From Self-Doubt to Pride: Understanding the Empowering Effects of Delivering School-Based Wellness Programmes for Emerging Adult Facilitators-A Qualitative Study.

Ample literature exists on the impact of prevention programmes on their target audience, while much less is known about how delivering such programmes influences their facilitators. Even less literature exists on the emotional and social processes that form this potential impact on facilitators. The current study analysed qualitative in-depth, non-structured interviews, as well as written essays provided by 33 student-facilitators who delivered the "Favoring Myself" programme in Israel during 2019-2021. This school-based wellness programme comprised 10 weekly, 90 min sessions on self-care behaviours, media literacy, self-esteem, and positive body image, which are well-known protective factors against risky behaviours. A thematic analysis was applied to explore the main themes in the collected data. An interesting affective transformation from self-doubt to pride in themselves emerged as a shared experience of these young facilitators. Facilitators related their ability to facilitate the programme, as well as to undergo an individual maturation and empowerment experience, to certain components of the programme itself, such as the preparatory course, individual supervision, and the peer-group experience. This shift from doubt to pride is discussed using two frameworks-a theoretical discourse of emerging adulthood as a developmental stage, and the self-determination theory.

Non-Cooperation within a School-Based Wellness Program during the COVID-19 Pandemic-A Qualitative Research.

This paper presents a qualitative analysis of COVID-19's impact on the development, delivery, and uptake of "Favoring Myself", a school-based interactive wellness program conducted via Zoom during 2020-2021. "Favoring Myself" targets resilience, self-esteem, body-esteem, self-care behaviors, and media literacy among 5th-grade preadolescents. Data were obtained from meetings, 23 semi-structured interviews with parents, teachers, and principals, and other modes of correspondence. All data were transcribed and thematically analyzed. The analysis highlighted the barriers faced when delivering external programs during COVID-19. Parents' difficulties in cooperating with the program, distrustful relationships between parents and the education system, as well as teachers' overload and stress, were identified as barriers to the external program's sustainability. These challenges are discussed in light of previous studies of school-based programs, the psychological and social contexts of an ongoing crisis and the impact of neoliberalism on education. This study concludes that school-based prevention programs and accompanying research should be more flexible and focus on understanding and relating to parents' and schools' fears, uncertainties, and resistance. It is the hope of the authors that knowledge created through this exploration will be helpful in future coping vis-à-vis prevention program teams and recipients in times of unpredictable, unmanageable, and overpowering crises.

Eating and Control Styles Axis in Mentalisation-Based Psychotherapy in Eating Disorders: A Randomised Clinical Trial.

Background: Clinicians need an instrument that helps their patients with eating disorders (ED) to explore their agent's inner intentions and confront negative behaviour and control styles. Objectives: To assess the feasibility and impact of an eating and control styles axis (ECOSA) during the first 8 months of mentalisation-based psychotherapy with a community-based sample of ED patients. Methods: Six experienced therapists and their consecutively admitted patients were randomly allocated to the intervention and control groups. A total of 94 women, M age = 24 were recruited between June 2020 and October 2021. Ninety completed it. Both groups received mentalisation-based psychotherapy, but only the intervention group used the ECOSA repeatedly. Therapists and participants were blinded to the study aims and hypothesis. Fidelity assessment was applied to ensure that the two groups differed mainly in terms of ECOSA usage. Results: The use of ECOSA, although less than advised, was reported as feasible. The effect size of the improvement in reflective functioning was larger than that of the control group and correlated significantly only in the intervention group with EDE-Q score (r = 0.46; p = 0.001). Conclusion: Although the study limitations: selective population, relatively small sample size and the lack of controlled confounder, the combined quantitative and qualitative results lend preliminary evidence for the validity and contribution of ECOSA as a possible instrument that may upgrade the clinician's toolbox in the treatment of ED. A more rigorous study design is needed to explore the potential usage of ECOSA as a clinical tool to enhance mentalisation among people with ED.

