Prevention Across the Spectrum: a randomized controlled trial of three programs to reduce risk factors for both eating disorders and obesity (original) (raw)
Related papers
Journal of Pediatric Psychology, 2013
Objective: To develop and pilot Life Smart, an 8-lesson program aimed at reducing risk factors for both eating disorders and obesity. Methods: Grade 7 girls and boys (N=115) from one independent school were randomly allocated to the Life Smart (2 classes; N = 51) or control (3 usual classes; N=64) conditions. Risk factors were measured at baseline and post-program (5-weeks later). Results: Life Smart was rated as moderately enjoyable and valuable by participants. ANCOVAs with baseline as a covariate revealed a significant main effect for group favouring Life Smart for shape and weight concern (Effect Size [ES] = .54), with post-hoc testing finding girls particularly benefited on this variable (ES = .78). Conclusions: Feedback was generally favourable, with some suggestions for even more interactive content. The program showed more promise with girls. Informed by these findings, the program underwent revisions and is now being evaluated in a randomized controlled trial.
The British Journal of Psychiatry, 2013
Body dissatisfaction during adolescence is common but not benign. Between 17 and 33% of adolescents report body dissatisfaction, with the figure higher for girls than boys. 1,2 Body dissatisfaction is a major public health concern because of its association with an array of negative outcomes, ranging from depression and eating disorders, to cosmetic surgery use, over-and under-exercising, obesity and unhealthy weight loss behaviours such as smoking. 1,3 As such, body dissatisfaction has been the focus of government policy in a number of countries. Schools offer an opportunity for prevention of body dissatisfaction, as programmes can be delivered across the population prior to the increase in body image dissatisfaction seen in late adolescence. 6 Previous work has shown that school-based interventions can reduce body dissatisfaction and its precursors. 7,8 However, delivery has usually been by clinical psychologists, 7,8 who are an expensive and limited resource in schools.
Clinical Psychologist, 2010
The objective of this study was to explore two aspects not investigated in a 2.5-year controlled evaluation of an 8-lesson media literacy program. First, the impact of the program on over-evaluation of shape and weight. Second, an examination of the program effects by participant baseline risk of developing an eating disorder. Grade 8 students (N ¼ 540, mean age ¼ 13.62 years) were assessed at baseline, post-program, 6-month, and 2.5-year follow-up. Controlling for baseline observations, linear mixed model analyses revealed a main effect for group, favouring media literacy, and a group 6 risk interaction, where high-risk media literacy participants had significantly lower over-evaluation scores than high-risk control participants. Both high-risk media literacy girls and boys, and low-risk media literacy girls scored significantly lower at 2.5year follow-up than controls. Media literacy can have a lasting, beneficial impact in reducing the core cognitive component of eating disorders in both high-and low-risk young adolescents.
Behaviour Research and Therapy, 2014
Objective: To investigate if baseline depression moderated response to Media Smart, an 8-lesson schoolbased program previously found to achieve a long-term risk reduction effect in young adolescents. Method: 540 Grade 8 students (M age ¼ 13.62 years, SD ¼ .37) from 4 schools participated with 11 classes receiving the Media Smart program (126 girls; 107 boys) and 13 comparison classes receiving their normal lessons (147 girls; 160 boys). Shape and weight concern, media internalization, body dissatisfaction, dieting, ineffectiveness, and perceived pressure were the outcome variables. Results: Moderation was indicated by significant interaction effects for group (Media Smart; Control) Â moderator (high depression; low depression) Â time (post-program; 6-month follow-up; 2.5year follow-up), with baseline entered as a covariate. Such effects were found for shape and weight concern, media internalization, body dissatisfaction, ineffectiveness and perceived pressure. Post-hoc testing found high depression Media Smart participants scored significantly lower than their control counterparts at post-program on shape and weight concern, media internalization and dieting, whereas low depression Media Smart participants scored significantly lower on shape and weight concern at 2.5year follow-up. Discussion: Media Smart achieved a reduction in eating disorder risk factors for high-depression participants and a reduced rate of growth in risk factor scores for low-depression participants. Trial registry name: Australian New Zealand Clinical Trials Registry. URL: http://www.anzctr.org.au. Registration identification number: ACTRN12608000545369.
