Improve Body Image Research Articles

Viewpoints of adolescents with overweight and obesity attending lifestyle obesity treatment interventions: a qualitative systematic review

Current UK guidance recommends that adolescents with obesity attend a family-based multi-component obesity intervention. However, these programmes suffer from low recruitment and high rates of attrition. Understanding the views of adolescents is necessary for developing future interventions. The aim of this systematic review was to synthesize and explore the views of adolescents who have attended an obesity intervention. Published literature was identified by searching six databases. Studies of adolescents (12-17years) who attended an obesity intervention were examined. Only studies that collected and analysed data qualitatively were included. Full texts were analysed using thematic synthesis. Twenty-eight studies were included. Thirty-five analytical themes were developed that were broadly divided into seven domains. Key themes included ensuring adolescents receive a 'tailored intervention' that involves 'active engagement'. Support from professionals, family and peers were valued highly. Adolescents expressed 'prior fears of attending interventions' and wanted 'longer term support'. 'Enjoyment of sport and physical activity' was evident, and adolescents were strongly motivated by improving body image and social desirability. Considering the views of adolescents attending obesity interventions may help to inform policy makers in the development of future interventions. This may lead to an improvement in recruitment and attrition rates.

Efficacy of psychosocial and physical activity‐based interventions to improve body image among women treated for breast cancer: A systematic review

Body image concerns warrant attention among women who have undergone treatment for breast cancer, due to their significant consequences for psychological and physical health, and interpersonal relationships. This paper systematically reviews the effectiveness of interventions on body image outcomes among this group, in order to inform health care provision and strategic directions for research. Fourteen electronic databases were searched for articles published between 1992 and 2017 that evaluated interventions with women who had undergone treatment for breast cancer in controlled trials with at least one body image measure. Data were extracted and studies were assessed for their methodological quality using the Cochrane Collaboration tool for assessing risk of bias. Twenty-one articles evaluating 26 interventions met inclusion criteria. Nine interventions significantly improved body image at either post-test or follow-up (ds=0.15-1.43), with none reporting sustained effects across all time points. Effective interventions comprised psychotherapy, psychoeducation, or physical activity, were delivered at different treatment stages and mostly adopted a multisession, face-to-face, group format. However, only 4 interventions were evaluated within methodologically rigorous studies and are therefore recommended for use by health professionals aiming to improve the body image of women at different stages of treatment for breast cancer. To advance the field, we recommend a less biomedical disease- and treatment-focused approach to interventions, and instead a more biopsychosocial theoretical approach targeting broader modifiable psychosocial influences upon body image. Replication and randomised controlled trials of greater rigour are also required to improve the methodological quality of studies.

Factors Affecting Body Image Discordance Amongst Korean Adults Aged 19-39 Years.

ObjectivesThis study was designed to investigate factors affecting the discordance between body image and body mass index amongst Korean adults aged 19–39 years.MethodsData (N = 59,361) from the 2014 Korean Community Health Survey was analyzed using descriptive analysis, chi-square test, and logistic regression analysis.ResultsTo examine the factors affecting body image discordance as observed in 43.1% of participants, the group was subdivided into underestimation and overestimation. There were 36.0% of participants that were body image discordant underestimators and 7.1% were overestimators. Multivariate logistic regression analysis showed that the underestimators tended to be men, graduated from high school, married, current/ex-smokers, ex-drinkers, had between 5 to 9 hours sleep (inclusive), had fair to good self-rated health, and demonstrated healthy weight control behavior, relative to the reference group. In comparison, overestimators tended to be in the 19–29 year group and had signs of depression. The OR of individuals who were men, married, and had healthy weight control behavior was significantly lower in the overestimators group.ConclusionThese findings show that tailored interventions to promote accurate body awareness should be based on the type of body image discordance. In addition, it is necessary to develop and implement a program of body image improvement that considers the factors affecting body weight discordance.

