Recent Innovations in Eating Disorder Prevention and Early Intervention

The field of eating disorder prevention research has made excellent progress over the past thirty years. It is estimated that more than 100 intervention approaches have been developed, and more than 60 separate prevention interventions have been evaluated in controlled trials (Austin, 2015; Stice, Becker, & Yokum, 2013). Prevention interventions have been shown to reduce eating disorder risk factors, symptoms, and onset (Stice et al., 2013). Despite progress in the development of interventions and understanding of their efficacy in methodologically rigorous research, historically broad scale uptake in real world settings (e.g., schools, community organisations, healthcare services) has been somewhat limited. As a result, the clinical impact and potential benefits of most evidence-based eating disorder prevention interventions are yet to be fully realised outside the ivory towers of science and academia. The delay in advances in scientific knowledge being translated into routine practice in real-world settings is not unique to eating disorder prevention; it is unfortunately common in medical and health research more broadly. For example, it takes an average of 17 years to translate original medical research into routine clinical practice (Brownson, Colditz, & Proctor, 2012). Fortunately, in recent years several eating disorder prevention interventions have been disseminated at scale in partnership with business, community, and government stakeholders. Nevertheless, developing strategies to rapidly translate advances in prevention intervention research into real world practice remains a priority for the eating disorder prevention field today (Austin, 2015). This chapter will provide a review of successful case examples, existing barriers, and future strategies related to the scaling up of evidence-based prevention interventions in the eating disorders field.

The Body Advocacy Movement (BAM) is an in-person, peer-led, cognitive-dissonance-based eating disorder (ED) prevention program that reduces fatphobia and anti-fat bias. Developing a digital adaptation of BAM has the potential to increase its accessibility and fill a critical gap in existing digital ED interventions, which to date have not specifically targeted anti-fat bias or fatphobia. This study applies a human-centered design approach to inform the development of a digital version of BAM. Semi-structured interviews were conducted with 31 participants, including 17 college students with elevated ED psychopathology and 14 past BAM participants. College students with elevated ED psychopathology shared experiences with fatphobia and anti-fat bias, how they use mental health technology, and thoughts on digitizing BAM. Past BAM participants shared experiences with BAM, how they use mental health technology, and thoughts on digitizing BAM. Interviews were analyzed using reflexive thematic analysis with a critical realist lens. College students with elevated ED psychopathology described pervasive and harmful experiences of anti-fat bias and fatphobia, coupled with difficulties accessing action-oriented mental health support, underscoring a gap in care that a digital adaptation of BAM could address. Both groups expressed strong interest in a hybrid digital format that combines synchronous and asynchronous components for a balance of social connection and flexibility. Findings suggest that a digital adaptation of BAM could address unmet needs in ED prevention by providing accessible, action-oriented content focused on reducing anti-fat bias and fatphobia. Incorporating synchronous social connection within a flexible, interactive framework may promote engagement and impact. A critical next step will involve designing and pilot testing this digital adaptation of BAM to evaluate its feasibility and effectiveness.

BackgroundThere is a growing body of research and evidence for the efficacy of Internet-based eating disorder (ED) prevention interventions for adults. However, much less is known about the reach, adoption, implementation and maintenance of these interventions. The RE-AIM (reach, efficacy/effectiveness, adoption, implementation, maintenance) model provides a framework to systematically assess this information.MethodsA literature search was conducted in PubMed, Web of Science and PsycINFO for articles published between 2000 and 2019. Additionally, reference lists of the studies included and existing reviews published until the end of 2020 were searched. Sixty original articles describing 54 individual studies fulfilled inclusion criteria. Data were extracted for a total of 43 RE-AIM indicators for each study. Fostering and hindering factors for reach, adoption, implementation and maintenance were assessed qualitatively.ResultsOverall reporting rates were best for the RE-AIM dimensions reach (62.6%), implementation (57.0%) and effectiveness (54.2%), while adoption (24.2%) and maintenance (21.5%) had comparatively low overall reporting rates. Reporting on indicators of internal validity, such as sample size, effects or description of interventions was better than indicators relevant for dissemination and implementation in real-world settings, e.g. characteristics of non-participants, characteristics and representativeness of settings, and data to estimate cost.ConclusionsBecause most Internet-based ED prevention interventions are provided in a research-funded context, little is known about their public health impact. Better reporting of factors determining external validity is needed to inform dissemination and implementation of these interventions.

