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Objective: The Student Bodies-Eating Disorders intervention (SB-ED), a digital cognitive behavior therapy-guided self-help intervention for college women with an eating disorder, is effective for reducing eating disorder psychopathology. The purpose of this study was to evaluate moderators and mediators of the SB-ED intervention. To our knowledge, this is the first evaluation of clinical mediators of a digital intervention for women with eating disorders. Method: This is an exploratory secondary analysis of a cluster randomized trial comparing the SB-ED intervention to referral to usual care among 690 women at 27 United States colleges. Moderators included body mass index (BMI), race, ethnicity, weight/shape concerns, eating disorder impairment, thin ideal internalization, depression, anxiety, and motivation for treatment, assessed at baseline. Thin ideal internalization and depressive symptoms were tested as predictors at postintervention and mediators at 2-year follow-up. Outcome was change in global eating disorder psychopathology. Results: BMI moderated the effect of the intervention at follow-up (but not posttreatment), with individuals with a lower BMI experiencing more continued improvements in eating disorder psychopathology following the intervention than individuals with a higher BMI. Thin ideal internalization mediated the effect of the intervention at follow-up, and depression partially mediated the effect of the intervention at follow-up. Conclusions: Results of the mediator analyses suggest that helping college women reduce inflated internalization of the thin ideal and improve depressive symptoms leads to improvements in eating disorder psychopathology. Results also suggest opportunities to optimize the intervention so individuals across the BMI spectrum experience ongoing improvements over time. What is the public health significance of this article?: The digital guided self-help Student Bodies-Eating Disorders intervention reduces women's thin ideal internalization and depressive symptoms, which in turn leads to improvements in eating disorder psychopathology. Women with higher body mass index (BMIs) experienced less continued improvement following the intervention, indicating future directions for intervention optimization. [ABSTRACT FROM AUTHOR]

Objective: Cognitive‐behavioral therapy (CBT)—therapist‐led (CBTth) and guided‐self‐help (CBTgsh)—has efficacy for binge‐eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods. Method: Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treatments for BED in the U.S. Predictors and moderators of outcomes (treatment completion and binge‐eating remission) were examined in N = 457 participants who received either CBTgsh (N = 164) or CBTth (N = 293). Results: Analyses, adjusting for demographic/clinical variables, indicated CBTth was significantly superior to CBTgsh for treatment completion (odds ratio [OR] = 20.0) and remission (OR = 14.6). For remission, analyses revealed significant predictors (age, treatment length, Weight Concern), a moderator (weight concern [OR = 5.13]), and a significant interaction between CBT‐type and treatment length (OR = 2.66). For CBTgsh, longer treatment was associated with less remission, whereas for CBTth, longer treatment was associated with greater remission. For CBTgsh, 44.1% with low weight concern versus 56.3% with high weight concern achieved remission whereas for CBTth, 43.5% with high weight concern and 61.0% with low weight concern achieved remission. Discussion: Analyses of aggregated RCT BED data, adjusting for demographic/clinical characteristics, indicated superiority (large effect‐sizes) in treatment outcomes of CBTth over CBTgsh and that Weight Concern moderated outcomes. [ABSTRACT FROM AUTHOR]

Objective: The Internet‐based Healthy Body Image (HBI) Program, which uses online screening to identify individuals at low risk of, high risk of, or with an eating disorder (ED) and then directs users to tailored, evidence‐based online or in‐person interventions to address individuals' risk or clinical status, was deployed at 28 U.S. universities as part of a randomized controlled trial. The purpose of this study is to report on: (a) reach of HBI, (b) screen results, and (c) differences across ED status groups. Method: All students on participating campuses ages 18 years or older were eligible, although recruitment primarily targeted undergraduate females. Results: The screen was completed 4,894 times, with an average of 1.9% of the undergraduate female student body on each campus taking the screen. ED risk in participating students was high—nearly 60% of students screened were identified as being at high risk for ED onset or having an ED. Key differences emerged across ED status groups on demographics, recruitment method, ED pathology, psychiatric comorbidity, and ED risk factors, highlighting increasing pathology and impairment in the high‐risk group. Discussion: Findings suggest efforts are needed to increase reach of programs like HBI. Results also highlight the increasing pathology and impairment in the high‐risk group and the importance of programs such as HBI, which provide access to timely screening and intervention to prevent onset of clinical EDs. [ABSTRACT FROM AUTHOR]