Disorders - Eating Disorders
Wilksch, S. M., OShea, A., Taylor, C. B., Wilfley, D., Jacobi, C., Wade, T. D.
BACKGROUND: Disordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can
be delivered at-scale are needed. METHOD(S): 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. RESULT(S): 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. CONCLUSION(S):
Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs.
Psychological Medicine, 48(12) : 2034-2044
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Self-help, Technology, interventions delivered using technology (e.g. online, SMS)
Agam-Bitton, R., Ahmad, W.
A., Golan, M.
Background Investigation of the optimal setting for body image prevention programmes is important to maximize the outcomes of
such programmes. Objectives We examined the preferred setting for a school-based wellness programme called \"In Favour of Myself\". Methods A total
of 259 girls (mean 13.82+/-0.64 years) were divided into a girls-only intervention group, a mixed-gender intervention and a waiting list control
group. The participants completed self-report questionnaires at baseline, post-intervention (2 months) and at follow-up (3 months) examining changes
in self-esteem, media literacy, body image and risk factors for eating disorders. The intervention group participants also completed a satisfaction
questionnaire. Results Both intervention groups demonstrated statistically significant improvements in identifying advertising strategies (p<0.01)
compared with the controls, with the girls-only arm (p<0.001) showing better results. Compared with the girls-only arm and the control group, the
mixed-gender group demonstrated statistically significantly greater improvements in the internalization of pressure for thinness (p<0.004), the
body-esteem appearance subscale (p<0.025) and body-esteem body-weight subscale (p<0.012) as well as reductions in their perceived current body
silhouettes and in the gap between their current and ideal body image (p<0.003). Body dissatisfaction was increased following the programme, although
not in a statistically significant manner, with the worst negative effect observed in the girls-only arm. All other differences among the study arms
did not show statistically significant differences. Mediation models revealed that body-esteem was directly mediated by group, with statistically
significant mediation only in the mixed group. Current body image was mediated indirectly by group through media literacy (i.e., recognizing
advertisement strategies and internalization of pressure for thinness), with statistical significance only in the mixed-gender arm compared with the
girls-only arm. Higher programme satisfaction was reported in the mixed-gender group (91%) vs. the girls-only groups (79%). Conclusions These
outcomes provide preliminary evidence indicating the superiority of a mixed-gender setting compared with a girls-only setting for delivering
prevention programmes to 13- to 14-year-old adolescents to enhance their media literacy, positive self-esteem and body image. Copyright © 2018 Agam-
Bitton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
PLoS
ONE, 13 (6) (no pagination)(e0198872) :
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Dondzilo, L., Rieger, E., Palermo, R., Bell, J.
Background and Objectives: Attentional bias towards thin-ideal body images has been implicated as a vulnerability factor
for eating disorder symptomatology. However, the nature and causal basis of its relationship with other cognitive vulnerability factors, namely,
eating disorder-specific rumination and negative mood, remains unclear. Accordingly, the current study investigated the causal influence of
attentional bias towards thin-ideal images on emotional and ruminative vulnerability, in response to a body image-related stressor. Methods: An
established attentional bias modification (ABM) procedure, the modified dot probe task, was used for the assessment and manipulation of attentional
bias. Female undergraduate students (N = 110) aged between 17 and 24 years were randomly assigned to either 'attend' towards or 'avoid' thin-
ideal images. Pre- and post-attentional training, participants completed the dot probe task, as well as state measures of rumination and negative
mood. Additionally, following post-ABM assessment of attentional bias, participants were given a body image-related stressor. Results: Results showed
that participants trained to attend to thin bodies reported heightened negative mood, in response to the stressor, compared with participants trained
to avoid thin bodies. On the other hand, groups did not demonstrate a differential increase in eating disorder-specific rumination in response to the
stressor. Limitations: The current findings will require replication with clinical samples. Additionally, state rumination and negative mood were
assessed via single items. Conclusions: These results provide the first causal evidence for the role of attentional bias towards thin-ideal images in
negative emotional vulnerability. Importantly, these results suggest attentional bias may serve as a risk factor for mood reactivity and a potential
target for strategies designed to enhance emotional resilience. Copyright © 2018 Elsevier Ltd
Journal of Behavior Therapy and Experimental Psychiatry, 61 : 128-
133
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Leme, A. C. B., Philippi, S. T., Thompson, D., Nicklas, T., Baranowski, T.