BackgroundResearch yields mixed results on whether feminist beliefs or self-identification are protective against body image disturbance and eating pathology in non-clinical populations. Further, no studies have examined feminism among those with diagnosed eating disorders. Additionally, previous studies have not examined the relationship between feminist identity and weight stigma. This study investigated these relationships and if there are differences in body image, eating pathology, and weight stigma among feminist identity types in women with eating disorders and college women using ANCOVAs.MethodsParticipants completed self-report measures and were women with eating disorders (N = 100) and college women (N = 240).ResultsSixty-four percent of the women with eating disorders and 75.8% of the college women identified as a feminist. An independent samples t-test found a significantly higher weight bias internalization in the clinical eating disorder sample than in the college women sample. No significant interactions were found between sample type and feminist identity for body image or weight bias internalization. Results were consistent when using a dichotomous feminist identity item and a seven-item continuous feminist identity item.ConclusionsDespite the clear impacts of the intersection of weight status and gender, results from this study suggest that identifying as a feminist is not sufficient to combate weight stigma. Findings highlight the need for further research investigating weight bias internalization within eating disorder prevention efforts and interventions.

Prevention of eating disorders: A systematic review and meta-analysis

Be Body Positive (BBP) is a psychoeducational website offering information and prevention strategies to children and young people (CYP), parents/carers and professionals across three modules: (1) body image and healthy eating, (2) selective eating versus avoidant/restrictive food intake disorder and (3) disordered eating versus eating disorders. The platform allows for easy access to evidence-based prevention/early intervention strategies created by clinicians with feedback from CYP and parents/carers. It is the product of a partnership between East London NHS Foundation Trust, North East London NHS Foundation Trust, Barnardo's and the East London Business Alliance, with funding by the NHS Transformation Directorate. Since its launch in May 2023, BBP has reached an audience of over 21,000 users, of which 18,000 are in the UK (as of 23 September 2024). Over 90% (n = 411) of professionals attending two national webinars indicated they are likely to use BBP to support CYP.

IntroductionObesity and eating disorders are public health problems that have lifelong financial and personal costs and common risk factors, for example, body dissatisfaction, weight teasing and disordered eating. Obesity prevention...

Examining weight suppression as a predictor and moderator of intervention outcomes in an eating disorder and obesity prevention trial: A replication and extension study

(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.

Objective This study evaluated the acceptability and effectiveness of the Eat Breathe Thrive (EBT) program as an eating disorder prevention intervention among women collegiate athletes. Method Change over time in eating disorder risk and competencies of positive embodiment were examined in 94 women (n = 48 EBT participants and n = 46 matched-controls) from one National Collegiate Athletic Association (NCAA) Division I-classified university in the United States. Eating disorder risk factors were measured using the Eating Disorder Examination Questionnaire (EDE-Q) and State Trait Anxiety Inventory (STAI). Aspects of positive embodiment were measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) and The Mindful Self-Care Scale (MSCS). Data were collected through participants’ completion of online surveys across three time-points. Results Repeated measures ANOVAS revealed EBT participants reported experiencing significantly less state anxiety and greater interoceptive body trusting over time relative to matched-controls. No other significant interactions were found. Respondents found the EBT program acceptable. Discussion Acceptability and partial support for integrative, yoga-based, interventions targeting Division I student-athletes is indicated.