The Impact of Delivering School-Based Wellness Programs for Emerging Adult Facilitators-A Quasi-Controlled Clinical Trial.

A quasi-controlled clinical trial included a university-based supervision course for facilitators of an interactive wellness school-based program. The study aimed to investigate how students that facilitate prevention programs are personally affected by delivering content related to self-esteem, body-image, and media literacy. In total, 66 university students who were either facilitators of preventive programs (intervention group) or non-facilitators (comparison group) completed questionnaires before, after, and three months following the program's termination. All methods were performed following the Declaration of Helsinki regulations and Consort 2010 guidelines. Participants in the facilitator group demonstrated statistically significant superiority, with large effect size, regarding improvement in identifying advertisement strategies. Weight-related body-esteem, and the reduced impact of media messages' pressure also had statistically significant superiority, with small effect size. The number of participants with pathological EAT-26 scores (>20) decreased from 5 to 2 in the facilitator group compared to an increase from 5 to 6 (no statistical significance) in the comparison group. Both groups demonstrated statistically significant decreases in eating disorder perceptions and behaviors from baseline to 3-month follow-up. Delivering a prevention program proved beneficial to facilitators, in addition to the target school pupils, and thus may be considered as part of the prevention programs' effectiveness assessment.

Feasibility and effect of adding a concurrent parental component to a school-based wellness program using two modes of mobile-based technology - mixed methods evaluation of RCT.

BACKGROUND: This study assessed the feasibility and effect of two mobile modes (WhatsApp vs. a specially designed app) in their delivery of updates and assignments to parents. METHODS: Two three-armed, randomized, controlled feasibility studies were conducted. In each trial, four schools with a total of 418 students in grade 5th, mean age 10.1 years, were randomly allocated to the control arm, youth-only arm, or youth & parental component arm. Only the data of those that completed all three assessments (pre, post and 3 months post program) were analyzed: 133 in the first trial and 137 in the second. In the youth-only arm, students participated in an interactive age-tailored prevention program delivered in 10 weekly, 90-min sessions on self-care behaviors, media literacy, self-esteem, and positive body image. The control groups in both studies received three health- and nutrition-related sessions. In the parental arm, in addition to the 'Favoring-Myself-Young's ten sessions program, parents received updates and were requested to complete shared assignments with their children. In the first year, the assignments were sent via WhatsApp, and in the following year via "Favoring Myself" smartphone application. Facilitators were third year undergraduate students. They used a detailed semi-structured guide and received 4-weekly hours of didactic and group dynamic supervision. Mixed-methods assessments were performed using semi-structured interviews with ten parents and five school staff members each year, as well as a computerized self-report questionnaire. RESULTS: Feasibility of parent-adolescent shared assignments in both digital modes was lower than expected. The use of WhatsApp had higher feasibility and uptake than the use of the special application. The addition of the concurrent parental component via WhatsApp was associated with superior improvement in self-esteem and identification of advertisement strategies, compared with the youth-only program. However, adolescents in the youth-only program delivered via the smartphone application demonstrated superior improvement compared to those in the youth and parental component arm. CONCLUSIONS: Although the addition of the concurrent parenting component was praised by the actively participating parents, overall, under the chosen structure and population, it did not prove to add statistically significant value to the youth-only arm. TRIAL REGISTRATIONS: NCT03216018 (12.7.2017) and NCT03540277 (26.4.2018).

The SHED Index: a tool for assessing a Sustainable HEalthy Diet.

