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Objective: Prevention programs for eating disorders (EDs) and high body index mass (BMI) have the potential to reduce the onset of these interconnected public health concerns. However, it remains unclear whether routine implementation of such programs would be cost‐effective. This study aims to determine the cost‐effectiveness of an intervention that aims to prevent both ED and high BMI. Method: A Markov model was developed to evaluate the incremental cost‐effectiveness of a targeted school‐based program, Healthy Weight, that aims to prevent both EDs and high BMI among Australian adolescents with body image concerns (aged 15–18 years), versus a "no intervention" comparator. A cost‐utility analysis was conducted from a "healthcare and education" sector perspective with costs (measured in 2019 Australian dollars) and health impacts modeled over the lifetime of the target population. An incremental cost‐effectiveness ratio (ICER), expressed as cost per health‐adjusted life year (HALY) gained, was calculated. Sensitivity analyses were done to test model assumptions. Results: The mean intervention cost and HALYs gained were AUD$2.13 million (95% CI, AUD$1.83–2.43 million) and 146 (95% CI, 90–209), respectively. With healthcare cost‐savings (AUD$3.97 million) included, the intervention was predicted to be cost‐saving (AUD$1.83 million; 95% CI, AUD$0.51–3.21 million). Primary findings were robust to extensive sensitivity analyses. Discussion: The Healthy Weight intervention is likely to represent good value‐for‐money. To ensure the successful implementation of this program at the population level, further research on its feasibility and acceptability among schools and the wider community is required. [ABSTRACT FROM AUTHOR]

Objective: Gay and bisexual men are at an increased risk for eating disorders (EDs) and muscle dysmorphia (MD) compared with their heterosexual counterparts. Existing dissonance‐based (DB) EDs prevention programs for this population have been evaluated in the United States; however, these programs have not been evaluated in the Brazilian context. Thus, we investigated the feasibility, acceptability, and efficacy of a DB ED prevention program (i.e., the PRIDE Body Project) among Brazilian cisgender gay and bisexual men. Method: Eligible men were randomly assigned to either a DB intervention (n = 74) condition or an assessment‐only control (AOC) condition (n = 75). Participants completed measures assessing ED and MD risk and protective factors at baseline, post‐intervention, 1‐month, 6‐month, and 1‐year follow‐up. Those in the intervention condition also completed acceptability measures. Results: Feasibility and acceptability ratings were highly favorable. Regarding efficacy, post‐intervention results were not significant, except for self‐objectification, which showed a significantly greater decrease in the DB condition compared with the AOC condition at all time‐points of follow‐ups (Cohen's d = −0.31 to −0.76). At follow‐up, the DB condition showed significantly greater decreases in appearance‐ideal internalization, drive for muscularity, self‐objectification, ED and MD symptoms at 1‐month, 6‐month, and 1‐year follow‐ups (d = −0.33 to −0.92) compared with the AOC condition. Significant increases were observed in the DB compared with the AOC condition for body appreciation at 1‐month, 6‐month, and 1‐year follow‐ups (d = 0.31–0.81). Discussion: Results support the feasibility, acceptability, and efficacy of the PRIDE Body Project up to 1‐year in Brazilian cisgender gay and bisexual men. Trial Registration: Brazilian Registry of Clinical Trials (ReBEC; available at http://www.ensaiosclinicos.gov.br/) number of registration: RBR‐62fctqz. [ABSTRACT FROM AUTHOR]

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. ClinicalTrials.gov Identifier: NCT05399446. [ABSTRACT FROM AUTHOR]

Dietary habits established in childhood, often persist into adulthood highlighting the importance of early intervention. However, limited interventions exist promoting "how" to establish healthful eating behaviors in children. To create impactful interventions, it is important they are based on evidence and co-designed with end-users. Fifteen child health nurses participated in this co-design study, underpinned by the Knowledge to Action Framework. Child health nurses reviewed evidence-based statements and then workshopped practical strategies. Findings from the co-design sessions were used to inform the development of a preventive intervention. The study has important health marketing implications for conducting co-design with child health nurses. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This Virtual Issue of the International Journal of Eating Disorders honors the legacy of the late Dr. C. Barr Taylor in the eating disorders (EDs) field. For decades, Dr. Taylor led the way in not only conducting the research needed to achieve the ultimate goal of making affordable, accessible, and evidence‐based care for EDs available to all, but also nurturing the next generation of scientific leaders and innovators. Articles included in this Virtual Issue are a selection of Dr. Taylor's published works in the Journal in the past decade, spanning original research, ideas worth researching, commentaries, and a systematic review. We hope this Virtual Issue will inspire the next generation of research in EDs, and equally, if not more importantly, the next generation of young investigators in the field. We urge the field to continue and build upon Dr. Taylor's vision—to increase access to targeted prevention and intervention for EDs in innovative and forward‐thinking ways—while embracing his unique and powerful mentorship style to lift up early career investigators and create a community of leaders to address and solve our field's biggest challenges. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

(1) Background: School professionals such as teachers and counsellors are uniquely positioned to facilitate discussion around disordered eating and body image; however, little is known about the needs of school professionals with respect to eating disorder prevention. This study aimed to explore the needs and perceptions of Australian school professionals regarding eating disorder prevention. (2) Methods: School professionals were recruited to a mixed-methods online cross-sectional survey. The survey assessed demographics and perceived needs and attitudes to eating disorder prevention. (3) Results: Most participants (92%) were willing to participate in eating disorder prevention; however, only 61% reported good knowledge and 41% reported feeling confident in implementing eating disorder prevention. Those who had received training in eating disorders (24%) reported higher confidence (p = 0.02) and knowledge (p = 0.04). Only 66% of respondents reported that all teachers should be involved in eating disorder prevention while barriers including workload, knowledge, and resources were commonly highlighted. Fewer respondents working in primary school settings reported the need for prevention approaches (p = 0.046). (4) Conclusions: Despite a willingness to be involved in the prevention of eating disorders, there are inconsistencies in attitudes regarding the role of school professionals in eating disorder prevention. The findings of this study reinforce that understanding professional roles, school settings, and personal attitudes is critical in the development of more efficacious school professional training and prevention interventions. [ABSTRACT FROM AUTHOR]