Purpose: To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized
controlled trial for girls targeting shared risk factors for obesity and disordered eating. Methods: Total of 253 girls, mean of 15.6 (0.05) years
from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. \"Healthy Habits, Healthy
Girls-Brazil (H3G-Brazil)\", originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6
months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were
added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity
variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way
analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention
prior to follow-up assessment. A conservative significance level was set at p < 0.01. Results: Beneficial effects were detected for PA social support
(F = 6.005, p = 0.01), and healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731,
p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy
weight control behaviors (OR = 1.92, 95% CI 1.15-3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects
were detected. Conclusion: H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy
weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an
intervention among low-income girls in Brazil. Trial registration: Level I: cluster randomized controlled trial Copyright © 2018 Springer
International Publishing AG, part of Springer Nature
Eating and
Weight Disorders, : 1-13
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Other Psychological Interventions, Dietary advice, dietary change, Physical activity, exercise
Matheson, E., Wade, T. D., Yiend, J.
Objective: Eating disorder
psychopathology is associated with a propensity to interpret ambiguous stimuli to be negatively related to one's appearance and self-worth. The
relative impact of modifying interpretation bias for these respective stimuli is unknown. Hence the main aim of the current study was to compare two
cognitive bias modification protocols targeting interpretation bias (CBM-I), one focused on appearance and the other on self-worth, in terms of
impacting interpretation bias, body dissatisfaction and negative affect. The appearance-based CBM-I protocol was developed for the current study.
Method: Female university students (N = 123) were randomized into one of three CBM-I conditions: appearance, self-worth or control. Immediately
following a negative induction that significantly increased body dissatisfaction and negative affect, participants underwent their respective CBM-I
training. Results: The CBM-I for appearance produced significant changes in the targeted bias, as well as significant improvements (moderate effect
sizes) in appearance satisfaction, relative to the CBM-I for self-worth and control conditions. Discussion: The results support the usefulness of the
CBM-I for appearance protocol, and suggests that this technique warrants further investigation with respect to modifying interpretation bias and risk
factors associated with eating disorder psychopathology. Null effects of CBM-I for self-worth should be interpreted in light of study limitations,
including the potential unsuitability of training material for young women. CBM-I for both types of interpretation bias should be evaluated in future
research. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, :
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Pennesi, J. L., Wade, T. D.
Objective:
This pilot study compared two brief online interventions, imagery rescripting and cognitive dissonance, to an assessment-only control condition in a
sample of body-dissatisfied young women at risk of developing an eating disorder. We examined the degree to which each intervention reduced
disordered eating and modified risk and protective factors for eating disorders. Method: Female university students (N = 107, 17-28 years of age)
completed a screening questionnaire, followed by random allocation to one of the three conditions, followed by a baseline assessment, body
dissatisfaction induction, and brief online intervention. Participants in the active conditions then completed online daily home practice and a
postintervention questionnaire. Results: Findings provide qualified support for the imagery rescripting intervention, with participants reporting
higher body image acceptance (Cohen's d = 0.49) than the cognitive dissonance condition, and higher self-compassion (d = 0.59) and lower levels of
disordered eating (d = 0.59) than the control condition, at postintervention. There was no significant impact of cognitive dissonance on any factors.
Change in body image acceptance and self-compassion mediated the relationship between allocated condition and change in disordered eating at
postintervention. Discussion: These findings provide preliminary support for the use of online-adapted imagery-based techniques (e.g., imagery
rescripting) to reduce risk for the development of an eating disorder by strengthening protective factors (i.e., body image acceptance and self-
compassion) and reducing disordered eating. Further exploration of the use of imagery strategies in the prevention of disordered eating is required,
including prospective tests of the mechanisms of action. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 51(5) : 439-
448
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions, Cognitive dissonance
therapy
Plessow, F., Singhal, V., Toth, A., Baskaran,
C., Eddy, K. T., Misra, M.