Autologous fat grafting after breast conserving surgery: Breast imaging changes and patient-reported outcome

Autologous fat grafting (AFG) to the breast is known to cause radiologic breast imaging changes. However, these changes have primarily been investigated in breast augmentation settings, whereas the radiologic breast imaging changes after AFG in patients who underwent breast conserving surgery (BCS) have been only sparsely studied. All women scheduled to receive AFG to reconstruct BCS defects at our institution between 2014 and 2015 were eligible to participate. Before and after AFG, participants underwent radiologic breast imaging and completed patient-reported outcome measures for body image, aesthetic breast appearance, scar quality, and fear of cancer recurrence. Moreover, an observer evaluated changes in the aesthetic breast appearance and scar quality. Of 49 eligible patients, 42 were included. Participants received 1-3 AFG procedures, with a mean total grafted volume of 135±74mL. Post-AFG breast imaging was performed 9±5 (range 2-25) months after the final AFG procedure. Comparison of pre- and post-AFG radiologic breast images revealed that 21% had developed calcifications, 85% had developed oil cysts, and 3% had developed increased scarring. Five patients presented with breast imaging changes that required biopsy or additional radiologic evaluation. Significant improvements were observed in breast aesthetic appearance, body image, and scar quality. No major surgical complications occurred. Minor surgical complications were observed in 3% of the patients. Using AFG to reconstruct BCS defects induces considerable radiologic breast imaging changes. Although the patients experience significant improvements in body image, breast aesthetic appearance, and scar quality, the long-term effect of breast imaging changes warrants further investigation.

A pilot study of a body image intervention for breast cancer survivors

Body image interventions for breast cancer survivors are lacking in empirical support. Examining existing research on effective body image interventions for women in midlife more broadly may provide useful insights. This pilot study assessed the acceptability, feasibility, and preliminary effects of a Cognitive Behavioural Therapy-based intervention adapted from women in midlife to promote positive body image among breast cancer survivors. Twenty-two breast cancer survivors received the 7-week group intervention, co-facilitated by a clinical psychologist and peer. Participant evaluations suggested the intervention was both acceptable (e.g., 94% would recommend it) and feasible (e.g., 91% completed the intervention). Improvements were identified at either post-test or 1-month follow-up in nearly all body image measures. Maintained improvements were found in body appreciation, weight and shape concern, acceptance of aging-related appearance changes, and self-esteem. This study suggests that the adapted intervention is acceptable, feasible, and demonstrates preliminary efficacy in improving body image and secondary outcomes among breast cancer survivors.

Images of Thin and Plus-Size Models Produce Opposite Effects on Women’s Body Image, Body Dissatisfaction, and Anxiety

Mainstream media’s promotion of dangerously thin female images likely lowers self-image satisfaction and contributes to pathological body concerns and disordered eating among women. We tested upward and downward social-comparison effects on self-evaluations by exposing 145 Spanish women to images of thin (upward) or overweight (downward) models. We also tested whether explicitly asking or not asking participants to compare themselves with the models would moderate social comparison effects. Exposure to thin models deteriorated body image while increasing body dissatisfaction and anxiety. Conversely, exposure to overweight models improved body image and decreased body dissatisfaction but it did not affect anxiety. Whether participants were asked to compare themselves to the models explicitly or implicitly had no effect on the participants’ responses. Furthermore, pre-existing body image concerns were not associated with the pre-to-post exposure effects. We propose that increasing the representation of normal weight and overweight women in media advertisements could help to neutralize or at least reduce the negative impact of media’s practice to idealize thin and overly thin women as symbols of female beauty.

Surgery for Deformities of the Thoracic Wall: No More than Strengthening the Patient's Self-Esteem?