Background: Adolescents with type 1 diabetes are at significantly increased risk for eating disorders and few interventions exist. Objective: This study examined the feasibility, acceptability, and preliminary effects of an internet‐based eating disorders prevention program adapted specifically for adolescent girls with type 1 diabetes. Participants and Methods: Thirty‐five girls (16.2 ± 1.1 years) participated Body Project (T1D Style), a 4‐week program consisting of four adolescent sessions focused on promoting illness acceptance, challenging sociocultural body image pressures, increasing social support, and teaching assertive communication. Caregivers participated in one session focused on fostering body image positivity and a healthy relationship with food. Pre‐intervention, post‐intervention, and 3‐month follow‐up surveys assessed disordered eating, body dissatisfaction, thin‐ideal internalization, diabetes acceptance, diabetes distress, and quality of life. Cohen's d effect sizes were calculated at post‐intervention and follow‐up. Program acceptability was assessed at post‐intervention. Manual fidelity and homework completion were monitored. Results: High manual fidelity, retention, and homework completion were achieved. Quantitative and qualitative feedback from teens and caregivers suggested high acceptability. Large effects (d = 1.35–0.83) were observed for dieting, body dissatisfaction, diabetes distress, diabetes acceptance, and diabetes‐related quality of life at post‐intervention, with large‐medium effects (d = 1.16–0.58) at follow‐up. Medium‐small effects (d = 0.49–0.78) at post‐intervention were observed for diabetes‐specific disordered eating and thin‐ideal internalization, with effects maintained at follow‐up. Conclusions: Results support the acceptability and feasibility of this targeted eating disorders prevention program for adolescent girls with type 1 diabetes. Future clinical trials are warranted to determine its effectiveness compared to a control condition. [ABSTRACT FROM AUTHOR]

Schleider and colleagues' paper on the application of single‐session interventions (SSIs) to eating disorders is timely given the broader focus in mental health on flexible approaches to delivering support at the time the person needs it most. The eating disorder field needs to embrace these innovations including developing a "single‐session mindset" with greater attention paid to testing the relevance of SSI for eating disorders. The use of well‐powered trials of brief, focused and rapidly scalable interventions is an ideal vehicle for generation and evaluation of new and longer interventions. Our future research agenda needs to carefully consider our target audience, the primary outcome variable of most relevance, and the SSI topic that would be most likely to effect change. Research in prevention might focus on weight concern and evaluation of SSIs that focus on self‐compassion or cognitive dissonance related to appearance ideals in the media. Work in early intervention could target denial and disordered eating using SSIs on growth mindset, behavioral activation, and imagery rescripting. Treatment waitlists provide another suitable opportunity, evaluating SSIs that aim to increase hope for change, treatment retention, and kick start early change in therapy, a robust predictor of better treatment outcome. [ABSTRACT FROM AUTHOR]

Objective: Age of eating disorder (ED) onset has been of significant interest to both researchers and clinicians. The identification of factors associated with early or child onset has important prevention and treatment implications. The presence of prior trauma, resultant posttraumatic stress disorder (PTSD), ED severity, and comorbid psychopathology are of particular relevance to age of ED onset, but data are limited. Methods: Adults (≥18 years, 93% female, total n = 1283) admitted to residential ED treatment self‐reported age of ED onset. Patients were divided into child onset (ages 5–10 years), adolescent onset (11–17 years), and adult onset (≥18 years) groups and compared on a number of clinical features and assessment measures. Results: The child onset group had significantly higher rates and doses of traumatic life events; higher current PTSD prevalence; higher BMIs, higher severity of ED, depression and state‐trait anxiety symptoms; worse quality of life; and more prior inpatient and residential admissions for ED treatment, in comparison to both the adolescent and adult onset groups. Similarly, the adolescent onset group had significantly higher rates than the adult onset group. Conclusions: These results have important implications for prevention, treatment and long‐term follow‐up and highlight the need for early trauma‐focussed treatment of ED patients. Highlights: Of 1283 adults admitted to residential eating disorder (ED) treatment, the 14% who self‐reported child onset EDs (before age 11 years) related significantly higher total numbers of lifetime traumas and higher rates of several types of traumas, especially acts of interpersonal violence, compared to the adolescent onset (11–17 years) and adult onset (>18 years) groupsThe child onset group also showed significantly higher rates of provisional PTSD; greater ED, PTSD, depressive and state‐trait anxiety symptom severity; higher admission BMI's and rates of obesity; worse quality of life; and more prior inpatient and residential admissions for ED treatment, in comparison to both the adolescent (11–17 years) and adult (>18 years) onset groupsIn addition, the adolescent onset group scored significantly higher on all measures and had more prior ED admissions compared to the adult onset group [ABSTRACT FROM AUTHOR]

Aims: Increasing evidence suggests that children and young people with type 1 diabetes (T1D) are at greater risk of disordered eating compared to children without T1D. Disordered eating in T1D has been linked to impaired wellbeing, increased health service use and early mortality. To address this problem, we will co‐develop a psycho‐education intervention for parents of children and young people with T1D, informed by the Information Motivation Behavioural Skills model. Methods: The objective of this study is to assess the feasibility and acceptability of the intervention compared to a waitlist control group using a feasibility randomised controlled trial (RCT) design. We aim to recruit 70 parents of children and young people with T1D (11–14 years), 35 in each arm. Those assigned to the intervention will be invited to participate in two workshops of 2 h each. Parents will be asked to complete outcome measures regarding eating habits, diabetes management, as well as a questionnaire based on the Information Motivation Behavioural Skills model which provides a theoretical foundation for the intervention. These will be completed at baseline, 1‐ and 3‐month post‐intervention. Children and young people will be asked to complete questionnaires on their eating behaviours at the same time intervals. Parents randomised to receive the intervention will be invited to take part in interviews to feedback on the intervention and research protocol acceptability. Conclusion: It is anticipated that the psycho‐education intervention aimed at parents will help prevent the development of disordered eating in children and young people with T1D and improve parental wellbeing. The results of this feasibility trial will determine whether this intervention approach is acceptable to families living with T1D, and whether a definitive RCT of intervention effectiveness is justified. Qualitative findings will be used to refine the intervention and study protocols. Trial registration: This protocol has been registered with ClinicalTrials.gov [Identifier: NCT04741568]. [ABSTRACT FROM AUTHOR]