Background: Disordered eating behavior is common in
conditions with functional hypothalamic amenorrhea, such as anorexia nervosa (AN) and exercise-induced amenorrhea, which are also associated with
anxiety and depression. In hypoestrogenic rodents, estrogen replacement reduces anxiety-related behavior. Similarly, we have shown that estrogen
replacement in adolescent girls with AN reduces anxiety and prevents the increased body dissatisfaction observed with increasing weight. However, the
impact of estrogen administration on disordered eating behavior and psychopathology in normal-weight young women with exercise-induced amenorrhea is
unknown. We hypothesized that (1) normal-weight oligo- and psychopathology compared to eumenorrheic athletes (EA) and nonathletes (NA), and (2) 12
months of estrogen replacement would improve those symptoms. Methods: Cross-sectional study (CSS): 109 OA 50 EA, and 39 NA 14-25 years old and of
normal weight, completed the Eating Disorder Inventory-2 (EDI-2) and Three-Factor Eating Questionnaire (TFEQ) as self-report assessments of
disordered eating behavior and psychopathology. Randomized controlled trial (RCT): OA were then randomized to receive either the 100-mcg transdermal
17beta-estradiol patch with cyclic progesterone (Patch), a combined oral contraceptive pill with 30 mcg ethinyl estradiol and 0.15 mg desogestrel
(Pill), or no estrogen (E-) for 12 months. None of the participants had a baseline diagnosis of an active eating disorder. Twenty-five 19 and 26
young women in the Patch, Pill, and E- groups completed the EDI-2 and 19 16 and 21 respectively completed the TFEQ at both baseline and 12-month
follow-up. Data were analyzed for E+ (Patch+Pill) versus E- groups and for routes of administration separately, controlling for age and weight
change. Results: CSS: OA showed higher EDI-2 Drive for Thinness (DT) and TFEQ Cognitive Restraint of Eating scores than EA and NA (p=0.008 and 0.02
and p=0.006 and 0.02 respectively) and higher EDI-2 Body Dissatisfaction (BD) scores than EA (p=0.04). RCT: Over 12 months, the E+ group, compared to
E-, showed improved trajectories for the EDI-2 DT (-0.60+/-0.52 vs. 1.25+/-0.68 p=0.04), EDI-2 BD (-0.81+/-0.54 vs. 2.18+/-0.71 p=0.002), and TFEQ
Uncontrolled Eating (UE) scores (-4.03+/-2.29 vs. 4.07+/-3.31 p=0.046). In 3-group comparisons (Patch, Pill, and E-), the Patch group outperformed
the E- group and showed significant decreases in EDI-2 BD and TFEQ UE scores (p=0.01 and 0.02 respectively), while only numerical differences were
observed between the Pill and Egroups. Conclusions: In young OA 12-month replacement of physiologic doses of estrogen improves trajectories of
disordered eating behavior and psychopathology, emphasizing the importance of normalizing estrogen levels in this population.
Endocrine Reviews. Conference: 100th Annual Meeting of the Endocrine Society, ENDO, 39(2 Supplement 1) :
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Rohde, P., Desjardins, C. D., Arigo, D., Shaw, H., Stice, E.
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. Copyright © 2018 Elsevier Ltd
Behaviour Research and Therapy, 106 : 8-
17
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions, Cognitive dissonance
therapy, Dietary advice, dietary change, Physical activity, exercise
Stice, E., Rohde, P., Shaw, H., Gau, J. M.
Objective:Compare the Healthy Weight obesity and eating disorder prevention program, which promotes
participant-driven gradual lifestyle changes to bring energy intake and expenditure into balance, to a new intervention, Project Health, which adds
activities to create cognitive dissonance about unhealthy eating, a sedentary lifestyle, and excess body fat, and an obesity education video-control
condition.Method:College students at risk for both outcomes because of weight concerns (N=364, 72% female) were randomized to condition, completing
pretest, posttest, and 6, 12 and 24-month follow-up assessments.Results:Project Health participants showed significantly smaller increases in
measured body mass index (BMI) through 2-year follow-up than both Healthy Weight participants and controls (both d='0.18), and significantly lower
onset of overweight/obesity over 2-year follow-up than Healthy Weight participants and controls (13 vs 21% and 22%). Healthy Weight and Project
Health participants showed significantly greater eating disorder symptom reductions than controls through 2-year follow-up. Healthy Weight and
Project Health participants showed marginally lower eating disorder onset over follow-up than controls (3 and 3% vs 8% respectively).Conclusions:The
reduced increases in BMI and future overweight/obesity onset for Project Health relative to both an active matched intervention and a minimal
intervention control condition are noteworthy, especially given the short 6-h intervention duration. The reduction in eating disorder symptoms for
Healthy Weight and Project Health relative to controls was also encouraging. Results suggest that adding dissonance-induction activities increased
weight loss effects. Yet, effects for both were generally small and the eating disorder onset prevention effects were only marginal, potentially
because intervention groups included both sexes, which reduced eating disorder incidence and sensitivity. Copyright © 2018 Macmillan Publishers
Limited, part of Springer Nature All rights reserved.