European Eating Disorders Review, 2010
There is currently controversy surrounding the effectiveness of universal versus selective prevention in eating disorders (ED). The present study aims at evaluating the effectiveness of universal school-based ED prevention administered to female secondary school students (n = 349). Students received either the full prevention programme (learning basic concepts of nutrition, criticism of aesthetic models of beauty emphasising extreme thinness, media literacy (ML)), a partial version of the programme (without nutritional education), or no prevention programme. Students were also classified on the presence or absence of distinct risk factors for ED: Early menarche, overweight, dieting, negative attitudes to food and perceived pressure to be thin. Pre-test data were collected 1 week prior to implementation of the prevention programme, and post-test data were collected on the last day of the programme. Results suggested that both the full and partial prevention programmes reduced perceived pressure to be thin and improved eating attitudes and knowledge of nutrition in all the participants (regardless of risk); however, greater effect sizes were found among particular high-risk groups (early menarche, overweight and highly influenced by aesthetic models of beauty emphasising extreme thinness). School-based programmes of universal intervention may have an important role to play in the prevention of ED. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.
BMC Public Health, 2013
Background: The prevention of eating disorders and disordered eating are increasingly recognized as public health priorities. Challenges in this field included moving from efficacy to effectiveness and developing an integrated approach to the prevention of a broad spectrum of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. The main aim of this effectiveness trial protocol is to test whether this program has effects when incorporating an integrated approach to prevention and when previously-trained community providers implement the intervention.
Combining Universal and Targeted Prevention for School-Based Eating Disorder Programs
… Journal of eating …, 2004
Objective: This study examined a step toward providing a universal prevention program to all students while targeting those at risk. Method: Seventy-eight 10th-grade female students were provided an on-line eating disorder prevention program and randomized to participate in (1) a higher risk and higher motivated group, (2) a lower risk or lower motivated group, or (3) a combined group. Results: The students in the first group made significantly fewer negative and more positive comments in the on-line group discussion than the higher risk and higher motivated participants in the combined group. However, there were no differences among groups on outcome measures. Discussion: The results suggest that, because it is relatively easy to provide interventions with separate groups, it seems appropriate to do so, if for no other reason than to minimize the few very negative comments that were posted by students that might have created an adverse environment for the higher risk-participants that the intervention specifically targets. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 35: 1-9, 2004.
Internet Interventions
Background: The worldwide prevalence of overweight and obesity is at alarming levels. Nearly one in three children in Europe is overweight or obese. Disordered eating and body image concerns are equally widespread and increase risk for more chronic and severe weight-related problems. Research has shown that online interventions that address both healthy weight regulation and body image can reduce risk for eating disorders and obesity simultaneously and are feasible to implement in school settings. To date, evaluation and dissemination of such programs in Europe is scant. Methods: The Healthy Teens @ School study is a multi-country cluster-randomized controlled trial (RCT) comparing the effectiveness of an unguided, online, multi-level intervention for promoting a healthy lifestyle and reducing problematic eating behavior, eating disorder and obesity risk among students aged 14 to 19 years with control condition. As part of the Horizon 2020 funded project ICare (GA No. 634757) the trial is conducted in Austria and Spain. Cluster randomization by school is used. The intervention is an adapted version of an evidence-based program developed in the USA (StayingFit). Participants of the intervention group are assigned to one of two possible program tracks based on the results of the initial online-assessment: Overweight adolescents are assigned to the "Weight Management" track emphasizing balanced eating and exercise for weight maintenance, and all other individuals are assigned to the "Healthy Habits" track which aims at promoting healthy habits related to e.g., nutrition, physical activity, sleep. The participants of both tracks work on ten modules (one 20-30 min module per week) during school hours and/or at home. Assessments are conducted at pre-and postintervention, and at 6-and 12-months after baseline assessment. The primary outcome is intuitive eating, secondary outcomes are eating disorder symptomatology, body image concerns, body mass index, food intake, physical activity, self-esteem, stress coping, depression, and anxiety. Following the initial assessment, individuals in the control group do not have access to the prevention program but continue as normal and are only prompted to the assessments at all time points. At the end of the 12-month study they will get access to the program.
BMC psychiatry, 2017
Previous prevention programs in the school context have not addressed both genders, have been time-consuming, or have had deficits in the evaluation method. The aim of the present study was to evaluate the impact of a universal prevention program for female and male adolescents on eating disorder pathology and related risk factors. Between February 2012 and July 2014, 2515 students in 23 schools from 8th or 11th grade were assessed for eligibility in this longitudinal cluster-randomized controlled trial with a six months follow-up. Of those students, 2342 were cluster-randomized to the intervention condition which received a six school hours universal prevention program or to the no treatment control condition. The complete case population comprised 724 students in the intervention (54.3% female, M = 14.3 years, SD = 1.61) and 728 in the control condition (57.0% female, M = 14.7 years, SD = 1.63). Random-effects analysis of covariance on the primary outcome showed no significant dif...