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Cited by 98Eating Disorders and BehaviorsNutrition, Health and Food BehaviorBody Image and Dysmorphia Studies

Interactions between risk factors in the prediction of onset of eating disorders: Exploratory hypothesis generating analyses

Open access
Stice, Eric, Desjardins, Christopher D.·2018·Behaviour Research and Therapy
DOI 10.1016/j.brat.2018.03.005PMC PMC5929474
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Abstract

Objective Because no study has tested for interactions between risk factors in the prediction of future onset of each eating disorder, this exploratory study addressed this lacuna to generate hypotheses to be tested in future confirmatory studies.Method Data from three prevention trials that targeted young women at high risk for eating disorders due to body dissatisfaction (N = 1271; M age 18.5, SD 4.2) and collected diagnostic interview data over 3-year follow-up were combined to permit sufficient power to predict onset of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) using classification tree analyses, an analytic technique uniquely suited to detecting interactions.Results Low BMI was the most potent predictor of AN onset, and body dissatisfaction amplified this relation. Overeating was the most potent predictor of BN onset, and positive expectancies for thinness and body dissatisfaction amplified this relation. Body dissatisfaction was the most potent predictor of BED onset, and overeating, low dieting, and thin-ideal internalization amplified this relation. Dieting was the most potent predictor of PD onset, and negative affect and positive expectancies for thinness amplified this relation.Conclusions Results provided evidence of amplifying interactions between risk factors suggestive of cumulative risk processes that were distinct for each disorder; future confirmatory studies should test the interactive hypotheses generated by these analyses. If hypotheses are confirmed, results may allow interventionists to target ultra high-risk subpopulations with more intensive prevention programs that are uniquely tailored for each eating disorder, potentially improving the yield of prevention efforts.

AI snapshot

Written from the paper’s full text.

TL;DR

This exploratory classification-tree analysis of 1,271–1,272 high-risk young women found disorder-specific amplifying interactions among risk factors predicting 3-year onset of anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder. The authors frame the results as hypothesis-generating and call for confirmatory tests.

Key findings

  • For anorexia nervosa, low BMI was the strongest predictor: AN onset was 0.3% in the upper 83% of BMI versus 11.1% in the lower 17%; among those with low BMI, onset was 9.0% with lower body dissatisfaction versus 71.4% with upper 11% body dissatisfaction.
  • For bulimia nervosa, overeating was the strongest predictor: onset was 4.5% in the lower 95% of overeating versus 33.3% in the upper 5%; a 4-way amplifying interaction involved overeating, positive thinness expectancies, body dissatisfaction, and thin-ideal internalization, with one high-risk node showing 72.7% onset.
  • For binge eating disorder, body dissatisfaction was the strongest predictor: onset was 2.7% in the lower 71% versus 14.3% in the upper 29%; high body dissatisfaction plus high overeating plus low dieting yielded 63.6% onset, and a second pathway involved high body dissatisfaction, high overeating, high dieting, and high thin-ideal internalization.
  • For purging disorder, dieting was the strongest predictor: onset was 11.3% in the upper 17% of dieting versus 2.8% in the lower 83%; high dieting plus high negative affect yielded 27.5% onset, adding high positive thinness expectancies yielded 46.2%, and very high negative affect appeared protective (25.0% versus 64.3% in an adjacent node).

Methods

  • Combined data from three eating disorder prevention trials targeting young women with body dissatisfaction (abstract N=1,271; methods N=1,272; M age 18.5, SD 4.2), with diagnostic interview data over 3-year follow-up.
  • Used classification tree analysis (CTA) with the Gini index to predict onset of subthreshold or threshold AN, BN, BED, and PD; participants meeting criteria for the target disorder at baseline were excluded from that tree.
  • Because cross-validation pruning removed all branches, the authors report unpruned trees with F-measure and G-mean, and conducted sensitivity checks with random forest and boosting classification.