BackgroundDuring the COVID-19 pandemic, there was a necessity for eating disorder (ED) outpatient treatment to be delivered virtually. Given this transition, and the surge in new ED cases, there was an urgent need to investigate virtually delivered ED prevention programs. This review aimed to identify the available evidence on virtual ED prevention programs for children, adolescents, and emerging adults.MethodUsing scoping review methodology, seven databases were searched for studies published from January 2000 to April 2021 reporting on virtually delivered ED prevention interventions for children and adolescents (< 18 years) and emerging adults (18–25 years). Studies were excluded if they contained adults (> 25 years) and individuals with clinical ED diagnoses. s and full-text papers were reviewed independently by two reviewers. Data was extracted on study type, methodology, age, sample size, virtual intervention, outcomes, and results. In April 2022, we used a forward citation chaining process to identify any relevant articles from April 2021 to April 2022.ResultsOf 5129 unique studies identified, 67 met eligibility criteria, which included asynchronous (n = 35) and synchronous (n = 18) internet-based programs, other e-technology including mobile apps (n = 3) and text messaging interventions (n = 1), computer-based programs (n = 6), and online caregiver interventions focused on child outcomes (n = 4). Few studies mainly included children and adolescents (n = 18), whereas the vast majority included emerging adults (n = 49). For children and adolescents, the most widely researched programs were Student Bodies and its adapted versions (n = 4), eBody Project (n = 2), and Parents Act Now (n = 2). For emerging adults, the most widely researched programs were Student Bodies and its adapted versions (n = 16), eBody Project (n = 6) and Expand Your Horizon (n = 4). These interventions were effective at reducing various symptoms and ED risk. Some studies demonstrated that virtual prevention intervention efficacy resembled in-person delivery.ConclusionVirtual prevention interventions for EDs can be effective, however more research is needed studying their impact on children and adolescents and on improving access for vulnerable groups. Additional efficacy studies are required, such as for text messaging and mobile app ED prevention interventions. Evidence-based recommendations for virtual ED prevention for children, adolescents, and emerging adults at-risk for EDs should be prioritized.

Do body checking and avoidance behaviours explain variance in disordered eating beyond attitudinal measures of body image?

Weight-related problems, including unhealthy weight control behaviors, binge eating, overweight and obesity, and eating disorders, are prevalent in youth. Furthermore, many young people exhibit more than one of these problems. Therefore, it is essential to consider how to simultaneously work toward the prevention of a broad range of weight-related problems in youth. Dieting, body dissatisfaction, weight talk, and weight-related teasing are commonly addressed risk factors within eating disorder prevention interventions, whereas low levels of physical activity and high intakes of foods high in fat and sugar are commonly addressed within interventions aimed at obesity prevention. Empirical data to be presented in this article demonstrate why risk factors such as dieting and body dissatisfaction, which are typically addressed within the eating disorder field, need to also be addressed within the obesity field. Although dieting and body dissatisfaction strongly predict weight gain over time, these findings are not always taken into account in the design of obesity interventions for youth. Possible reasons as to why risk factors such as dieting, body dissatisfaction, and weight stigmatization may be not adequately addressed within interventions addressing obesity are discussed. Suggestions for how physicians and other nonphysician clinicians might link messages from the fields of both eating disorders and obesity into their work with youth are provided. Finally, the potential for work on mindfulness and yoga to decrease risk factors for both eating disorders and obesity are explored.

Abstract Both eating disorders and obesity are serious public health concerns. Given the chronic course of these conditions, there is a major emphasis on their prevention. However, many concerns have been raised about the optimal approach to the prevention of both eating disorders and obesity. This chapter reviews controversies in the prevention of eating disorders and obesity, including potential iatrogenic effects of prevention, and whether programming should be implemented at the level of public policy. Next, we review the debate regarding the integration of prevention efforts for these conditions, including the feasibility and acceptability of these integrated approaches. The chapter continues with a brief review of some of the best practices for the integrated prevention of both obesity and eating disorders identified in previous research. Finally, we discuss newer perspectives in this research, including broadening targets of prevention, integrating technology, and enhancing the cultural sensitivity of eating disorder and obesity prevention.

This article focuses on applying systematic reviews to the Early Intervention (EI) literature. Systematic reviews are defined and differentiated from traditional, or narrative, reviews and from meta-analyses. In addition, the steps involved in critiquing systematic reviews and an illustration of a systematic review from the EI literature are detailed.