PURPOSE: Promoting sustainable diets through sustainable food choices is essential for achieving the sustainable development goals set by the United Nations. Establishing a practical tool that can measure and score sustainable and healthy eating is highly important. METHODS: We established a 30-item questionnaire to evaluate sustainable-dietary consumption. Based on the literature and a multidisciplinary advisory panel, the questionnaire was computed by principal component analysis, yielding the Sustainable-HEalthy-Diet (SHED) Index. A rigorous multi-stage process included validation in training-verification sets, across recycling efforts, as an indicator of environmental commitment; and validation across the proportion of animal-protein consumption, as an indicator of adherence to a sustainable and healthy dietary-pattern. The EAT-Lancet reference-diet and the Mediterranean-Diet-score were used to investigate the construct validity of the SHED Index score. Reliability was assessed with a test-retest sample. RESULTS: Three-hundred-forty-eight men and women, aged 20-45 years, completed both the SHED Index questionnaire and a validated Food-Frequency-Questionnaire. Increased dietary animal-protein intake was associated with a lower SHED Index total score (p < 0.001). Higher recycling efforts were associated with a higher total SHED Index score (p < 0.001). A linear correlation was found between the SHED Index score and food-groups of the Eat-Lancet-reference diet. A significant correlation was found between the Mediterranean-Diet-score and the SHED Index score (r = 0.575, p < 0.001). The SHED Index score revealed high reliability in test-retest, high validity in training and verification sets, and internal consistency. CONCLUSION: We developed the SHED Index score, a simple, practical tool, for measuring healthy and sustainable individual-diets. The score reflects the nutritional, environmental and sociocultural aspects of sustainable diets; and provides a tangible tool to be used in intervention studies and in daily practice.

The risk of developing disordered eating following a family-based program among children with overweight and obesity and their siblings: Retrospective and prospective analyses.

BACKGROUND: Studies have raised the concern that dieting and weight-loss programs may be a potential risk factor for developing eating disorders, and may have a potential to affect siblings as well. This study assessed the long-term risk of developing disordered eating among children with overweight and obesity and their siblings as well as the change in the obesogenic environment following a family-based intervention program. METHODS: In a 30-month retrospective follow-up study (n=18 families in intervention group, n=26 families in control group, total of 81 children and siblings) and a 14-month prospective follow-up study (n=42 families, 78 children and siblings), families with one or more children with overweight or obesity ages 8-14 years participated in a multidisciplinary parent-child program called "Maccabi Active". Children's version of the eating-attitude-test (ChEAT) questionnaire, family eating-and-activity-habits questionnaire (FEAHQ) and BMI z-score were measured. RESULTS: in the retrospective study, no difference between groups with respect to ChEAT scores in children and siblings was found. In the prospective study, the FEAHQ score significantly decreased after completion of the program (ΔFEAHQ=-16.2±4.9, p=0.001) and continued to decrease in the 8-month follow-up (ΔFEAHQ=-23.2±5.7, p=0.001). BMI z-scores decreased after 6 months (ΔBMI z-score=-0.3±0.1, p=0.014), and did not increase in the 8-month follow-up. CONCLUSIONS: Our findings suggest no exacerbation in disordered eating behaviors among children with overweight or obesity or their siblings, thus alleviating concerns surrounding the development of disordered eating after participating in a family-based intervention. Moreover, improvement in obesogenic environment suggests potential benefits to the entire family.

School-based versus after-school delivery of a universal wellness programme - A randomized controlled multi-arm trial.

Positive self-image and body image as well as high self-esteem and media literacy are considered protective factors against health-compromising behaviours. Investigation of the optimal setting for body image prevention programmes is important to maximize outcomes from such programmes. Most universal wellness programmes are school based and thus delivered to a "captive" population. Only a few reports have been published about wellness programmes delivered in after-school settings, and none of them compared delivery after school to delivery in a school-based setting. AIMS: To assess the acceptability, feasibility and efficacy of an interactive wellness preventive programme (In Favour of Myself) when delivered in a school-based setting versus an after-school setting. METHODS: A randomized controlled multi-arm trial with 224 adolescent girls aged 13-15 years old was conducted. There were 102 girls participating in the after-school setting and 102 girls in the school-based setting. The programme contained nine 90-minute lessons, delivered weekly over 2 months. An intention-to-treat assessment was performed three times: at baseline, at the programme's conclusion (two months) and at follow-up (3 months). RESULTS: At programme termination and follow-up, the impact of In Favour of Myself was higher among participants in the after-school setting than in the school-based setting with respect to advertisement strategies, media pressure, gap between current and ideal body image, drive for thinness and self-esteem. CONCLUSIONS: This study provides support for a community-led approach to promote health behaviours, an approach that currently is a significant feature of health improvement policy and practice.