In most cases, correction of a pectus deformity is performed for cosmetic reasons. The main indication for corrective therapy is impaired body image and self-esteem due to the deformity. In these instances, patients suffer from a lower quality of life that is not correlated with the severity of the chest wall deformity. After correction of a pectus excavatum (PE) or pectus carinatum (PC) patients experience a significant improvement in body image and self-esteem. For many, corrective surgery is life changing as it leaves patients feeling satisfied with the appearance of their chest, and this in turn increases their engagement in social activities. As this correction is mainly performed in adolescence, the treatment has a high impact on the future of patients that is often rooted in decisions made and actions taken during puberty.

More than my RA: A randomized trial investigating body image improvement among women with rheumatoid arthritis using a functionality-focused intervention program.

Negative body image is prevalent in women with rheumatoid arthritis and can affect other areas of well-being. Patients have expressed desire for body image to be addressed in treatment. Yet, it is not routinely addressed and no experimental intervention research has been conducted, until now. This randomized trial evaluated a brief online body image intervention for women with rheumatoid arthritis, with a focus on body functionality (everything the body is capable of doing) as the primary technique. Women with rheumatoid arthritis and who wanted to feel better about their body (N = 84; Mage = 44.82) were randomized to the Expand Your Horizon intervention (comprising 3 writing exercises focusing on body functionality) or a waitlist control group. Primary outcomes concerned body image and secondary outcomes related to rheumatoid arthritis; these outcomes were assessed at pretest, posttest, and at 1-week and 1-month follow-up. Multilevel modeling analyses showed that, relative to control, participants in the intervention experienced improvements in various aspects of body image (functionality appreciation, body appreciation, body satisfaction, body-self alienation) and decreases in depression, with effects persisting at 1-week and 1-month follow-up. No intervention effects were found for body-self harmony, rheumatoid arthritis-specific disability, pain-related disability, and anxiety. Focusing on body functionality can improve body image and reduce depression in women with rheumatoid arthritis. The intervention technique is easy and affordable to deliver and could be a fruitful addition to extant treatments for rheumatoid arthritis. (PsycINFO Database Record

Effect of acceptance and commitment therapy on body image flexibility and body awareness in patients with psychosomatic disorders: a randomized clinical trial.

ObjectiveThe aim of this research was to examine the effectiveness of the acceptance and commitment therapy (ACT) for body image flexibility and body awareness in these patients.MethodsA randomized clinical trial was conducted at Kashan University of Medical Sciences clinics in Kashan, Iran, from December 1, 2017 to March 30, 2018. A sample of 75 patients with psychosomatic disorders was selected by convenience sampling. The selected patients were randomly divided into three 25-member groups. The experimental group received medicinal treatment combined with the (ACT). The active control group received the usual treatment plus psycho education in general psychology, and the treatment group solely received the medicinal treatment usually used in the treatment centers. The results were obtained using the following scales in the pretest and posttest phases and the two-month follow-up: the demographic questionnaire; Shields’ body awareness questionnaire; and Sandoz’s body image flexibility questionnaire. The data were analyzed using the descriptive statistics tests (mean and standard deviation) and the repeated measures analysis of variance and chi-square tests in IBM-SPSS version 21.ResultsThere was no significant difference among the three groups in terms of body image flexibility, body awareness, somatic symptoms, and demographic variables. The results of the posttest and follow-up examinations suggested that the ACT group more effectively and significantly improved body image flexibility and body awareness as compared to both of the control groups (p=0.02).ConclusionsThe ACT successfully improves body image flexibility and body awareness in patients with psychosomatic disorders.Clinical trial registrationThis research was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2017092532057N2.FundingResearch and Technology Department of Kashan University of Medical Sciences funded the study (Ref: 96053).

Self-care Habits of Nurses and the Perception of Their Body Image.

The aim of this qualitative, phenomenological study was to explore the self-care habits of nurses in the hospital setting and how these habits influenced the perception of body image. The nursing profession often requires the nurse to place the health of patients before their own. Very little information is found in the literature regarding the self-care habits of nurses. The data were collected through in-depth interviews with 12 participants who worked as hospital nurses in northern Indiana. The analysis revealed 6 themes in self-care among nurses and how they viewed their bodies. In conclusion, being conscious about body image was the most frequently occurring theme and was referenced more than 4 times the other themes. The findings of this study may be useful in identifying ways to improve the shortcomings of nurses' self-care habits to improve body image and promote healthier lifestyles.