International Journal of
Obesity, 42(3) : 462-468
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions, Cognitive dissonance
therapy, Dietary advice, dietary change, Physical activity, exercise
Warschburger, P., Zitzmann, J.
Disordered eating is highly prevalent during adolescence and has a detrimental effect on further
development. Effective prevention programs are needed to prevent unhealthy developmental trajectories. This study evaluated the efficacy of the
POPS-program (POtsdam Prevention at Schools), a universal school-based eating disorder prevention program for adolescents. In a cluster-randomized
design, we compared the intervention group receiving the prevention program to a waiting control group. Outcomes included indicators of disordered
eating and relevant risk factors for eating disorders (body dissatisfaction, internalization of the thin ideal, perceived media pressure,
perfectionism, emotional element of exercise, social comparison, and perceived teasing). Questionnaires were administered at the start of the
intervention, 3 and 12 months post intervention. At baseline, 1112 adolescents aged 10 to 16 years participated (49% girls; 51% intervention group).
Intention-to-treat analyses with the complete data set and per-protocol analyses as a completer analysis were performed. The intervention group
showed a more favorable course compared to the control group regarding all observed risk factors for eating disorders except for perceived teasing.
Effect sizes were small but comparable to other primary prevention programs. At 1-year follow-up, a small but significant effect on disordered eating
was observed. Results of the per-protocol analyses were mostly confirmed by the intention-to-treat analyses. Results were promising for both genders
although girls benefited more regarding disordered eating and internalization of the thin ideal. Further studies are warranted examining successful
program elements and whether gender-specific programs are needed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Youth and Adolescence, 47(6) : 1317-
1331
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Wilksch, S. M., O'Shea, A., Wade, T. D.
BACKGROUND: Diagnostic outcomes in eating disorder (ED) risk reduction trials are important but rarely reported.\rMETHODS: An online
pragmatic randomized-controlled trial was conducted with young-adult women in Australia and New Zealand seeking to improve their body image. Media
Smart-Targeted (MS-T) was a 9-module program released weekly while control participants received tips for positive body image. Eating Disorder
Examination-Questionnaire (EDE-Q) scores from baseline and 12-month follow-up were used to investigate two outcomes: ED onset in those who were
asymptomatic at baseline (prevention effects); and, ED remission in those who met diagnosis at baseline (treatment effects).\rRESULTS: MS-T
participants were 66% less likely than controls to develop an ED by 12-month follow-up (nonsignificant). MS-T participants who met ED criteria at
baseline were 75% less likely than controls to still meet diagnostic criteria at follow-up. This effect was significant and remained so for both
those who did and who did not access external face-to-face ED treatment during the trial.\rCONCLUSIONS: While further investigations are necessary,
MS-T has fully automated procedures, low implementation costs, the potential to be delivered at-scale to assist those assist those where face-to-face
services are limited or not available (e.g., remote areas).
International Journal of Eating Disorders, 51(3) : 270-
274
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Vimalakanthan, K., Kelly, A. C., Trac,
S.
This study used a novel intervention
grounded in social mentalities theory to compare the effects of cultivating a caregiving versus competitive mentality when intervening with
appearance comparisons. For 48hours, 120 female undergraduates were randomly assigned to use one of three strategies whenever they made unfavorable
appearance comparisons: cultivating compassion and loving-kindness toward the comparison target (Caregiving); comparing themselves favorably to the
target in non-appearance domains of superiority (Competition); or distracting themselves (Control). Although there was no main effect of condition,
trait social comparison orientation interacted with condition to predict outcomes. Among women engaging more frequently in social comparison, the
Caregiving condition was more effective than the Competition condition at reducing body dissatisfaction, restrained eating, and body, eating, and
exercise-related comparisons. Findings suggest that cultivating a compassion-focused, caregiving mentality when threatened by appearance comparisons
could be beneficial to women who engage more frequently in social comparison. Copyright © 2018 Elsevier Ltd. All rights reserved.
Body Image, 25 : 148-
162
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions, Self-help