Girls-only vs. mixed-gender groups in the delivery of a universal wellness programme among adolescents: A cluster-randomized controlled trial.

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. TRIAL REGISTRATION: NCT02653586.

Gender related differences in response to "in favor of myself" wellness program to enhance positive self & body image among adolescents.

BACKGROUND: Physical, neurological and psychological changes are often experienced differently by male and female adolescents. Positive self-esteem, emotional well-being, school achievements, and family connectedness are considered as protective factors against health-compromising behaviors. This study examines the gender differences in respect to the effect of a school-based interactive wellness program--"In Favor of Myself"--on self-image, body image, eating attitudes and behaviors of young adolescents. METHODS: Two hundred and ten adolescents (mean age 13.5) participated in the intervention group, 55% were girls and 45% boys. Program consisted of eight 90-minutes structured sessions integrated into a regular school coping skills curriculum. The program focused on self-esteem, self-image, body image, media literacy and cognitive dissonance. The overall impact of the program and the study protocol were previously published. RESULTS: Overall, there are gender related differences in respect to body image and self-image in young adolescents in response to "In Favor of Myself". Compared to boys, girls reported at baseline higher self-esteem, being more contingent by appearance, and their self-image was more influenced by popularity, appearance, interpersonal communication and admired people. Furthermore girls presented greater gap between current body figure and perceived ideal figure. Not only were girls more dissatisfied with their body, but they were more active in attempts to become and/or remain "thin". At program termination, gender × time effect was detected in reduction of self-worth contingent by others, change in importance given to achievements at schools, parents' perceptions, as well as the impact of comparisons to friends and family members on self-image. CONCLUSIONS: Girls exhibited more gains than boys from 'In Favor of Myself' which raise the questions about how effective would be the program when delivered in mixed gender groups vs. mono-gender groups.

Parenting and the parallel processes in parents' counseling supervision for eating-related problems.

This paper presents an integrative model for supervising counselors of parents who face eating-related problems in their families. The model is grounded in the theory of parallel processes which occur during the supervision of health-care professionals as well as the counseling of parents and patients. The aim of this model is to conceptualize components and processes in the supervision space, in order to: (a) create a nurturing environment for health-care facilitators, parents and children, (b) better understand the complex and difficult nature of parenting, the challenge counselors face, and the skills and practices used in parenting and in counseling, and (c) better own practices and oppose the judgment that often dominates in counseling and supervision. This paper reflects upon the tradition of supervision and offers a comprehensive view of this process, including its challenges, skills and practices.

The effect of "in favor of myself": preventive program to enhance positive self and body image among adolescents.

BACKGROUND: Positive self-esteem, emotional well-being, school achievements and family connectedness are considered protective factors against health-compromising behaviors. This study examined the effect of an interactive, community-based, media literacy and dissonance wellness program, In Favor of Myself, on the self-image, body image, eating attitudes and behavior of young adolescents. A preliminary cohort study was conducted among 972 program participants who did not take part in the controlled trial. Over 75% of participants said they would recommend the program to their friends. METHODS: A controlled trial was conducted to evaluate program acceptability, efficacy and effectiveness among 259 participants (210 in the intervention group and 49 in the control group), aged 12-14 years, who completed questionnaires during at least two assessment times. Program materials were provided, along with leaders' training, in order to ensure quality program delivery and creation of a wide network of committed program leaders. RESULTS: The program significantly reduced drive for thinness and self-worth contingent upon others' approval, the gap between current body figure and ideal figure, and the impact of mood on girls' self-image. Superiority was found among those participating in the intervention group with respect to recognizing media strategies, the influence of media on desire to change, and the influence of appearance on self-confidence and drive for thinness. CONCLUSIONS: In Favor of Myself shows promising results for strengthening adolescents' ability to cope with the challenges of their life stage. Suggestions for improving In Favor of Myself are presented.