The impact of exposure to films of natural and built environments on state body appreciation

Previous work has shown that exposure to images of nature results in elevated state body appreciation, but static images may lack ecological validity. Here, we examined the impact of exposure to short films of simulated, first-person walks in natural or built environments. Thirty-six university students completed a measure of state body appreciation before and after watching films of either a walk in a natural or a built environment created specifically for the present study. Two weeks later, they completed the same task but watched the other film type. Results indicated that exposure to the film of a natural environment resulted in significantly elevated state body appreciation (d = 0.66). There was no significant change in state body appreciation following exposure to the film of the built environment (d = 0.14). These findings suggest that exposure to films depicting the natural environment may promote immediate, moderate-sized improvements in state body image.

Body image dissatisfaction and depression in postbariatric patients is associated with less weight loss and a desire for body contouring surgery

BackgroundOverhanging skin in postbariatric patients leads to a negative body image. In patients with obesity, negative body image is related to more depressive symptoms and a higher weight. This relationship might also be important in postbariatric patients, because improvement of body image via body contouring surgery (BCS) could lead to better weight loss results. ObjectivesTo evaluate the relationship between body image, depressive symptoms, and weight loss in a postbariatric population, focusing on desire for BCS. SettingOutpatient clinic. MethodsOne thousand twenty-four primary bariatric surgery patients were contacted, and 590 patients agreed to participate and filled in online questionnaires regarding body image (Body Shape Questionnaire and Multidimensional Body-Self Relations Questionnaire-Appearance Scales) and depression (Beck Depression Inventory-II). Differences between patients who had BCS, patients who desired BCS, and patients who did not desire BCS were studied. The mediating role of body image in the association between percentage total weight loss and depressive symptoms was assessed via a 2-mediator model. ResultsThere was a desire for BCS in 368 patients (62.4%); these patients had significantly lower scores on appearance evaluation and body image satisfaction scales and showed more depressive symptoms. Patients without a desire (n = 157, 26.6%) had lowest rates of depressive symptoms and a more positive body image. Sixty-five patients (11.0%) had undergone BCS. In the patients who desired BCS, percentage total weight loss was negatively affected by depressive symptoms via appearance evaluation and body-area satisfaction. ConclusionsThere are striking differences regarding body image satisfaction and depressive symptoms when comparing postbariatric patients and without desire for BCS. Body image satisfaction is associated with less depressive symptoms in all postbariatric patients. In patients who desired BCS, body image is one of the mediators of the relationship between percentage total weight loss and depressive symptoms. Therefore, body image should be taken seriously and be part of outcome assessment in postbariatric patients.

Outcomes, quality of life, and long-term results after pectus repair from around the globe

The procedure introduced by Donald Nuss in 1997 at the American Pediatric Surgical Association meeting has now been adopted by pediatric, thoracic, and plastic surgeons around the globe. Since its introduction, the Nuss procedure has been the subject of intense scrutiny. More than 20 years since the original publication, medical centers from around the world have reported their experience with the procedure and robust evidence now supports its safety and efficacy.Additionally, in collaboration with psychologists in Norfolk, a methodology was devised to measure the psychosocial as well as the physical benefits of the procedure. Extensive independent multinational and multi-institutional data demonstrate repair of pectus excavatum using the Nuss procedure results in marked improvement in both physical function and body image. This report reviews the outcomes, quality of life, and long-term results of numerous centers worldwide since the introduction of the procedure.

Mechanism of Change in Cognitive Behavioral Therapy for Body Image and Self-Care on ART Adherence Among Sexual Minority Men Living with HIV.