Objective: Body image concerns and extreme weight control behaviors frequently develop in childhood indicating an important age group for the implementation of universal–selective prevention approaches. This systematic review aimed to evaluate the effect of universal–selective prevention interventions addressing disordered eating, body image concerns, and/or extreme weight control behaviors in children aged 6–12 years. Method: Nine databases were searched up to April 2021. Studies were included if they delivered a universal–selective prevention intervention to children aged 6–12 years and reported outcomes relating to body image, disordered eating, or weight control behaviors. The review was conducted in line with the PRISMA Guidelines. Results: A total of 42 articles describing 39 studies included in the review, with most (n = 24; 57%) classified as neutral quality. Thirty studies implemented an eating disorder specific universal–selective program and nine implemented lifestyle interventions plus content to address disordered eating risk factors. Meta‐analysis (n = 16 studies) revealed an improvement in body image‐related outcomes across all studies (standardized mean difference [SMD] 0.26 [95%CI 0.01, 0.51]); with a high level of heterogeneity (Î2 = 89.9%; p <.01). Meta‐analysis according to gender revealed a general improvement in body image‐related outcomes for girls (SMD 0.40 [95%CI 0.07, 0.73]), but not boys (SMD 0.23 [95%CI −0.24, 0.70]). Discussion: By investigating child, parental and teaching interventions and including outcomes such as weight control and disordered eating behaviors, a trend toward a reduction in eating disorder risk factors was observed, particularly body image‐related outomes in girls. Future directions include embedded disordered eating prevention materials within existing lifestyle interventions and inclusion of more diverse samples. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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Objective: Few prevention programs have been developed and empirically evaluated to address eating disorder (ED) and muscle dysmorphia (MD) symptoms in men. Furthermore, new strategies for the broad implementation of available programs are needed. We investigated the acceptability and efficacy of a dissonance‐based (DB) intervention for Brazilian undergraduate men with body dissatisfaction to target risk and protective factors for ED and MD symptoms (the Body Project: More Than Muscles) after an online training for facilitators. Method: Participants were randomized to a two‐session DB‐intervention (n = 89) or assessment‐only control (AOC) (n = 91), and completed validated measures assessing ED and MD risk and protective factors pre‐intervention, post‐intervention, and at 4‐ and 24‐week follow‐up post‐intervention. Results: Acceptability ratings were highly favorable. Regarding efficacy, the DB condition demonstrated significantly greater decreases in ED and MD risk factors compared to AOC from pre‐intervention to 4‐week (p‐values <.05, between‐condition Cohen's d = 0.35–1.10) and 24‐week follow‐up (p‐values <.05, between‐condition Cohen's d = 0.33–0.78). Results at post‐intervention were not significant, with the exception that body appreciation showed significantly greater improvements in the DB condition (post‐intervention: p <.01, between‐condition Cohen's d = 0.40; 4‐week: p <.001, between‐condition Cohen's d = 0.80; and 24‐week follow‐up: p <.001, between‐condition Cohen's d = 0.58). Discussion Results support the acceptability and efficacy of a DB‐intervention delivered in‐person after an online training for facilitators up to 24‐week follow‐up in Brazilian men. [ABSTRACT FROM AUTHOR]

Fifteen prevention-related publications in Eating Disorders during 2020 are reviewed. Two models frame this analysis: (1) the Mental Health Intervention Spectrum: health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into a cycle: rationale, theory, and methodology, shaped by critical, integrative reviews → clarification of risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination. In this cycle the first two phases and the last phase inform advocacy for social policies supporting prevention. Ten articles comprising a special issue on yoga demonstrate the value of investing in translational prevention science that acknowledges (a) embodying experiences as a broad category of protective factors; (b) the utility of multidimensional theoretical models; and (c) social justice issues that advocacy efforts must address to make programs widely and equitably available. Other articles reviewed show, for example, that studies of emotion dysregulation and emotional eating are needed to enter a prevention cycle that moves us beyond body image (or weight/shape) concerns in defining high-risk groups and developing indicated prevention. Finally, implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies are discussed. [ABSTRACT FROM AUTHOR]

This article provides the concluding thoughts on the special issue, Yoga forPositive Embodiment in Eating Disorder Prevention and Treatment, which illustrate the progress being made on the relationship between yoga practice and the different indicators of positive embodiment that is relevant for the prevention and treatment of eating disorders. Based on the current body or work, we offer recommendations for the next steps for researchers for population-based, qualitative, and prevention and intervention research. [ABSTRACT FROM AUTHOR]

Background: Eating problems are highly prevalent among young adults. Universities could be an optimal setting to prevent the onset of eating disorders through psychological intervention. As part of the World Mental Health‐International College Student initiative, this systematic review and meta‐analysis synthesizes data on the efficacy of eating disorder prevention programs targeting university students. Method: A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, PsycINFO) for randomized trials comparing psychological preventive interventions for eating disorders targeting university students with psychoeducation or inactive controls was performed on October 22, 2019. Results: Twenty‐seven studies were included. Thirteen (48.1%) were rated to have a low risk of bias. The relative risk of developing a subthreshold or full‐blown eating disorder was incidence rate ratio = 0.62 (95% CI [0.44, 0.87], nc = 8, numbers‐needed‐to‐treat [NNT] = 26.08; standardized clinical interviews only), indicating a 38% decrease in incidence in the intervention groups compared to controls. Small to moderate between‐group effects at posttest were found on eating disorder symptoms (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, nc = 26), dieting (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, nc = 21), body dissatisfaction (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, nc = 25), drive for thinness (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, nc = 12), weight concerns (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, nc = 13), and affective symptoms (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, nc = 18). The effects on bulimia nervosa symptoms were not significant. Heterogeneity was moderate across comparisons. Discussion: Eating disorder prevention on campus can have significant, small‐to‐moderate effects on eating disorder symptoms and risk factors. Results also suggest that the prevention of subthreshold and full‐syndrome eating disorders is feasible using such interventions. More research is needed to identify ways to motivate students to use preventive eating disorder interventions. Antecedentes: Los trastornos de la conducta alimentaria son altamente prevalentes entre los adultos jóvenes. Las universidades podrían ser un entorno óptimo para prevenir la aparición de trastornos alimentarios a través de la intervención psicológica. Como parte de la iniciativa World Mental Health‐International College Student, esta revisión sistemática y meta‐análisis sintetiza datos sobre la eficacia de los programas de prevención de trastornos alimentarios dirigidos a estudiantes universitarios. Método: Una búsqueda bibliográfica sistemática de datos bibliográficas (CENTRAL, MEDLINE, PsycINFO) para ensayos aleatorios que comparaban intervenciones preventivas psicológicas para trastornos alimentarios dirigidos a estudiantes universitarios con psicoeducación o controles inactivos fue realizada hasta el 22 de octubre de 2019. Resultados: Se incluyeron 27 estudios. Trece (48,1%) fueron calificados como de bajo riesgo de sesgo. El riesgo relativo de desarrollar un trastorno de la conducta alimentaria subclínico (parcial) o completo fue IRR = 0.62 (95% CI [0.44, 0.87], nc = 8, NNT = 26.08; sólo entrevistas clínicas estandarizadas), lo que indica una disminución del 38% en la incidencia en los grupos de intervención en comparación con los controles. Se encontraron efectos pequeños a moderados entre los grupos en la post‐prueba en los síntomas del trastorno alimentario (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, nc = 26), dieta (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, nc = 21), insatisfacción corporal (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, nc = 25), impulso por delgadez (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, nc = 12), problemas de peso (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, nc = 13) y síntomas afectivos (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, nc = 18). Los efectos sobre los síntomas de la bulimia nervosa no fueron significativos. La heterogeneidad fue moderada en las comparaciones. Discusión: La prevención de los trastornos de la conducta alimentaria en el campus universitario puede tener efectos significativos, de pequeños a moderados, sobre los síntomas del trastorno alimentario y los factores de riesgo. Los resultados también sugieren que la prevención de los trastornos alimentarios subclínicos o parciales y síndromes completos es factible utilizando tales intervenciones. Se necesita más investigación para identificar formas de motivar a los estudiantes a usar intervenciones preventivas para los trastornos de la conducta alimentaria. [ABSTRACT FROM AUTHOR]