Health perceptions, self and body image, physical activity and nutrition among undergraduate students in Israel.

PURPOSE: This study examines health perceptions, self and body image, physical exercise and nutrition among undergraduate students. METHODS: A structured, self-reported questionnaire was administered to more than 1500 students at a large academic institute in Israel. The study population was heterogenic in both gender and fields of academic study. RESULTS: High correlations between health perceptions, appropriate nutrition, and positive self and body image were found. The relationships between these variables differed between the subpopulation in the sample and the different genders. Engagement in physical exercise contributed to positive body image and positive health perceptions more than engagement in healthy nutrition. Nutrition students reported higher frequencies of positive health perceptions, positive self and body image and higher engagement in physical exercise in comparison to all other students in the sample. CONCLUSIONS: This study suggests, as have many before, that successful health promotion policy should reflect a collectivist rather than an individualist ethos by providing health prerequisites through a public policy of health-promotion, where the academic settings support a healthy lifestyle policy, by increasing availability of a healthy, nutritious and varied menu in the cafeterias, and offering students various activities that enhance healthy eating and exercise. IMPLICATIONS AND CONTRIBUTION: This study examined health perceptions, self-image, physical exercise and nutrition among undergraduate students and found high correlations between these topics. Nutrition students reported higher frequencies of positive health perceptions, and positive self and body image and engaged more in physical exercise when compared with all other students in the sample.

The journey from opposition to recovery from eating disorders: multidisciplinary model integrating narrative counseling and motivational interviewing in traditional approaches.

BACKGROUND: In the world of today's of ever-briefer therapies and interventions, people often seem more interested in outcome than process. This paper focuses on the processes used by a multidisciplinary team in the journey from opposition to change to recovery from eating disorders. The approach outlined is most relevant to those with severe and enduring illness. METHODS: This paper describes a five-phase journey from eating-disorder disability and back to health as it occurs for patients in a community-based facility. This integrative model uses narrative and motivational interviewing counseling weaved into traditional approaches. It approaches illness from a transdiagnostic orientation, addressing the dynamics and needs demanded by the comorbidities and at the same time responding effectively in a way that reduces the influence of the eating disorder. The treatment described involves a five-phase journey: Preliminary phase (choosing a shelter of understanding); Phase 1: from partial recognition to full acknowledgment; Phase 2: from acknowledgment to clear cognitive stance against the eating disorder; Phase 3: towards clear stance against the "patient" status; Phase 4: towards re-authoring life and regaining self-agency; Phase 5: towards recovery and maintenance. RESULTS: In a longitudinal study of patients with a severe and debilitating eating disorder treated with this approach. The drop-out rate was less than 10%. This was during the first two months of treatment for those diagnosed with bulimia nervosa, and this was higher than in those diagnosed with anorexia nervosa. At the end of treatment (15 months to 4 years later) 65% of those treated with anorexia nervosa and 81% of those treated with bulimia nervosa were either in a fully recovered state or in much improved. At the four-year follow-up, 68% of those diagnosed with anorexia nervosa and 83% of those diagnosed with bulimia nervosa were categorized as either fully recovered or much improved. All patients who completed the program were gainfully employed. CONCLUSIONS: The collaborative work, which is the heart of the described model increases the patient's and family's ownership of treatment and outcome and strengthen the therapeutic bond, thus enhances recovery.

Parenting styles and eating disorder pathology.