Body image disturbance is a common problem reported among sexual minority men living with HIV, and is associated with poor antiretroviral therapy (ART) adherence. Recently, a novel integrated intervention (cognitive behavioral therapy for body image and self-care; CBT-BISC) was developed and pilot tested to simultaneously improve body image and ART adherence in this population. Although CBT-BISC has demonstrated preliminary efficacy in improving ART adherence, the mechanisms of change are unknown. Utilizing data from a two-armed randomized controlled trial (N = 44 sexual minority men living with HIV), comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition, sequential process mediation via latent difference scores was assessed, with changes in body image disturbance entered as the mechanism between treatment condition and changes in ART adherence. Participants assigned to CBT-BISC reported statistically significant reductions in body image disturbance post-intervention, which subsequently predicted changes in ART adherence from post-intervention to long term follow-up (b = 20.01, SE = 9.11, t = 2.19, p = 0.028). One pathway in which CBT-BISC positively impacts ART adherence is through reductions in body image disturbance. Body image disturbance represents one, of likely several, mechanism that prospectively predicts ART adherence among sexual minority men living with HIV.

Effects Of 8-week Physical Education Courses On Body Image, Anxiety, And Exercise Self-efficacy

Exercise has been identified as a potential tool to mediate anxiety and improve self-efficacy and body image, however, the effectiveness of college physical education (PE) courses on psychological health needs further evaluation. PURPOSE: To examine the effects of 8-week PE courses on body image, anxiety, and exercise self-efficacy. METHODS: Seventy-five females (mean ± SD; Age: 20.8 ± 3.6 y; Height: 164.7 ± 7.0 cm; Weight: 68.5 ± 16.3 kg; Body fat percentage [BF%]: 27.3 ± 8.7 %) enrolled in college PE courses of Kickboxing (n=14), Beginning Jogging (n=8), Intermediate Jogging (n=22), Strength Training (n=14), and Conditioning (n=15) volunteered to participate in this study. Each course met 3 times a week for 50 minutes each class period during the 8-week long course. At the start and completion of each course, participants completed the Body Shape Questionnaire, Exercise Self-Efficacy (ESE), and Social Physique Scale, and height, weight, and BF%, measured by bioelectrical impedance analysis, were recorded. RESULTS: There were no significant differences pre- to post-testing in weight or activity levels outside of PE in any of the 5 courses (p>0.05). BF% significantly decreased pre- to post-testing in Intermediate Jogging (p=0.03), but not in the other courses. Social physique anxiety decreased in Beginning Jogging (p=0.024) and Strength Training (p=0.05), but not in the other courses. All courses had a significant improvement in body image (p<0.05) and ESE (p<0.05). BF% had a significant negative correlation with body image (R= -0.53, p<0.05) and ESE (R= -0.24, p=0.02), and a positive correlation with anxiety (R=0.53, p<0.05). Individual heath rating had a significant positive correlation with body image (R=0.47, p<0.05) and ESE (R=0.44, p<0.05), and a negative correlation with BF% (R= -0.26, p<0.05) and anxiety (R= -0.42, p<0.05). ESE had a significant positive correlation with body image (R=0.40, p=0.003) and anxiety (R=0.32, p=0.033). CONCLUSIONS: Lower BF% was associated with better body image, exercise self-efficacy, and lower anxiety. However, these results indicate regular exercise through 8-week PE college courses may aid in improving body image and exercise self-efficacy and decreasing anxiety even if there are no changes in weight or body fat percentage.

Perceptions of masculinity and body image in men with prostate cancer: the role of exercise.