Limitations

  • The authors state the high-risk body-dissatisfied sample may not generalize to other populations, and that high-risk designs may bias results toward risk factors correlated with that risk status.
  • The authors state some measures did not show unidimensionality, so formal tests of factorial invariance across samples were not conducted; they also did not assess biological risk factors.
  • The authors state prospective data establish temporal precedence but not causality, and the analyses are exploratory and hypothesis-generating rather than confirmatory; the text also makes evident that rare outcomes/class imbalance led to pruning all branches and modest F-measure/G-mean values.

Model-written summary. Check it against the paper before relying on it.

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Registry

Crossref · 10.1016/j.brat.2018.03.005

Cites

54 of 54 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Overeating amplified the relation between body dissatisfaction and binge eating disorder onset.

    “Body dissatisfaction was the most potent predictor of BED onset, and overeating, low dieting, and thin-ideal internalization amplified this relation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures are sufficiently comparable across the three trials to combine into a single sample.
    • Rests on an assumption: Combining the three trials provided sufficient power to predict onset of each eating disorder.
  • Findingown data

    Negative affect amplified the relation between dieting and purging disorder onset.

    “Dieting was the most potent predictor of PD onset, and negative affect and positive expectancies for thinness amplified this relation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures are sufficiently comparable across the three trials to combine into a single sample.
    • Rests on an assumption: Combining the three trials provided sufficient power to predict onset of each eating disorder.
  • Findingown data

    The classification tree for BN identified overeating, positive expectancies for thinness, body dissatisfaction, and thin-ideal internalization as important classifiers of whether a participant would subsequently develop BN.

    “Figure 2 shows the classification tree for BN. Overeating, positive expectancies for thinness, body dissatisfaction, and thin-ideal internalization were identified as important classifiers of whether a participant would subsequently develop BN.”
    Quote in the paperSubstantial claim
  • Findingown data

    Thin-ideal internalization amplified the relation between body dissatisfaction and binge eating disorder onset.

    “Body dissatisfaction was the most potent predictor of BED onset, and overeating, low dieting, and thin-ideal internalization amplified this relation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures are sufficiently comparable across the three trials to combine into a single sample.
    • Rests on an assumption: Combining the three trials provided sufficient power to predict onset of each eating disorder.
  • Findingown data

    Low dieting amplified the relation between body dissatisfaction and binge eating disorder onset.

    “Body dissatisfaction was the most potent predictor of BED onset, and overeating, low dieting, and thin-ideal internalization amplified this relation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures are sufficiently comparable across the three trials to combine into a single sample.
    • Rests on an assumption: Combining the three trials provided sufficient power to predict onset of each eating disorder.
  • May combine two claims. 51
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    The overall classification rate for the anorexia nervosa tree was .982 compared to .979 for the null tree, with F-measure .303 and G-mean .438.

    “The overall classification rate for the tree was .982 compared to .979 for the null tree (where all participants are predicted not to develop AN) and the F-measure was .303 and the G-mean was .438.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The measures are sufficiently comparable across the three trials to combine into a single sample.
    • Rests on an assumption: Combining the three trials provided sufficient power to predict onset of each eating disorder.

  • May combine two claims.

    Findingown data

    The average correlation among the risk factors was .14 (range = .01 - .54), suggesting the risk factors were relatively independent.

    “The average correlation among the risk factors was .14 (range = .01 – .54), suggesting that the risk factors were relatively independent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Random forest identified BMI as 3 times more important than body dissatisfaction, whereas boosting identified BMI as 7 times more important than body dissatisfaction and 4 times more important than dieting.

    “The random forest identified BMI as being 3 times more important than body dissatisfaction (which had roughly equivalent importance to dieting), whereas boosting identified BMI as being 7 times more important than body dissatisfaction and 4 times more important than dieting.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures are sufficiently comparable across the three trials to combine into a single sample.
    • Rests on an assumption: Combining the three trials provided sufficient power to predict onset of each eating disorder.

  • May combine two claims.