Objective: Most advertisements contain thin‐ideal imagery enhanced by digital modification. The deleterious effects on body image and eating disorder risk of exposure to such images have been well documented. One of the proposed macro‐level solutions to mitigate these effects has been the use of labels on images, primarily disclaimer labels. A growing number of studies have explored the usefulness of such labels in protecting body image against the detrimental effects of media exposure; however, findings have been divergent. Methods: The current study aimed to conduct a systematic review and meta‐analysis of the existing literature investigating the effects of including labels on media images on body image. Results: The systematic review identified n = 22 studies that were included in a narrative review, n = 18 were included in the meta‐analysis. Overall, findings provided little support for the use of disclaimer or warning labels as a means of protecting against the detrimental effects of media exposure on body image. Furthermore, findings suggested that such labels might increase state appearance comparison when exposed to media images. Discussion: These findings are especially concerning in light of recent legislative efforts to mitigate media effects through the use of labels on imagery, as well as industry initiatives based on image labeling. Additional research examining alternative strategies for universal prevention of body image and eating concerns is warranted. [ABSTRACT FROM AUTHOR]

The article focuses on introducing a special issue dedicated to exploring the mechanisms underlying eating disorders. Topics include the psychological and biological factors contributing to these disorders, the latest research methodologies used to study them, and potential therapeutic interventions to improve treatment outcomes.

Objective: This systematic review aimed to evaluate the nature of interventions addressing eating psychopathology in athletes, identify the characteristics of successful interventions, and review the efficacy of interventions at reducing or preventing eating psychopathology. Method: SPORTDiscus, MEDLINE, and PsycINFO were searched to identify studies addressing eating psychopathology in athletes, which included an outcome measure of disordered eating. Results: Seventeen studies (11 randomised controlled trials, six nonrandomised trials) reporting data on 13 interventions were included. The methodological quality was observed to be generally low. All interventions (11 implemented in North America) were delivered face to face in groups with variable duration and intensity. Thirteen studies reported significant reductions in athletes' eating psychopathology following the intervention, with seven reporting sustained effects (small to moderate). Successful interventions were characterised by higher intervention dosage, higher retention, and incorporated a focus on self‐esteem and self‐efficacy. Conclusion: The complex nature of interventions, combined with a lack of evaluation data and poor methodological quality, limits the scaling and refinement of many interventions. Future research should explore other modes of delivery, collect evaluation data, and adhere to clearer study reporting. Doing this will consequently improve the development and delivery of effective eating psychopathology interventions offered to athletes more widely. [ABSTRACT FROM AUTHOR]

Background Past research has yielded promising results on the effectiveness of Internet-based interventions to prevent eating disorders (EDs) in adolescents, but further information is needed to evaluate the public health impact of their large-scale dissemination. This article used an established framework to systematically review the extent to which indicators of the reach, effectiveness, adoption, implementation and maintenance [cf. Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM)-framework] of universal and targeted online ED prevention programmes are reported in the literature, in order to estimate their future dissemination potential. Methods The literature search was conducted on PubMed, Web of Science and PsycINFO, and complemented by searching existing reviews and the reference lists of the studies included. Twenty-two studies published between 2000 and April 2019 met the inclusion criteria. We extracted data on a total of 43 indicators, within RE-AIM dimensions for each article, including qualitative coding of fostering and hindering factors. Results Reach (55.0%) and implementation (54.0%) were the dimensions reported on most frequently, followed by effectiveness (46.8%), adoption (34.7%) and maintenance (18.2%). While internal validity indicators were frequently reported (e.g. sample size, effects and intervention intensity), most studies failed to report on elements of external validity, such as representativeness of participants and settings, adoption rates, implementation costs and programme sustainability. Conclusions Evidence indicates that Internet-based ED prevention programmes can reach a large number of adolescents and can be feasibly implemented in school settings. However, given the paucity of large-scale dissemination studies available for review, the degree to which schools are willing to adopt preventive interventions, as well as the transferability of programmes to different settings and geographical regions remains unclear. [ABSTRACT FROM AUTHOR]

