduce weight stigma.

The potential benefits of death reflection for improving women's body image.

This study investigated death reflection as a novel strategy to improve body image among women. Young adult women (N = 158; Mage = 21.35) completed a death reflection exercise, a death-related active control exercise (to ensure that effects were due to the manner in which women reflected on their death, rather than due to thoughts about death in general), or a non-death-related active control exercise. Participants completed measures of body image at posttest and 1-week follow-up. The women in the death reflection group, compared to the non-death-related control group, experienced higher body weight satisfaction at posttest. Among women higher in beauty orientation, those in the death reflection group experienced higher body shape satisfaction compared to women in the death-related control group. Effects were medium-to-large in magnitude. No group differences were observed for overall appearance satisfaction, appearance importance, broad conceptualisation of beauty, and endorsement of cultural appearance ideals. These findings provide preliminary support for death reflection as a technique to improve some facets of women's body image. Yet, future research is needed to test whether these effects are replicable and can be extended to other facets of body image.

Looking to the future: Priorities for translating research to impact in the field of appearance and body image.

The field of body image and appearance research and practice is progressing; however, there is still work to be done to ensure broad societal impact. This article consolidates reflections from a range of established and early career experts in the field of appearance and body image, with a focus on stimulating and guiding future agenda setting and translation from research to impact. We conducted a thematic analysis of transcripts from nine recorded 5-minute presentations, delivered by researchers and clinicians as part of a special invited presentation session at a biennial international conference, 'Appearance Matters,' in the UK. Four themes were identified: Moving Beyond the Individual; Consolidation and Collaboration; Commitment to Implementation; and Positive and Protective Frameworks. These themes are discussed alongside recommendations for researchers and practitioners working in these fields to advance research, advocacy, and impact outside of academia.

A pilot controlled trial of a cognitive dissonance-based body dissatisfaction intervention with young British men.

This pilot study evaluated a body image intervention for men, Body Project M. Seventy-four British undergraduate men took part in two 90-min intervention sessions, and completed standardised assessments of body image, bulimic pathology, and related outcomes at baseline, post-intervention, and 3-month follow-up. Fifty-three other men completed the questionnaires as an assessment-only control group. Per-protocol analysis showed that Body Project M improved men's dissatisfaction with body fat and muscularity, body appreciation, muscularity enhancing behaviours, appearance comparisons, and internalization (ds=0.46-0.80) at post-intervention. All except dissatisfaction with muscularity and internalization were sustained at 3-month follow-up. No effects were found for bulimic pathology. Post-intervention effects for dissatisfaction with muscularity and internalization only were retained under intention-to-treat analysis. Participants were favourable towards the intervention. This study provides preliminary evidence for the acceptability and post-intervention efficacy of Body Project M. Further development of the intervention is required to improve and sustain effects.

Does mindfulness have potential in eating disorders prevention? A preliminary controlled trial with young adult women.

AIM: This preliminary randomized controlled trial assessed the feasibility of a pilot mindfulness-based intervention with respect to reducing the risk of eating disorders in young women. METHODS: Forty-four young adult women with body image concerns (Mage = 20.57, SD = 3.22) were randomly allocated to a mindfulness-based or a dissonance-based intervention (3 × 1 h weekly sessions), or to assessment-only control. Self-report measures of eating disorder risk factors, symptoms and related psychosocial impairment were compared at baseline, post-intervention, and at 1- and 6-month follow up. RESULTS: At post-intervention, acceptability ratings for both interventions were high. Mindfulness participants demonstrated statistically significant improvements relative to control at post-intervention for weight and shape concern, dietary restraint, thin ideal internalization, eating disorder symptoms and related psychosocial impairment; however, these gains were largely lost over follow up. Dissonance participants did not show statistically significant improvements relative to control on any outcomes, despite small to moderate effect sizes. CONCLUSIONS: These preliminary findings demonstrate the acceptability and short-term efficacy of a mindfulness-based approach to reducing the risk of disordered eating in young women. This provides support for the continued evaluation of mindfulness in the prevention and early intervention of eating disorders, with increased efforts to produce maintenance of intervention gains.

Randomized controlled trial of an online mother-daughter body image and well-being intervention.