    Findingown data

    The three samples varied in age, ethnic/racial composition, and parental education.

    “Table 2 reports the age, ethnic/racial composition, and parental education (a proxy for socioeconomic status) for the three samples, which varied in these demographic factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Boosting identified thin-ideal internalization and negative affect as having the greatest predictive power for BN, but suggested overeating and body dissatisfaction had similar predictive power.

    “Boosting identified the thin-ideal internalization and negative affect as having the greatest predictive power, but suggested that overeating and body dissatisfaction had similar predictive power.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The F-measure for the PD tree was .227 and the G-mean was .371, suggesting moderate predictive accuracy.

    “The F-measure was .227 and the G-mean was .371, suggesting moderate predictive accuracy of this tree.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The overall classification rate for the PD tree was .951 compared to .945 for the null tree.

    “The overall classification rate for this tree was .951 compared to .945 for the null tree.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The overall classification rate for the BN tree was .945 compared to .937 for the null tree.

    “The overall classification rate for this tree was .945 compared to .937 for the null tree.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    As with BN, random forest did not identify any one predictor as more important than other predictors for BED, while boosting identified body dissatisfaction, negative affect, and mental health care as slightly more important.

    “As with BN, random forest did not identify any one predictor as more important than other predictors, while boosting identified body dissatisfaction, negative affect, and mental health care as slightly more important.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Random forest and boosting confirmed that BMI was the most important predictor for AN, followed by body dissatisfaction and to a lesser extent dieting.

    “Random forest and boosting confirmed that BMI was the most important predictor followed by body dissatisfaction and to a lessor extent dieting.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The F-measure for the AN tree was .303 and the G-mean was .438, providing evidence of moderate prediction accuracy.

    “The F-measure was .303 and the G-mean was .438, providing evidence of moderate prediction accuracy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Elevated dieting emerged as the most potent risk factor for PD; among those in the upper 17% of dieting the incidence of PD was 11.3%, versus 2.8% for those in the lower 83% of dieting.

    “Elevated dieting emerged as the most potent risk factor; among those in the upper 17% of dieting the incidence of PD was 11.3%, versus 2.8% for those in the lower 83% of dieting.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The F-measure for the PD tree was .227 and the G-mean was .371.

    “The F-measure was .227 and the G-mean was .371.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    As with BN, the random forest identified overeating, functional impairment, and body dissatisfaction as having the greatest importance for BED, while boosting identified body dissatisfaction, negative affect, and dieting as most importance.

    “As with BN, the random forest identified overeating, functional impairment, and body dissatisfaction as having the greatest importance, while boosting identified body dissatisfaction, negative affect, and dieting as most importance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The F-measure for the BN tree was .193 and the G-mean was .333, suggesting predictive accuracy for this tree was somewhat lower than for the AN tree.

    “The F-measure was .193 and the G-mean was .333, suggesting that the predictive accuracy for this tree was somewhat lower than for the AN tree.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The F-measure for the BED tree was .288 and the G-mean was .431.

    “The F-measure was .288 and the G-mean was .431.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The F-measure for the BN tree was .193 and the G-mean was .333.

    “The F-measure was .193 and the G-mean was .333, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The F-measure for the BED tree was .288 and the G-mean was .431, suggesting moderate accuracy of the tree.

    “The F-measure was .288 and the G-mean was .431, suggesting moderate accuracy of the tree.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among those in the lower 71% of body dissatisfaction, the incidence of BED was 2.7%, versus 14.3% for those in the upper 29% of body dissatisfaction.

    “Among those in the lower 71% of body dissatisfaction, the incidence of BED was 2.7%, versus 14.3% for those in the upper 29% of body dissatisfaction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The overall classification rate for the BED tree was .944 compared to .936 for the null tree.

    “The overall classification rate for this tree was .944 compared to .936 for the null tree.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    This high-risk sample also showed elevated thin-ideal internalization, dieting, and overeating.