Background: Very few programs aimed at improving body image among adolescent boys have been effective, and there is still no clear evidence as to what will work for universal prevention of eating disorders and body dissatisfaction with this group. We combined two previously efficacious programs and used a design thinking framework to optimise program content alongside potential end-users including adolescent boys, teachers, parents, and experts. Goodform is a four-session universal program that aims to reduce body dissatisfaction and prevent the use of muscle-building supplements among 14-to-16 year old adolescent boys.Methods/design: Goodform will be trialled using a cluster randomised controlled trial (RCT) conducted in Australian schools, with Year 9 boys as participants. The intervention is teacher-delivered. Data will be collected at three time points: baseline, post-intervention, and follow-up (2 months). Three primary outcome constructs will be examined, including body dissatisfaction (Male Body Attitudes Scale-Revised) and attitudes towards appearance and performance enhancing substances (APES; Outcome Expectations for Steroid and Supplement Use, Intentions to use APES) and actual use of APES at each time point. Three secondary outcome constructs will be examined, which are social norms for APES (adapted Peer Norms Scale), negative body talk (Male Body Talk Scale), and internalisation of and pressure to attain appearance ideals (Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised). Internalisation of appearance ideals will also be examined as a mediator of change in primary outcomes. Teachers will provide data on adherence to lessons, student engagement/enjoyment, and understanding of the content.Discussion: The GoodForm RCT will trial a novel, generalizable, and extensively developed program intended to improve boys' body image and reduce actual and intended APES use. We anticipate that it will provide a novel contribution to the field of boys' body dissatisfaction prevention.Trial Registration: This trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry on May 14th 2019, registration number ACTRN12619000725167. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of the Female Athlete Body project (FAB) in reducing eating disorder (ED) symptoms and risk factors. Method: This study was a community participatory three‐site, two‐arm, cluster randomized controlled trial (RCT). Female collegiate athletes (N = 481) were randomly assigned by team to the FAB intervention, a behavioral ED risk factor reduction program, or a waitlist control condition. Primary analyses examined 18‐month effects for ED pathology. Secondary analyses examined risk factors and correlates (e.g., thin‐ideal internalization, negative mood, Female Athlete Triad knowledge, and body mass index [BMI]). Results: Linear mixed effects models with team as a cluster level variable and study condition as a between‐subjects variable revealed significantly reduced dietary restraint in FAB teams relative to control teams. FAB teams also reported significantly fewer objective and subjective binge episodes than control teams. Finally, FAB teams showed significantly lower thin‐ideal internalization and increased BMI at 18‐months. No other significant differences were found. Discussion: This RCT examined the effects of a short intervention on ED pathology and risk factors in female collegiate athletes through 18‐month follow‐up. This trial is one of only three trials with female athletes that have shown long‐term reductions in any ED symptoms or produced positive effects on ED risk factors. The present study is the first to find such effects with athletes using a brief (i.e., 4 hr) intervention at 18‐month follow‐up. Although small effects were found, the current trial provides valuable lessons about future design and implementation of similar trials with athletes. Trial Registration: Clinical trials NCT01735994. [ABSTRACT FROM AUTHOR]

Objective: As eating disorders (EDs) often emerge during college, managing EDs would ideally integrate prevention and treatment. To achieve this goal, an efficient tool is needed that detects clinical symptoms and level of risk. This study evaluated the performance of a screen designed to identify individuals at risk for or with an ED. Participants: Five hundred forty-nine college-age women. Methods: Participants completed a screen and diagnostic interview. Results: Using parsimonious thresholds for ED diagnoses, screen sensitivity ranged from 0.90 (anorexia nervosa) to 0.55 (purging disorder). Specificity ranged from 0.99 (anorexia nervosa) to 0.78 (subthreshold binge eating disorder) compared to diagnostic interview. Moderate to high area under the curve values were observed. The screen had high sensitivity for detecting high risk. Conclusions: The screen identifies students at risk and has acceptable sensitivity and specificity for identifying most ED diagnoses. This tool is critical for establishing stepped care models for ED intervention. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify changes in the risk of eating disorders after a one-year follow-up of a dissonance-based eating disorders prevention program. The Body Project was implemented in a sample of male and female university students: 133, 110, and 74 at baseline, post-test, and follow-up respectively, and we tested the change in disordered eating behaviors (DEB) over time, and by levels of variables that according to the theoretical model lie on the path between the intervention and DEB, with one-way MANOVA analyses of repeated measures for the associations between internalization of the esthetic thin ideal, depressive symptoms, and DEB. The average value of DEB was 5.23 at pre-test, 3.45 at post-test, and 2.80 at follow-up. The model with DEB at each time point, as dependent variables, and internalization of the esthetic thin ideal and depressive symptoms, as independent variables, showed a significant effect of internalization of the esthetic thin ideal, F(2, 136) = 7.66, p =.0011, while there was no significant effect of depressive symptoms, F(2, 136) = 0.45, p =.6191, indicating that the intervention exerted its effect on DEB via the former variable. The intervention proved to produce effects after a one-year follow-up. These findings support the implementation of universal prevention programs using dissonance-based techniques. [ABSTRACT FROM AUTHOR]

In the last few decades much effort has been devoted to developing prevention programs for eating disorders, as most individuals with these pathologies do not receive treatment and tend to become chronic. The purpose of this study was to evaluate a cognitive dissonance and media literacy intervention aimed at preventing eating disorders in female adolescents. Eighty-eight female students (aged 12–17) from Argentina, participated in a 3-session program. Adolescents completed a baseline, post-intervention and a 6-month follow-up survey. A significant decrease in thin-ideal internalization, body image concerns, influence of advertising, drive for thinness and bulimic attitudes was found at post-intervention. In addition, the number of participants with disturbed eating attitudes and behaviors decreased at post-intervention. Results for body image concerns and drive for thinness were maintained at follow-up. En las últimas décadas se ha dedicado mucho esfuerzo para desarrollar programas de prevención de trastornos alimentarios, ya que la mayoría de los individuos con estas patologías no reciben tratamiento y estos trastornos tienden a volverse crónicos. El propósito de este estudio fue evaluar una intervención basada en el enfoque de la alfabetización en medios y los principios de disonancia cognitiva para prevenir los trastornos de la conducta alimentaria en adolescentes femeninas. Ochenta y ocho estudiantes mujeres entre 12 y 17 años de Argentina participaron en un programa de 3 sesiones. Las adolescentes completaron una encuesta pre-intervención, post-intervención y un seguimiento a los 6 meses. En la post-intervención se encontró una disminución significativa de la internalización del ideal de delgadez, la preocupación por la imagen corporal, la influencia de los medios, la búsqueda de delgadez y actitudes bulímicas. Además, el número de participantes con actitudes y conductas alimentarias disfuncionales también disminuyó postintervención. Los resultados en la preocupación por la imagen corporal y la búsqueda de delgadez se mantuvieron en el seguimiento. [ABSTRACT FROM AUTHOR]

Recruiting diverse samples for prevention trials is challenging, but essential. This paper provides baseline data for four racial/ethnic groups from a randomized controlled trial of a mobile-based prevention intervention and systematically reviews recruitment trends in diversity across technology-based prevention studies. Female emerging adults completed measures of appearance esteem, body image flexibility, appearance comparison, and self-compassion. White participants reported lower body esteem and body image flexibility, and higher appearance comparison compared to Black and Asian participants. Latina participants evidenced higher appearance comparison compared to Black participants. The literature review revealed that while rates of diversity in previous trials vary, the majority of the participants were White. Efforts are needed to increase diversity in prevention trials. [ABSTRACT FROM AUTHOR]