OBJECTIVE: Poor body image is a public health issue. Mothers are a key influence on adolescent girls' body image. This study evaluated an accessible, scalable, low-intensity internet-based intervention delivered to mothers (Dove Self Esteem Project Website for Parents) on mothers' and their adolescent daughters' body image and psychosocial well-being. METHOD: British mother-daughter dyads (N = 235) participated in a cluster randomized controlled trial (assessment-only control; mothers viewed the website without structured guidance [website-unstructured]; mothers viewed the website via a tailored pathway [website-tailored]). Dyads completed standardized self-report measures of body image, related risk factors, and psychosocial outcomes at baseline, 2 weeks post-exposure, 6-week, and 12-month follow-up. RESULTS: Dyadic models showed that relative to the control, mothers who viewed the website reported significantly higher self-esteem at post-exposure (website-tailored), higher weight esteem at 6-week follow-up (website-tailored), lower negative affect at 12-month follow-up (website-tailored), engaged in more self-reported conversations with their daughters about body image at post-exposure and 6-week follow-up, and were 3-4.66 times more likely to report seeking additional support for body image issues at post-exposure (website-tailored), 6-week, and 12-month (website-tailored) follow-up. Daughters whose mothers viewed the website had higher self-esteem and reduced negative affect at 6-week follow-up. There were no differences on daughters' body image, and risk factors among mothers or daughters, at post-exposure or follow-up. Tailoring website content appeared beneficial. CONCLUSIONS: This intervention offers a promising 'first-step' toward improving psychosocial well-being among mothers and daughters. In order to further optimize the intervention, future research to improve body image-related outcomes and to understand mechanisms for change would be beneficial. (PsycINFO Database Record

Effectiveness of a brief school-based body image intervention 'Dove Confident Me: Single Session' when delivered by teachers and researchers: Results from a cluster randomised controlled trial.

UNLABELLED: This study evaluated a 90-min single session school-based body image intervention (Dove Confident Me: Single Session), and investigated if delivery could be task-shifted to teachers. British adolescents (N = 1707; 11-13 years; 50.83% girls) participated in a cluster randomised controlled trial [lessons as usual control; intervention teacher-led (TL); intervention researcher-led (RL)]. Body image, risk factors, and psychosocial and disordered eating outcomes were assessed 1-week pre-intervention, immediate post-intervention, and 4-9.5 weeks follow-up. Multilevel mixed-models showed post-intervention improvements for intervention students relative to control in body esteem (TL; girls only), negative affect (TL), dietary restraint (TL; girls only), eating disorder symptoms (TL), and life engagement (TL; RL). Awareness of sociocultural pressures increased at post-intervention (TL). Effects were small-medium in size (ds 0.19-0.76) and were not maintained at follow-up. There were no significant differences between conditions at post or follow-up on body satisfaction, appearance comparisons, teasing, appearance conversations and self-esteem. The intervention had short-term benefits for girls' body image and dietary restraint, and for eating disorder symptoms and some psychosocial outcomes among girls and boys. A multi-session version of the intervention is likely to be necessary for sustained improvements. Teachers can deliver this intervention effectively with minimal training, indicating broader scale dissemination is feasible. TRIAL REGISTRATION: ISRCTN16782819.

Enhancing dissemination in selective eating disorders prevention: an investigation of voluntary participation among female university students.

Maximising dissemination of efficacious psychological interventions is an important undertaking, particularly in prevention work where the target population may not be seeking help. Consequently, the current study investigated voluntary participation in a selective eating disorder prevention programme by examining predictors of, and evaluating a motivational enhancement approach to, increased participation. Female students studying first-year psychology (N = 124, M(age) = 19.30, SD = 1.55) completed baseline measures, were randomised to a motivational or control condition, then presented with a flyer for an eating disorders prevention trial and assessed regarding potential participation. Results showed that interest and likelihood of participation were low overall and lack of time the most commonly endorsed reason. Participants high on weight concerns were more likely to cite the group format of the intervention as a deterrent. A greater belief in the helpfulness of body image programmes and higher personal ineffectiveness were significant predictors of interest in participation. There was no significant difference between those who did and did not undergo the motivational enhancement with respect to interest and likelihood of participation. These findings suggest important avenues for consideration when designing eating disorder prevention efforts relying on voluntary participation, and highlight the importance of evaluating programmes cross-culturally.