    “Fortunately, this high-risk sample also showed elevated thin-ideal internalization, dieting, and overeating (Stice et al., 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Stice et al., 2017

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Confirmatory factor analyses revealed that some measures did not show unidimensionality, which led the authors to not conduct formal tests of factorial invariance across the samples.

    “confirmatory factor analyses revealed that some of measures did not show unidimensionality, which led us to not conduct formal tests of factorial invariance across the samples.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The Eating Disorder Diagnostic Interview showed high inter-rater agreement (ICC = .88) and 1-week test-retest reliability (ICC = .95) in the combined sample.

    “Inter-rater agreement for 298 randomly selected participants (ICC = .88) and 1-week test-retest reliability for 282 randomly selected participants (ICC = .95) in the combined sample were high.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Dummy coded variables for intervention condition were included to control for intervention condition.

    “We included dummy coded variables that reflected the conditions in the trials (e.g., coded 1 for participants assigned to the Body Project prevention program and 0 for participants assigned to other conditions) to control for intervention condition.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The dual pathway model posits that pressure to be thin and internalization of the thin beauty ideal contributes to body dissatisfaction, which increases risk for unhealthy dietary restriction and negative affect, which increase risk for onset of binge eating and compensatory weight control behaviors.

    “For instance, the dual pathway model posits that pressure to be thin and internalization of the thin beauty ideal contributes to body dissatisfaction, which in turn increases risk for both unhealthy dietary restriction and increased negative affect, which both theoretically increase risk for onset of binge eating and compensatory weight control behaviors (Stice, 1994).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Stice, 1994

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Random forest and boosting sensitivity checks confirmed BMI as the most important predictor and provided some support for the importance of body dissatisfaction.

    “Thus, these results confirm that BMI is the most important predictor and provided some support for the importance of body dissatisfaction.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures are sufficiently comparable across the three trials to combine into a single sample.
    • Rests on an assumption: Combining the three trials provided sufficient power to predict onset of each eating disorder.

  • May combine two claims.

    Study design and conductown data

    The present study combined data from three large eating disorder prevention trials that targeted young women at high risk for future eating disorders by virtue of body dissatisfaction, which increased the incidence of threshold and subthreshold AN, BN, BED, and PD over 3-year follow-up, improving ability to correctly classify individuals.

    “The present study combined data from three large eating disorder prevention trials that targeted young women at high-risk for future eating disorders by virtue of body dissatisfaction, which increased the incidence of threshold and subthreshold AN, BN, BED, and PD over 3-year follow-up, improving our ability to correctly classify individuals as developing each of these eating disorders.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Combining the three trials provided sufficient power to predict onset of each eating disorder.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    CTA, random forests, and boosting are non-parametric statistical techniques and do not have distributional or linearity assumptions.

    “It is important to note that CTA, random forests, and boosting are non-parametric statistical techniques, and as such, do not have distributional or linearity assumptions.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Expectancy theory posits that expecting dieting and thinness to result in greater social acceptance increases risk for restricting anorexia nervosa and bulimia nervosa, and expecting that eating reduces negative affect increases risk for binge eating.

    “Similarly, expectancy theory posits that expecting that dieting and thinness result in greater social acceptance putatively increases risk for both restricting anorexia nervosa and bulimia nervosa, and expecting that eating reduces negative affect increases risk for binge eating (Hohlstein et al., 1998).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hohlstein et al., 1998 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Several steps were taken to reduce overfitting in classification tree analysis, including minimum node sizes, complexity parameter, and cross-validation.

    “Several steps were taken to reduce overfitting, including setting the minimum size that a node cannot be further split (20), setting the minimum size for a terminal node (10), setting the threshold complexity parameter (0.01), and using cross-validation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The previous report confirmed that this sample had elevated body dissatisfaction relative to a representative community sample.

    “The previous report also confirmed that this sample had elevated body dissatisfaction relative to a representative community sample (Stice et al., 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Stice et al., 2017

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Although random forest did not identify any one predictor as most important for PD, boosting suggested negative affect as the most important variable, consistent with evidence that it emerged twice in the tree.