Our objective was to investigate the association between parenting style and eating disorder symptoms in patients treated in an intensive outpatient center for eating disorders. The study design is a cross-sectional survey set in a community-based facility for eating disorders. Participants included 53 families, including 32 with a child meeting the DSM-IV criteria for anorexia nervosa, 18 for bulimia nervosa, and 3 diagnosed ED-NOS. Data was collected using the Parental Authority Questionnaire (PAQ), the Eating Disorders Inventory-2 (EDI-2) and the Eating Attitudes Test (EAT-26). Significant, negative correlations were found between drive for thinness scores and body dissatisfaction scores and the patient's perception of the father as authoritative. Total patient EDI score was significantly and positively correlated with patient's perception of the father as authoritarian and inversely correlated with her perception of him as authoritative. These results emphasize the importance of fathers' role in the eating disorder pathology, a relatively untapped area of research.

Self-monitoring in anorexia nervosa.

BACKGROUND: A possible connection between Mark Snyder's concept of self-monitoring and anorexia nervosa (AN) has not previously been examined. AIMS: We hypothesized that AN symptomatology correlates positively with the Other-Directedness aspect of Snyder's self-monitoring construct and negatively with its Extraversion aspect. METHOD: 194 women with a history of AN were classified as currently ill (n = 17), partially recovered (n = 106) and recovered (n = 71).These women and 100 female controls with no history of an eating disorder completed Snyder's Self-Monitoring Scale (SMS) and the Eating Attitudes Test-26 (EAT-26). ;Other-Directedness' and ;Acting and Extraversion'subscales were derived from an exploratory factor analysis of the Hebrew version of the SMS. Mean total and subscale scores were compared across groups, and correlations were calculated between EAT-26 scores and SMS total and subscale scores. RESULTS: Both subscales of the SMS correlated significantly with total scores but not with one another. As expected, AN symptomatology and EAT-26 scores were associated positively with Other-Directedness yet negatively with Acting and Extraversion, rendering the correlation with total SMS scores insignificant. CONCLUSION: Different aspects of Snyder's self-monitoring construct correlate in opposite directions with eating pathology and AN symptomatology. AN appears to be associated with high Other-Directedness but low Acting and Extroversion.

An integrative quantitative model of factors influencing the course of anorexia nervosa over time.

OBJECTIVE: To identify factors influencing the course of anorexia nervosa (AN) over time. METHOD: Former female patients with AN (36 remitted and 24 nonremitted) and 31 healthy females responded to standardized interviews and self-rating questionnaires. Remitted patients maintained normal eating, normal weight, and regular menses for the past 12 months. Patients not fulfilling these criteria were considered nonremitted. RESULTS: Using logistic regression, we identified that number of hospitalizations, duration of ambulatory treatment, past vegetarianism, past anxiety, and childhood sexual abuse differentiated remitted from nonremitted patients, predicting nonremission. A similar analysis identified that elevated follow-up vegetarianism and eating-related concerns and lower body mass index (BMI) differentiated remitted from nonremitted patients, contributing to nonremission. Univariate analyses identified that remitted patients had elevated anxiety and eating-related obsessionality compared with the controls, suggesting these variables to potentially predispose to AN. DISCUSSION: Elevated anxiety and eating-related obsessionality may increase the risk for the development of AN and for nonremission.

Parenting styles and weight-related symptoms and behaviors with recommendations for practice.

With the incidence of eating disorders increasing in recent years, the role of parents in the pathology of these illnesses is of great interest, particularly the impact of their parenting style. Few studies have investigated the connection between parenting styles and adolescent eating disorders. Reviewed here are key studies on parenting style categorized into the following four broad areas related to eating disorder pathology: food-related symptoms, feeding style, research on ethnic populations, and populations with eating disorders. The results reflect previous findings on the benefits of the authoritative parenting style. Suggestions for parenting programs and further research are included.