The goal of this study was to explore the association between levels of exercise and patterns of masculinity, body image, and quality of life in men undergoing diverse treatment protocols for prostate cancer. Fifty men with prostate cancer (aged 42-86) completed self-report measures. Self-reported measures included the following: the Godin Leisure Time Exercise Questionnaire (GLTEQ), Masculine Self-esteem Scale (MSES), Personal Attributes Questionnaire (PAQ), Body Image Scale (BIS), and the Functional Assessment of Cancer Therapy-Prostate (FACT-P). Masculinity, body image, and quality of life scores were compared between men obtaining recommended levels of exercise (aerobic or resistance) and those not obtaining recommended level of exercise. Secondary outcomes included the association between masculinity, body image, and quality of life scores as they relate to exercise levels. There were significantly higher scores of masculinity (p < 0.01), physical well-being (p < 0.05), prostate cancer specific well-being (p < 0.05), and overall quality of life (p < 0.05) in those obtaining at least 150min of moderate to vigorous aerobic exercise. In the 48% of men who had never received androgen deprivation therapy, significantly higher levels of masculinity, body image, and quality of life were observed in those meeting aerobic guidelines. Whether treatment includes androgen deprivation or not, men who participate in higher levels of aerobic exercises report higher levels of masculinity, improved body image, and quality of life than those who are inactive. Future longitudinal research is required evaluating exercise level and its effect on masculinity and body image.

Obligatory exercise and coping in treatment-seeking women with poor body image.

Obligatory exercise is characterized by continued exercise despite negative consequences, and intense negative affect when unable to exercise. Research suggests psychosocial differences between individuals that exercise in an obligatory manner and those that do not. It also has been speculated that obligatory exercise may serve coping and affect regulation functions, yet these factors have not been routinely examined in community women with poor body image. The purpose of the current study was to investigate psychosocial differences between obligatory and non-obligatory exercisers, and to examine the use of obligatory exercise as an avoidant coping strategy in a sample of women with poor body image. Women (n = 70) seeking treatment for body dissatisfaction were divided into obligatory and non-obligatory exercise groups based on their scores on the Obligatory Exercise Questionnaire. Participants then completed an assessment battery about eating pathology, body image, reasons for exercise, coping strategies, and negative affect. Independent t test analyses indicated that obligatory exercisers had significantly greater eating disorder symptomatology, avoidant coping, and appearance- and mood-related reasons for exercise than non-obligatory exercisers. Multiple regression analyses revealed that eating disorder symptomatology and avoidant coping were significant predictors of obligatory exercise. There are distinct psychosocial differences between women with poor body image who exercise in an obligatory fashion and those who do not. The current study suggests that obligatory exercise may serve as an avoidant coping strategy for women with poor body image. Enhancing healthy coping strategies may be an important addition to body image improvement programs. V, cross-sectional descriptive study.

63 The Relation Between Satisfaction with Appearance and Ethnicity

Although the general research on body image has shown that there are associations between ethnicity and perceptions of body image, to our knowledge, no studies have examined the relation between satisfaction with appearance and ethnicity after a burn injury. The purpose of the study was to determine the impact that ethnicity has on satisfaction with appearance; and to determine the impact of satisfaction with appearance on community integration. All participants were part of a larger Burn Model System (BMS) national database. Adult participants completed the Satisfaction with Appearance Scale (SWAP) and the Community Integration Questionnaire (CIQ) at discharge, 6 months, 12 months and 24 months post burn injury. Higher scores on the SWAP indicate lower satisfaction with appearance and higher scores on the CIQ indicate greater integration into the community. A total of 1220 participated in the study but may not have completed the measures at each timepoint. Mean age was 40.1 (sd=13), mean burn size TBSA = 19.5% (sd=18), mean length of stay = 29.5(sd=37), 53% had a head/neck burn and 73% were male. Three sets of linear regression models were completed after adjusting for ethnicity (white, non-Hispanic versus non-white), age, sex and % TBSA. SWAP and CIQ scores between white and non-white participants are significantly different at all three time points (see table 1). On average, white participants reported more satisfaction with their appearance and integrated better into the community than non-white participants. The regression results also indicate that SWAP is significantly associated with CIQ after adjusting for race, sex, age, and burn size at 6, 12, and 24 months. For example, at 12 months, every one unit increase in CIQ was associated with a decrease in SWAP scores of 0.039 points. These results show that burn survivors who identify as non-White are more dissatisfied with their appearance. This dissatisfaction can also affect other outcomes, such as integrating back into the community. Research has shown that those with darker pigmented skin tend to produce more hypertrophic scarring, which may contribute to dissatisfied appearance and impact community re-integration. Cultural differences and degree of acceptance by communities may also impact satisfaction. Interventions on improving body image need to account for the unique ethnic differences of our population and the impact that body image has on other important functional outcomes.