Objectives: Insomnia and loss of appetite are the most common side effects of methylphenidate in patients with attention deficit/hyperactivity disorder (ADHD). The adverse effects may limit optimal dosing and patients' compliance with treatment leading to the discontinuation of treatment. This research evaluates the preventive effects of cyproheptadine on sleeping and appetite disorders induced by methylphenidate in ADHD children. Methods: During this exploratory, randomised, double-blinded, placebo-controlled clinical trial, forty patients with ADHD diagnosis who had received methylphenidate randomly were assigned to participate in the cyproheptadine or the placebo group. Patients' weight and Pittsburgh Sleep Quality Index (PSQI) score were recorded at baseline, after four, six and eight weeks of treatment. The ADHD Parent Rating Scale-V score was also defined at the beginning and the end of study for each patient. Results: There was no significant difference between the cyproheptadine and the placebo groups regarding their weight, rate of growth and PSQI score in the monthly assessment. In addition, there was no significant difference in response to the therapy between the two groups. Conclusions: Based on our findings, cyproheptadine does not have any considerable preventive effect on sleeping and appetite disorders induced by methylphenidate in ADHD children. [ABSTRACT FROM AUTHOR]

Background: The development of efficacious, cost-effective, and widely accessible programs for the prevention of eating disorders (EDs) is crucial in order to reduce the ED-related burden of illness. Programs using dissonance-based and cognitive behavioral approaches are most effective for the selective prevention of ED. Internet-based delivery is assumed to maximize the reach and impact of preventive efforts. However, the current evidence for Internet-based ED prevention is limited. The present trial evaluates the efficacy and cost-effectiveness of two new interventions (based on dissonance theory and principles of cognitive behavioral therapy (CBT)) that are implemented as add-ons to the existing Internet-based ED prevention program ProYouth.Methods: The trial is one of five sub-projects of the German multicenter consortium ProHEAD. It is a three-arm, parallel, randomized controlled superiority trial. Participants will be randomized to (1) the online program ProYouth (active control condition) or (2) ProYouth plus a structured dissonance-based module or (3) ProYouth plus a CBT-based chat group intervention. As part of ProHEAD, a representative school-based sample of N = 15,000 students (≥ 12 years) will be screened for mental health problems. N = 309 participants at risk for ED (assessed with the Weight Concerns Scale (WCS) and the Short Evaluation of Eating Disorders (SEED)) will be included in the present trial. Online assessments will be conducted at baseline, at end of intervention (6 weeks), at 6 months follow-up, and - as part of ProHEAD - at 12 and 24 months follow-up. The primary outcome is ED-related impairment (assessed with the Child version of the Eating Disorder Examination-Questionnaire (ChEDE-Q)) at the end of the intervention. Secondary outcomes include ED-related symptomatology at follow-up, ED-related stigma, ED-related help-seeking, and acceptance of and compliance with the interventions. For the health economic evaluation data on costs of the interventions, healthcare utilization and health-related quality of life will be assessed.Discussion: This is the first study augmenting a flexible prevention approach such as ProYouth with structured evidence-based modules in order to overcome some of the key limitations in the current practice of ED prevention.Trial Registration: German Clinical Trials Register (DRKS), DRKS00014679 . Registered on 25 April 2018. [ABSTRACT FROM AUTHOR]

Sizeism has a negative impact on women and perpetuates fat shaming. Conventional therapeutic suggestions for addressing weight concerns focus on self-discipline rather than on the larger social, cultural, or political contexts of weight stigma. Feminist scholars, therapists, and activists have encouraged social activism to promote psychological well-being and challenge systemic weight prejudice. Results of research on health prevention and promotion efforts have begun to shift thinking away from weight loss and toward deconstructing and changing anti-fat attitudes. We highlight some individual and community-based fat activists to illustrate how their strategies and ideas challenge sizeism in a variety of areas, including the rhetoric of fat, body positivity, photography/art, nutrition/exercise, and diversity/intersectionality. Fat activism has utility within a therapeutic context, especially for those who have experienced sizeism. We strongly encourage therapists to work closely with clients on finding sources and types of fat activism that represent their unique identities, which may be more difficult for those with marginalized identities. [ABSTRACT FROM AUTHOR]

Background: Disordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can be delivered at-scale are needed. Methods: A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) and Student Bodies (SB) were both 9-module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination–Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-month follow-up. Results: Baseline was completed by 608 women (M age = 20.71 years); 33 were excluded leaving 575 randomized to: MS-T (N = 191) ; SB (N = 190) or control (N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls; 78% of this sample completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T participants reported significantly higher quality of life–mental relative to both SB and controls (6-month follow-up), while MS-T and controls had lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5 variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up. Conclusions: Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs. [ABSTRACT FROM AUTHOR]

The present study tested hypothesized mechanisms underlying the effects of two selective prevention interventions targeting both obesity and eating disorders ( Healthy Weight and the newly developed Project Health ), relative to video control. Tests examined mediation for the significant weight gain prevention and eating disorder symptom prevention effects previously reported. College students ( N  = 364; 72% women) with weight concerns were randomized to condition and assessed for 2-years post-intervention. Project Health participants had significant improvements in 2 of the 7 proposed mediators relative to comparisons (i.e., cognitive dissonance, the unhealthy Western dietary pattern) but change in these variables did not mediate its effect on long-term BMI change. Two variables emerged as full mediators of the eating disorder prevention effects for both experimental interventions: body dissatisfaction and negative affect. Analyses failed to support the exploratory hypothesis that change in eating disorder symptoms mediated the effects of condition on BMI gain. This report is the among the first to examine mediation for programs aimed at preventing both weight gain and eating disorders, particularly in mixed-gender groups. Mediational analyses are essential in identifying the mechanism of intervention action, which can inform improvements to prevention programs. [ABSTRACT FROM AUTHOR]

Research on programs for preventing eating disorders and systematic strategies to enhance the effects of such programs were reviewed. Several studies have investigated preventive programs in schools and programs targeting girls in a vulnerable age for developing these disorders. Findings suggest that preventive programs should focus not only on disorder specific risk factors but also on broader features including other mental health problems. Currently, dissonance-based interventions (DBIs) are considered the "gold-standard" of preventive programs for adolescent girls. It would be necessary to develop efficient and eflective preventive programs requiring minimum number of sessions in the future, because other problems would also have to be addressed. It is suggested that preventive programs should specifically consider cognitive development, the training of teachers and students as facilitators, and addressing problems having shared risk factors. [ABSTRACT FROM AUTHOR]

