Effects of an Internet-based intervention for subthreshold eating disorders: A randomized controlled trial
Abstract
Background Women reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.Aims To adapt and evaluate the effects of the Internet-based prevention program "Student Bodies™" for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method 126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies™+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. "Student Bodies™" was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.Results At 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20-87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63-95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.Conclusion The adapted "SB+" program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.
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All studies of indicated Internet-based eating disorder prevention programs recruited only young females and mainly university students, with only two recruiting a very small percentage of members of the community, thus limiting the external validity of findings.
“However, all studies recruited only young females and mainly university students, with only two recruiting a very small percentage of members of the community [25, 28], thus limiting the external validity of findings.”
With the exception of the study by Vollert et al. which did not report outcomes, all trials of indicated Internet-based eating disorder prevention programs reported eating disorder risk reduction following the intervention.
“With the exception of the study by Vollert et al. [28] who focussed on the impact of recruitment strategies and did not report outcomes, all trials reported eating disorder risk reduction following the intervention [25–27, 29].”
Other trials of online programs employed either face-to-face or telephone diagnostic interviews or an online validated structured self-report measure to exclude participants with an eating disorder.
“Other trials of online programs employed either face-to-face or telephone diagnostic interviews [25, 28] or an online validated structured self-report measure [29] to exclude participants with an eating disorder.”
Telephone or face-to-face interview processes have the advantage of accurately excluding those with full syndrome eating disorders and may increase participant commitment.
“Telephone or face-to-face interview processes [25–27] have the advantage of accurately excluding those with full syndrome eating disorders and may increase participant commitment.”
Based on the current and previous research, it is likely that indicated Internet-based intervention outcome studies require large numbers of potential participants to be screened to achieve samples that meet certain eligibility criteria (i.e., 1500-4500 participants).
“Nevertheless, based on the current and previous research, it is likely that indicated Internet-based intervention outcome studies require large numbers of potential participants to be screened to achieve samples that meet certain eligibility criteria (i.e., 1500–4500 participants) [25, 28, 29].”
The online screening approach used in the current study is not without its limitations.
“although also employed in other indicated eating disorder prevention trials [25, 26, 29] the online screening approach used in the current study is not without its limitations.”
Adherence to more structured interventions is not invariably superior.
“in the four indicated trials of StudentBodies, participants completed between 12 and 68% of required monitoring assessments [25–28], suggesting that adherence to more structured interventions are not invariably superior”
Other studies of indicated prevention programs have broadened their criteria to include individuals with lower levels of weight concerns (e.g., WCS > 47) or body dissatisfaction only without any additional behavioural criteria.
“other studies of indicated prevention programs have broadened their criteria to include individuals with lower levels of weight concerns (e.g., WCS > 47; [25, 26]) or body dissatisfaction only without any additional behavioural criteria [29].”
The proportion of interested individuals excluded due to severe eating disorder pathology in this study (51%) is markedly higher than in other indicated prevention trials (less than 15%).
“The majority of interested individuals (51%) were excluded due to their severe eating disorder pathology, in marked contrast to less than 15% in other indicated prevention trials [25, 27, 29].”
Attrition rates in the current trial were higher compared to indicated trials of StudentBodies and The Body Project, where assessment completion ranged from 63 to 91% at post-intervention.
“Thus, attrition rates was higher compared to indicated trials of StudentBodies and The Body Project, where assessment completion ranged from 63 to 91% at post-intervention [25–27, 29].”
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- Authors
- Jacobi, C., Völker, U., Trockel, M. T., & Taylor, C. B.
- Affiliations
- Technische Universität Dresden (DE)
- Stanford Medicine (US)
- Corresponding author
- Jacobi, Corinna
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 50
- Issue
- 2
- Pages
- 93-99
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2049092105
- Cited by
- 138
- References
- 37
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 9 · 2023: 16 · 2022: 11 · 2021: 5 · 2020: 13 · 2019: 2 · 2018: 9 · 2017: 14 · 2016: 8 · 2015: 13 · 2014: 10 · 2013: 10 · 2012: 4
- FWCI
- 8.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Else Kröner-Fresenius-Foundation (P19/06//A05/06)
- NIMH (MH081124)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Keywords
- subthreshold eating disorders, disordered eating, student population, binge eating, purging, weight and shape concerns, restrictive eating, compensatory behavior, women, eating disorder prevention, Eating Disorder Examination Questionnaire
- MeSH terms
- Adolescent, Adult, Feeding and Eating Disorders, Female, Humans, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Internet, Early Medical Intervention
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