A randomised-controlled trial investigating potential underlying mechanisms of a functionality-based approach to improving women’s body image

Focusing on body functionality is a promising technique for improving women’s body image. This study replicates prior research in a large novel sample, tests longer-term follow-up effects, and investigates underlying mechanisms of these effects (body complexity and body-self integration). British women (N = 261) aged 18–30 who wanted to improve their body image were randomised to Expand Your Horizon (three online body functionality writing exercises) or an active control. Trait body image was assessed at Pretest, Posttest, 1-week, and 1-month Follow-Up. To explore whether changes in body complexity and body-self integration ‘buffer’ the impact of negative body-related experiences, participants also completed beauty-ideal media exposure. Relative to the control, intervention participants experienced improved appearance satisfaction, functionality satisfaction, body appreciation, and body complexity at Posttest, and at both Follow-Ups. Neither body complexity nor body-self integration mediated intervention effects. Media exposure decreased state body satisfaction among intervention and control participants, but neither body complexity nor body-self integration moderated these effects. The findings underscore the value of focusing on body functionality for improving body image and show that effects persist one month post-intervention.

Using internet-based self-help to bridge waiting time for face-to-face outpatient treatment for Bulimia Nervosa, Binge Eating Disorder and related disorders: Study protocol of a randomized controlled trial

BackgroundEating disorders are serious conditions associated with an impaired health-related quality of life and increased healthcare utilization and costs. Despite the existence of evidence-based treatments, access to treatment is often delayed due to insufficient health care resources. Internet-based self-help interventions may have the potential to successfully bridge waiting time for face-to-face outpatient treatment and, thus, contribute to overcoming treatment gaps. However, little is known about the feasibility of implementing such interventions into routine healthcare. The aim of this study is to analyze the effects and feasibility of an Internet-based self-help intervention (everyBody Plus) specifically designed for patients with Bulimia Nervosa, Binge Eating Disorder and other specified feeding and eating disorders (OSFED) on a waiting list for outpatient face-to-face treatment. The aim of this paper is to describe the study protocol. MethodsA multi-country randomized controlled trial will be conducted in Germany and the UK. N = 275 female patients awaiting outpatient treatment will be randomly allocated either to the guided online self-help intervention “everyBody Plus” or a waitlist control group condition without access to the intervention. everyBody Plus comprises eight weekly sessions that cover topics related to eating and exercise patterns, coping with negative emotions and stress as well as improving body image. Participants will receive weekly individualized feedback based on their self-monitoring and journal entries. Assessments will take place at baseline, post-intervention as well as at 6- and 12-months follow up. In addition, all participants will be asked to monitor core eating disorder symptoms weekly to provide data on the primary outcome. The primary outcome will be number of weeks after randomization until a patient achieves a clinically relevant improvement in core symptoms (BMI, binge eating, compensatory behaviors) for the first time. Secondary outcomes include frequency of core symptoms and eating disorder related attitudes and behaviors, as well as associated psychopathology. Additional secondary outcomes will be the participating therapists' confidence in treating eating disorders as well as perceived benefits of everyBody Plus for patients. DiscussionTo the best of our knowledge, this is the first randomized controlled trial examining the effects of Internet-based self-help for outpatients with eating disorders awaiting face-to-face outpatient treatment. If proven to be effective and successfully implemented, Internet-based self-help programs might be used as a first step of treatment within a stepped-care approach, thus reducing burden and cost for both patients and health care providers.