    “Although the random forest did not identify any one predictor as most important, boosting suggested that negative affect as the most important variable, consistent with the evidence that it emerged twice in this tree.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The PD tree findings corroborate that additional branching is associated with negative affect but a single branching for dieting.

    “This corroborates the findings in the PD tree that shows additional branching associated with negative affect but a single branching for dieting.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Lower thin-ideal internalization mitigates the risk conveyed by the combination of overeating, body dissatisfaction, and dieting, reducing the incidence of BED onset to 24%, versus 64% for individuals with higher thin-ideal internalization.

    “The final split suggested that lower thin-ideal internalization mitigates the risk conveyed by the combination of overeating, body dissatisfaction, and dieting, reducing the incidence of BED onset to 24%, versus the 64% observed for individuals with higher thin-ideal internalization.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Very high negative affect may serve as a protective factor against PD, potentially because anhedonia reduces appetite and caloric intake.

    “These results suggest that very high negative affect may serve as a protective factor, potentially because anhedonia reduces appetite and caloric intake.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Neither technique identified a single predictor as the most important for BED, suggesting multiple predictors of relatively equal importance for predicting BED.

    “However, neither technique identified a single predictor as the most important, suggesting multiple predictors of relative equal importance for predicting BED.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Dieting emerged as the most potent predictor of PD onset, replicating previous findings from an independent sample.

    “Dieting emerged as the most potent predictor of PD onset, replicating previous findings from an independent sample (Stice et al., 2011a)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Stice et al., 2011a

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationown data

    There is a non-linear relation between body dissatisfaction and BED onset.

    “Results might communicate that there is a non-linear relation between body dissatisfaction and BED onset.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    With regard to prediction of future AN onset, results suggested low BMI was the most potent predictor, and elevated body dissatisfaction amplified the predictive effects of low BMI.

    “With regard to the prediction of future AN onset, results suggested that a low BMI was the most potent predictor, and that elevated body dissatisfaction amplified the predictive effects of a low BMI”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The presence of high body dissatisfaction among low-weight young women may reflect extreme fat phobia that drives the caloric restriction that results in AN.

    “The presence of high body dissatisfaction among low-weight young women may reflect extreme fat phobia that drives the caloric restriction that results in AN.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Results provided evidence for a 3-way interaction between dieting, negative affect, and positive thinness expectances in predicting PD onset, which included a non-linear effect of negative affect.

    “In terms of predicting PD onset, results provided evidence for a 3-way interaction between dieting, negative affect, and positive thinness expectances, which included a non-linear effect of negative affect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The PD tree suggested that negative affect amplified the risk of high dieting, high positive thinness expectancies amplified the risk of high negative affect, but high negative affect paradoxically mitigated the risk of high positive thinness expectances.

    “Thus, this tree suggested that negative affect amplified the risk of high dieting, that high positive thinness expectancies amplified the risk of high negative affect, but that high negative affect paradoxically mitigated the risk of high positive thinness expectances.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    All three methods selected body dissatisfaction as important and two methods identified overeating and dieting as important for BED.

    “Thus, all three methods selected body dissatisfaction as important and two methods identified overeating and dieting as important.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Positive expectances regarding thinness further amplified risk for PD onset, with over 46% of those with a confluence of dieting, negative affect, and positive thinness expectances showing PD onset.

    “There was also evidence that positive expectances regarding thinness further amplified risk for PD onset, which is another novel finding, with over 46% of those with a confluence of these three risk factors showing PD onset.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The random forest and boosting identified several predictors with similar importance, suggesting multiple risk factors may play a role in predicting BN onset.

    “The random forest and boosting identified several predictors with similar importance suggesting that multiple risk factors may play a role in predicting BN onset.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Results dovetail with prior evidence that body dissatisfaction increases risk for BN.