Background: Eating disorders are serious mental disorders and are associated with substantial economic and social burden. The aim of this study is to undertake a systematic review of the cost-effectiveness studies of both preventive and treatment interventions for eating disorder. Method: Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsycINFO, Academic Search Complete, Global Health, CINAHL complete, Health Business Elite, Econlit, Health Policy Reference Center and ERIC) were searched for published cost-effectiveness studies of eating disorder prevention and treatment including papers published up to January 2017. The quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: In all, 13 studies met the review inclusion criteria as full cost-effectiveness studies and 8 were published since 2011. The studies included three modelled and one trial-based study focused on prevention, two trial-based and one modelled study for anorexia nervosa treatment and three trial-based studies for bulimia nervosa treatment. The remaining studies targeted binge-eating disorder or non-specific eating disorder treatment. The average percent of CHEERS checklist items reported was 71% (standard deviation 21%). Eating disorder interventions were mainly cost-saving or more effective and more costly compared to comparators; however, some results did not reach statistical significance. In the two studies that achieved 100% CHEERS checklist, one study reported that a cognitive dissonance intervention might be cost-effective for prevention of anorexia nervosa and bulimia nervosa with a 90% participation rate and the second study supported lisdexamfetamine to be cost-effective in the treatment of binge-eating disorder. Insufficient evidence for long-term cost-effectiveness (e.g. over 2 years) was found. Conclusion: Cost-effectiveness studies in eating disorder appear to be increasing in number over the last 6 years. Findings were inconsistent and no firm conclusion can be drawn with regard to comparative value-for-money conclusions. However, some promising interventions were identified. Further research with improved methodology is required. [ABSTRACT FROM AUTHOR]

The article discusses research on the use of a dissonance-based eating disorder intervention program. Topics include the psychological significance of objectification of women and maladaptive social comparison, measurements of self-esteem, and treatment of eating disorder symptoms using the intervention known as the Body Project.

Objective Examine the impact of age on baseline eating disorder symptoms/risk factors and on the effects of completing three variants of an eating disorder prevention program. Method Six hundred and eighty women (60% White) were randomized to clinician-led Body Project groups, peer-led Body Project groups, an Internet-based version of the Body Project (eBodyProject), or educational video control condition. Participants, who were on average 22.2 years old ( SD = 7.1, range 17-64, median = 19), were assessed at pretest, posttest, and 6-month follow-up. Results Two of the seven baseline variables were significantly associated with age, indicating that older age was associated with lower reported dieting ( r = −.12) and better psychosocial functioning ( r = −.13). Interactions indicated that age moderated the intervention effects, such that group-based programs were superior to the Internet-delivered version in terms of eating disorder symptom reductions for women up to age 20, whereas the Internet-delivered program was superior to group-based interventions, particularly in terms of BMI reduction, for women over approximately age 25. None of the four tests examining whether age moderated the effects of delivering Body Project groups by mental health clinicians versus undergraduate peer educators were significant. Discussion Results suggest that group-based versions of the Body Project should be implemented with young women up to the age of 20, as they produce larger eating disorder symptom reductions, whereas the Internet version of the Body Project should be implemented with women aged 25 or older, as it produces superior weight loss/gain prevention effects. [ABSTRACT FROM AUTHOR]

Objective Flexible, individualized interventions allow participants to adjust the intensity of support to their current needs. Between-persons, participants with greater needs can receive more intense support, within-persons, participants can adjust utilization to their current level of symptoms. The purpose of the present study was to analyze associations between ED-related symptoms and utilization of the individualized program ProYouth both between- and within-persons, aiming to investigate whether participants adapt utilization intensity to their current needs. Method Generalized estimated equations (GEEs) were used to analyze log data on program utilization (monthly page visits, monthly use of chats and forum) assessed via server logs and self-reported data on ED-related symptoms from N = 394 ProYouth participants who provided longitudinal data for at least two months. Results Between-persons, page visits per month were significantly associated with compensatory behavior, body dissatisfaction, and binge eating. Monthly use of the more intense modules with personal support chat and forum was associated with the frequency of compensatory behavior. Within-persons, unbalanced nutrition and dieting showed the strongest associations with monthly page visits. Monthly use of chats and forum was significantly associated with compensatory behavior and unbalanced nutrition and dieting. Discussion Results indicate that program utilization is associated with ED-related symptoms between- as well as within-persons. The individualized, flexible approach of ProYouth thus seems to be a promising way for Internet-based provision of combined prevention and early intervention programs addressing ED. [ABSTRACT FROM AUTHOR]

The 15-year follow-up study (Bar, Chassin & Dionne, 2017) suggests of the Dance School Ecological Prevention Program (Piran, 1999) that it may have had long-term effects on the prevention of bulimia. This pattern of findings is in line with the results of the older cohort in the original outcome evaluation study. If the results of the follow up study hold when the 15-year outcome evaluation study is compared to a control group from a similarly competitive ballet school, this would reinforce the cause of prevention in the field of sports and dance, if not beyond. It will further support the implementation of systemic changes in the social and educational environments of children towards the prevention of eating disorders. [ABSTRACT FROM AUTHOR]

This essay illustrates group work with adolescent girls struggling with emotional dysregulation and maladaptive coping. Mutual aid and female empowerment are advanced through the development of interpersonal relationships and interaction related to stress management, adaptive coping strategies, diversity, healthy relationships, self-esteem, self-harm and emotional regulation. [ABSTRACT FROM AUTHOR]

Objective: Because independent trials have provided evidence for the efficacy and effectiveness of the dissonance-based Body Project eating disorder prevention program, the present trial tested whether clinicians produce the largest intervention effects, or whether delivery can be task-shifted to less expensive undergraduate peer educators or to Internet delivery without effect size attenuation, focusing on acute effects. Method: In this study, 680 young women (Mage = 22.2 years, SD = 7.1) recruited at colleges in 2 states were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or an educational video control condition. Results: Participants in all 3 variants of the Body Project intervention showed significantly greater reductions in eating disorder risk factors and symptoms than did educational video controls. Participants in clinician-led and peer-led Body Project groups showed significantly greater reductions in risk factors than did eBody Project participants, but effects for the 2 types of groups were similar. Eating disorder onset over 7-month follow-up was significantly lower for peer-led Body Project group participants versus eBody Project participants (2.2% vs. 8.4%) but did not differ significantly between other conditions. Conclusions: The evidence that all 3 dissonance-based prevention programs outperformed an educational video condition, that both group-based interventions outperformed the Internet-based intervention in risk factor reductions, and that the peer-led groups showed lower eating disorder onset over follow-up than did the Internet-based intervention is novel. These acute-effects data suggest that both group-based interventions produce superior eating disorder prevention effects than does the Internet-based intervention and that delivery can be task-shifted to peer leaders. [ABSTRACT FROM AUTHOR]

