Prevention of eating disorders in at-risk college-age women.

CONTEXT: Eating disorders, an important health problem among college-age women, may be preventable, given that modifiable risk factors for eating disorders have been identified and interventions have been evaluated to reduce these risk factors. OBJECTIVE: To determine if an Internet-based psychosocial intervention can prevent the onset of eating disorders (EDs) in young women at risk for developing EDs. SETTING: San Diego and the San Francisco Bay Area in California. PARTICIPANTS: College-age women with high weight and shape concerns were recruited via campus e-mails, posters, and mass media. Six hundred thirty-seven eligible participants were identified, of whom 157 were excluded, for a total sample of 480. Recruitment occurred between November 13, 2000, and October 10, 2003. Intervention A randomized controlled trial of an 8-week, Internet-based cognitive-behavioral intervention (Student Bodies) that included a moderated online discussion group. Participants were studied for up to 3 years. MAIN OUTCOME MEASURES: The main outcome measure was time to onset of a subclinical or clinical ED. Secondary measures included change in scores on the Weight Concerns Scale, Global Eating Disorder Examination Questionnaire, and Eating Disorder Inventory drive for thinness and bulimia subscales and depressed mood. Moderators of outcome were examined. RESULTS: There was a significant reduction in Weight Concerns Scale scores in the Student Bodies intervention group compared with the control group at postintervention (P < .001), 1 year (P < .001), and 2 years (P < .001). The slope for reducing Weight Concerns Scale score was significantly greater in the treatment compared with the control group (P = .02). Over the course of follow-up, 43 participants developed subclinical or clinical EDs. While there was no overall significant difference in onset of EDs between the intervention and control groups, the intervention significantly reduced the onset of EDs in 2 subgroups identified through moderator analyses: (1) participants with an elevated body mass index (BMI) (> or =25, calculated as weight in kilograms divided by height in meters squared) at baseline and (2) at 1 site, participants with baseline compensatory behaviors (eg, self-induced vomiting, laxative use, diuretic use, diet pill use, driven exercise). No intervention participant with an elevated baseline BMI developed an ED, while the rates of onset of ED in the comparable BMI control group (based on survival analysis) were 4.7% at 1 year and 11.9% at 2 years. In the subgroup with a BMI of 25 or higher, the cumulative survival incidence was significantly lower at 2 years for the intervention compared with the control group (95% confidence interval, 0% for intervention group; 2.7% to 21.1% for control group). For the San Francisco Bay Area site sample with baseline compensatory behaviors, 4% of participants in the intervention group developed EDs at 1 year and 14.4%, by 2 years. Rates for the comparable control group were 16% and 30.4%, respectively. CONCLUSIONS: Among college-age women with high weight and shape concerns, an 8-week, Internet-based cognitive-behavioral intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of EDs, at least in some high-risk groups. To our knowledge, this is the first study to show that EDs can be prevented in high-risk groups.

The adverse effect of negative comments about weight and shape from family and siblings on women at high risk for eating disorders.

OBJECTIVE: Our purpose with this work was to examine the relationship between negative comments about weight, shape, and eating and social adjustment, social support, self-esteem, and perceived childhood abuse and neglect. METHODS: A retrospective study was conducted with 455 college women with high weight and shape concerns, who participated in an Internet-based eating disorder prevention program. Baseline assessments included: perceived family negative comments about weight, shape, and eating; social adjustment; social support; self-esteem; and childhood abuse and neglect. Participants identified 1 of 7 figures representing their maximum body size before age 18 and parental maximum body size. RESULTS: More than 80% of the sample reported some parental or sibling negative comments about their weight and shape or eating. Parental and sibling negative comments were positively associated with maximum childhood body size, larger reported paternal body size, and minority status. On subscales of emotional abuse and neglect, most participants scored above the median, and nearly one third scored above the 90th percentile. In a multivariate analysis, greater parental negative comments were directly related to higher reported emotional abuse and neglect. Maximum body size was also related to emotional neglect. Parental negative comments were associated with lower reported social support by family and lower self-esteem. CONCLUSIONS: In college women with high weight and shape concerns, retrospective reports of negative comments about weight, shape, and eating were associated with higher scores on subscales of emotional abuse and neglect. This study provides additional evidence that family criticism results in long-lasting, negative effects.

Application of an algorithm-driven protocol to simultaneously provide universal and targeted prevention programs.

OBJECTIVE: Our objective was to develop a model to simultaneously prevent eating disorders and weight gain among female high school students. METHOD: Of 188 female 10th graders enrolled in health classes, 174 elected to participate in the current study. They were assessed on-line and decided to participate in one of four interventions appropriate to their risk. RESULTS: The algorithm identified 111 no-risk (NR), 36 eating disorder risk (EDR), 16 overweight risk (OR), and 5 both risks. Fifty-six percent of the EDR and 50% of the OR groups elected to receive the recommended targeted curricula. Significant improvements in weight and shape concerns were observed in all groups. DISCUSSION: An Internet-delivered program can be used to assess risk and provide simultaneous universal and targeted interventions in classroom settings.

An evaluation of an Internet-delivered eating disorder prevention program for adolescents and their parents.

PURPOSE: To evaluate the effectiveness of Student Bodies, an Internet-delivered eating disorder prevention program for adolescents, and a supplemental program for their parents. METHODS: One hundred fifty-two 10th grade females completing a health course at a private sectarian school, and 69 of their parents were assigned to either the Internet-delivered intervention group or to a comparison group (students) or wait-list control group (parents). Student participants completed subscales of the Eating Disorder Inventory, Eating Disorder Examination-Questionnaire, and a content knowledge test. Parents completed the Parental Attitudes and Criticism Scale. RESULTS: The main effects of the intervention were assessed pre- to post- and post- to follow-up using ANCOVA, with the baseline assessment of the independent variable as the covariate. Students using the program reported significantly reduced eating restraint and had significantly greater increases in knowledge than did students in the comparison group. However, there were no significant differences at follow-up. Parents significantly decreased their overall critical attitudes toward weight and shape. CONCLUSION: The program demonstrates the feasibility of providing an integrated program for students and their parents with short-term positive changes in parental attitudes toward weight and shape.