    “Results dovetail with prior evidence that body dissatisfaction increases risk for BN (Killen et al., 1996)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Killen et al., 1996 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Results suggested a complex 4-way interaction between body dissatisfaction, overeating, dieting, and thin-ideal internalization in predicting BED onset, which included a non-linear effect for body dissatisfaction.

    “With regarding to BED, results suggested a complex 4-way interaction between body dissatisfaction, overeating, dieting, and thin-ideal internalization, which included a non-linear effect for body dissatisfaction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Elevated positive expectances regarding thinness and body dissatisfaction amplified the risk conveyed by overeating in the prediction of BN onset, resulting in an incidence of BN onset of 57%.

    “and that elevated positive expectances regarding thinness and body dissatisfaction amplified the risk convened by overeating in the prediction of BN onset, resulting in an incidence of BN onset of 57%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Results provided evidence of a complex 4-way interaction between overeating, positive expectations regarding thinness, body dissatisfaction, and thin-ideal internalization in predicting BN onset, which included a non-linear effect of positive thinness expectances.

    “In terms of the prediction of future BN onset, results provided evidence of a complex 4-way interaction between overeating, positive expectations regarding thinness, body dissatisfaction, and thin-ideal internalization, which included a non-linear effect of positive thinness expectances.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Elevated negative affect amplified the relation between elevated dieting and risk for PD onset, with over 27% of individuals with a confluence of these two risk factors showing PD onset.

    “Results suggested that elevated negative affect amplified the relation between elevated dieting and risk for PD onset, which is a novel finding, with over 27% of individuals with a confluence of these two risk factors showing PD onset.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Low dieting amplified the risk conveyed by the combination of elevated body dissatisfaction and overeating in predicting BED onset, resulting in a node in which 64% of participants showed BED onset.

    “Unexpectedly according to existing etiologic theories, results suggested that low dieting amplified the risk conveyed by the combination of elevated body dissatisfaction and overeating, resulting in a node in which 64% of participants showed BED onset.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    All three methods suggested overeating was important and two methods identified body dissatisfaction and thin-ideal internalization as important for BN.

    “Therefore, all three methods suggested that overeating was important and two methods identified body dissatisfaction and thin-ideal internalization as important.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Findings suggest that body dissatisfaction increases risk for future AN onset, though only for individuals with a low BMI.

    “Findings also suggest that body dissatisfaction increases risk for future AN onset, though it only did so for individuals with a low BMI.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The evidence of protective factors, such as high dieting and very high negative affect, is another novel contribution, though those applied to somewhat rare high-risk subgroups.

    “Further, the evidence of protective factors, such as high dieting and very high negative affect is another novel contribution, though those applied to somewhat rare high-risk subgroups”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationown data

    The evidence of amplifying interactions between risk factors is a unique contribution to the literature and suggests that it might be prudent for etiologic theories to incorporate a cumulative risk factor process.

    “The evidence of amplifying interactions between risk factors is a unique contribution to the literature and suggests that it might be prudent for etiologic theories to incorporate a cumulative risk factor process.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    Prospective data are useful for establishing temporal precedence between risk factors and subsequent onset of the pathological condition, but prospective data do not permit causal inferences.

    “Fourth, although prospective data are useful for establishing the temporal precedence between the risk factors and subsequent onset of the pathological condition, prospective data does not permit causal inferences.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The risk factors for each of the examined eating disorders were distinct, which implies that etiologic processes for these disorders might be qualitatively distinct.

    “More generally, the fact that the risk factors for each of the examined eating disorders were distinct is a third novel contribution, which implies that etiologic processes for these disorders might be qualitatively distinct.”
    Quote in the paperSubstantial claim
57 of 57

  • The authors state this as an assumption.

    The measures showed similar internal consistency across the three samples.

    “We also examined the assumption that the measures showed similar internal consistency across the three samples.”
    “These data suggest that the measures showed similar internal reliability across the three samples.”

  • The paper relies on this without support.

    The measures are sufficiently comparable across the three trials to combine into a single sample.