Background: 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. Methods: 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. Results: 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 differences between the intervention and control groups in their eating disorder pathology change scores six months after the intervention. Regarding secondary outcomes, participants in the intervention group showed a greater increase in knowledge about eating disorders both after the intervention (p < .001, ES = 1.06) and six months later (p = .01, ES = 0.40). Greater reductions in anxiety severity were observed in the intervention group post-intervention (p = .02, ES = 0.22) which was not maintained at the six months follow-up. Results differed between participants from grade 8 and 11. Conclusion: The present universal prevention program can be particularly recommended for adolescents from grade 11. [ABSTRACT FROM AUTHOR]

Objective: At the turn of the millennium, eating disorders (EDs) prevention was largely nonexistent. No program had reduced future onset of EDs in even a single trial, and most had not reduced ED symptoms. Sixteen years later, the ED prevention field has translated basic risk factor research into interventions, with demonstrated efficacy and effectiveness in reducing ED risk factors and symptoms, as well as future ED onset in some trials. This article reviews the aforementioned progress focusing on a model intervention (i.e.. the Body Project [BP]). Method: The article is a qualitative review of the existing BP literature. Results: Although clinical psychology has struggled with bridging the research practice gap and translating efficacy and effectiveness research into clinical implementation, researchers, clinicians, and community stakeholders working with the BP have made significant progress in addressing barriers to scalability, large-scale implementation, and sustainability, reaching 3.5 million girls and young women in 125 countries. Conclusion: The successful evolution of the BP from basic research to traversing the efficacy-to-effectiveness-to-dissemination/implementation continuum has yielded significant public health impact and is thus a fitting case for this special issue commemorating the 125th anniversary of the American Psychological Association. The BP example may help others broadly implement efficacious interventions for other mental health problems. [ABSTRACT FROM AUTHOR]

Objective This pilot study investigated the effectiveness of a social media literacy intervention for adolescent girls on risk factors for eating disorders. Method A quasi-experimental pre- to post-test design comparing intervention and control conditions was used. Participants were 101 adolescent girls ( Mage = 13.13, SD = 0.33) who were allocated to receive three social media literacy intervention lessons ( n = 64) or to receive classes as usual ( n = 37). Self-report assessments of eating disorder risk factors were completed one week prior to, and one week following the intervention. Results Significant group by time interaction effects revealed improvements in the intervention condition relative to the control condition for body image (body esteem-weight; d = .19), disordered eating (dietary restraint; d = .26) and media literacy (realism scepticism; d = .32). Discussion The outcomes of this pilot study suggest that social media literacy is a potentially useful approach for prevention of risk for eating disorders in adolescent girls in the current social media environment of heightened vulnerability. Replication of this research with larger, randomized controlled trials, and longer follow-up is needed. [ABSTRACT FROM AUTHOR]

Objective To investigate the quality of randomized controlled trials (RCTs) of eating disorder prevention. Method A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library to January 2016. Studies were included if they were RCTs that tested an eating disorder prevention program. We identified 96 studies with a total 15,350 participants (91% female, M age = 17 years) and rated quality with the Quality Rating Scale (QRS; Moncrieff et al., 2001). Results The mean QRS score was 62% ( SD = 13%). Several standards of quality were not frequently fulfilled (i.e., failed to achieve an optimal rating), for example, power calculation (85%), intent-to-treat analysis (54%), blinding of assessor (75%), representative sample (78%), adequate sample size (75%), and appropriate duration of trial including follow-up (67%). QRS was positively and significantly associated with publication year, number of authors, and PubMed-indexation. Discussion Given the majority of eating disorder prevention studies had problems with trial quality, it is recommended that future RCTs follow quality checklists and CONSORT guidelines, that RCTs are registered, and protocols published in advance. In addition, funding bodies are called on to deliver the support needed to ensure that preventions for eating disorders are efficiently and cost-effectively achieved. [ABSTRACT FROM AUTHOR]

The definition of universal prevention is important for theoretical, research, and policy-related reasons. The present article provides an etymological and historical look at the concept of universal prevention, in and of itself and in terms of its position on the mental health intervention spectrum involving mental health promotion, selective prevention, indicated prevention, case identification, and treatment. Following a summary of the features commonly associated with universal prevention, these characteristics are fashioned into a family resemblance model for defining the construct. This model is applied to four of the articles constituting the journal Eating Behaviors' special issue on the universal prevention of eating disorders. It is argued that this family resemblance approach captures the diversity of current universal approaches to reducing risk factors and/or preventing eating disorders. This type of definition, coupled with Foxcroft's (2014) tripartite functional analysis of universal prevention, has the potential to improve evaluations of universal prevention, as well as large-scale collaborative projects that seek to integrate programs across the mental health intervention spectrum. [ABSTRACT FROM AUTHOR]

New approaches to universal eating disorders prevention and interventions targeting macro-environmental change are greatly needed, and research-to-policy translation efforts hold promise for advancing both of these goals. This paper describes as a policy-translation case example an academic-community-government partnership of the Strategic Training Initiative for the Prevention of Eating Disorders, Multi-Service Eating Disorders Association, and the office of Massachusetts Representative Kay Khan, all based in Massachusetts, USA. The partnership's research-to-policy translation project focused on dietary supplements sold for weight loss and muscle building, which have been linked with serious injury and death in consumers. Youth and people of all ages with eating disorders and body dysmorphic disorder may be especially vulnerable to use these products due to deceptive promises of fast and safe weight loss and muscle gain. The research-to-policy translation project was informed by a triggers-to-action framework to establish the evidentiary base of harm to consumers, operationalize policy solutions to mitigate harm through legislation, and generate political will to support action through legislation introduced in the Massachusetts legislature to restrict sales of weight-loss and muscle-building dietary supplements. The paper concludes with lessons learned from this unique policy translation effort for the prevention of disordered weight and shape control behaviors and offers recommendations for next steps for the field to advance research and practice for universal, macro-environmentally targeted prevention. [ABSTRACT FROM AUTHOR]