    “We combined data from one efficacy trial (Trial 1; Stice, Marti, Spoor, Presnell, & Shaw, 2008b) and two effectiveness trials (Trial 2; Stice, Rohde, Shaw, & Gau, 2011b; Trial 3; Stice, Rohde, Butryn, Shaw, & Marti, 2015) that used parallel recruitment and assessment procedures, resulting in a sample of 1,272 participants (M age = 18.5, SD = 4.2).”
    “We attempted to conduct more formal tests of factorial invariance across the samples, but preliminary analyses suggested that some scales did not show unidimensionality, resulting in poor model fits for the configural models.”

  • The paper relies on this without support.

    Ethnicity/race and parental education do not predict future onset of eating disorders and variation in these factors did not bias the predictive effects.

    “Given that ethnicity/race and parental education have not been found to predict future onset of eating disorders and showed only small correlations with the risk factors in the combined sample (M r = .02; largest r = .20, which was between age and thin-ideal internalization), it is unlikely that variation in these demographic factors biased the predictive effects.”

  • The paper relies on this without support.

    Combining the three trials provided sufficient power to predict onset of each eating disorder.

    “Data from three prevention trials that targeted young women at high risk for eating disorders due to body dissatisfaction (N=1271; M age 18.5, SD 4.2) and collected diagnostic interview data over 3-year follow-up were combined to permit sufficient power to predict onset of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) using classification tree”

  • The authors state this as an assumption.

    The observed effects will replicate in future high-risk studies.

    “Assuming these effects replicate”
    “Assuming effect replicate in a future high-risk studies”
    “Again assuming these findings replicate”

  • The paper relies on this without support.

    Even the most promising eating disorder prevention programs at best produce a 60% reduction in future eating disorder onset over multiple-year follow-up periods.

    “This is critical because even the most promising eating disorder prevention programs at best produced a 60% reduction in future eating disorder onset over multiple-year follow-up periods”

  • The paper relies on this without support.

    The high-risk sample by virtue of body dissatisfaction permitted sufficient sensitivity to address the novel research question.

    “using data from a unique large sample of individuals at elevated risk for future onset of eating disorders by virtue of body dissatisfaction that permitted sufficient sensitivity to address this novel research question.”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Combined sample size differs between abstract and Methods

    Minor

    The abstract reports 1,271 participants, whereas the Methods section reports 1,272 for the combined sample.

  • Discussion reverses the reported AN boosting ranking

    Minor

    The AN Results section says boosting ranked dieting above body dissatisfaction relative to BMI. The Discussion instead describes body dissatisfaction as preceding dieting in the supporting analyses.

  • BED boosting results name different leading predictors

    Minor

    The Results section names dieting among the most important BED predictors identified by boosting; the Discussion substitutes mental health care in its account of the same analysis.

3 of 3

Cites

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1 of the 55 references couldn’t be matched to a known paper.

Cited by

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Related

Authors
Stice, E., & Desjardins, C. D.
Affiliations
Oregon Research Institute (US)
Corresponding author
Stice, Eric
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2018-06
Volume
105
Pages
52-62
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2018.03.005
PMC
PMC5929474
OpenAlex
W2801839764
Cited by
98
References
55
Citations by year
2026: 4 · 2025: 16 · 2024: 20 · 2023: 11 · 2022: 17 · 2021: 11 · 2020: 6 · 2019: 10 · 2018: 2 · 2017: 1
FWCI
8.50
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
NIH (MH/DK061957, MH070699, MH086582)
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
eating disorders, anorexia nervosa, bulimia nervosa, binge eating disorder, purging disorder, risk factor interactions, body dissatisfaction, thin-ideal internalization, overeating, dieting, low body mass index, negative affect, eating disorder prevention, classification trees
MeSH terms
Adolescent, Adult, Feeding and Eating Disorders, Body Image, Feeding Behavior, Female, Humans, Predictive Value of Tests, Risk Factors, Self Concept, Body Mass Index, Young Adult

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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