Eating disorder prevention programs: A meta-analytic review.

“Indeed, targeted prevention programs for high risk individuals (also termed secondary prevention), addressing these risk factors, and often adopting therapy components utilized in women with eating disorders, have been administered, with documented short term success to date ( Piran, 2005 ; Stice & Shaw, 2004 ).”

“Andres De Los Reyes and Alan E. Kazdin have identified effects of specific treatment techniques by averaging effects multiple times—not only within studies but also between studies of the same or similar techniques (e.g., Matt, 1989; Stice & Shaw, 2004).”

“Stice and Shaw (2004) conducted a meta-analytic review of ED prevention programmes and discovered that all programmes that reduced current or future ED symptoms used interactive as opposed to didactic approaches.”

“The factors that we identified are those typically recognized as relating to disordered eating.(4) However, the major influence of mood and self-esteem was unexpected.”

“Many extant ED prevention programs (i.e., media education, cognitive dissonance-based educational approach) focus on lowering levels of BD and factors closely associated with BD such as internalization of body shape ideal (Stice & Shaw, 2004).”

“Although previous reviews were discouraging about the potential for preventing eating disorders (Austin, 2000; Pratt & Woolfenden, 2002), the meta-analysis of the available data by Stice and Shaw (2004) has demonstrated aspects of prevention programs that are associated with improved efficacy.”

“This unique aspect of the Student Body program, over and above what existing prevention curricula offer, could lead to better outcomes than previously reported in the prevention literature ( Stice & Shaw, 2004 ).”

“For example, Stice and Shaw (2004) provided meta ‐ analytic evidence on the use of a proximal approach called dissonance ‐ based interventions (DBI) which encourage individuals to adopt a way of thinking that contradicts their current way of thinking (e.g., challenging social constructions of “…”

“Large groups enable programs to be more readily delivered by external psychologists (due to reduced costs) rather than teachers which is an important advantage given that research suggests that compared to teacher-led programs, psychologist facilitated programs have better outcomes [59, 61].”

“While some research indicates that these interventions are effective at reducing eating disorders and related variables such as body dissatisfaction, other research indicates that these interventions are not effective ( Stice & Shaw, 2004 ).”

“Targeted interventions have been shown to be more effective than universal interventions across several domains, including programs designed to prevent eating disorders (Stice & Shaw, 2004), obesity (Stice, Shaw, & Marti, 2006), and depression (Stice, Shaw, Bohon, Marti, & Rohde, 2009).”

“This finding suggests that it might be beneficial to identify women evidencing high thin-ideal internalization and design prevention efforts specifically for them because previous studies indicate that eating disorder prevention is more successful when it is targeted (Stice & Shaw, 2004).”

“We drew upon the content of the Clarke program as a starting point, as well as our experience with the design of eating disorder prevention programs (35).”

“…findings will have the potential to inform prevention of binge eating and BN. Prevention programs have begun to target women at high risk for eating disorders by selecting those who exhibit high levels of body image disturbances and/or dietary restraint (Chase & Cullen, 2001; Stice & Shaw, 2004).”

“Interactive techniques such as writing, discussion, and homework were employed because intervention effects have been found to be greater when prevention programs are interactive rather than didactic ( Stice and Shaw 2004 ).”

“Based on a power analysis using a small effect size (i.e., Cohen’s d = .2) and power of .80, a total sample size of 966 (i.e., 322 per condition) would have been needed to detect significant changes (Cohen, 2003; Stice & Shaw, 2004).”

“This message has been used with efficacy in other women’s health areas such as disordered eating, which, like indoor tanning, can be viewed as an appearance-control behavior (Stice and Shaw 2004).”

“Body image programs have been designed mostly to reduce or prevent negative body image or eating disorders (e.g., Kater, Rohwer, & Londre, 2002; Stice & Shaw, 2004; Yager & O’Dea, 2008).”

“While prior reviews have found greater benefit when targeting females (Stice and Shaw 2004; Stice et al. 2007), and combined programming has only benefited boys (Yager et al.”

“In concert with research on prevention (e.g., Stice and Shaw 2004 ), findings suggest interventions targeting appearance pressure from interpersonal sources can help to reduce bulimic tendencies of Chinese adolescents.”

“Within this context it is important to note that although selected prevention programs often produce large effects, there is a risk of stigmatization (Stice & Shaw, 2004).”

“High levels of body dissatisfaction are then linked to eating pathology through two (dual) pathways: dieting or restrictive eating and increases in negative affect ( Attie & Brooks-Gunn, 1989 ; Leon, Fulkerson, Perry, & Early-Zald, 1995 ; Stice & Shaw, 2004 ).”

“We targeted middle adolescence because past research has demonstrated that adolescents over the age of 15, relative to younger adolescents and children, are more likely to show a positive response to programs aimed at preventing and decreasing body dissatisfaction (Stice & Shaw, 2004).”

“There are suggestions that programs utilising active prevention components may produce larger effects and many opportunities exist [39,42].”

“On the basis of a meta-analysis of 38 eating disorder prevention studies conducted in various populations (e.g., adolescents, college students), Stice and Shaw (2004) reported that 61% of prevention programs resulted in significant reductions in at least one risk factor, such as body…”

“…37, No. 3, August 2009, 327 336 ISSN 0306-9885 print/ISSN 1469-3534 online # 2009 Taylor & Francis DOI: 10.1080/03069880902957049 http://www.informaworld.com focused on the reduction of such overconcern with weight and shape aiming at a reduction of the incidence of ED (e.g. Stice & Shaw, 2004).”

“When researchers had used multiple measures of the drive or disordered eating, we observed the following guidelines, adapted from Stice and Shaw (2004): effect sizes were calculated for the scale that had the strongest construct validity.”

“Given these links, many eating disorder prevention programs target body dissatisfaction (Stice & Shaw, 2004).”

“Also, female HE&PE participants used more dieting methods and disordered eating behaviors (vomiting, laxative abuse, fasting, smoking for weight control, excessive exercise and slimming pills) than their non-HE&PE counterparts [5], and this is of concern because dieting is known to precede and predict eating disorders…”

“This primary prevention approach to eating disorders could complement nicely with the delivery of more targeted interventions for those students who have already been identified with eating disorder symptoms (Stice & Shaw, 2004).”

“Psychoeducational programs that are interactive and include cognitive interventions to affect maladaptive attitudes and behaviors have been shown to reduce symptoms and risk factors for psychological disorders (Stice & Shaw, 2004; Stice, Shaw, & Burton, 2006).”

“Second, it is important to acknowledge that participants were from a non-clinical population; individuals struggling with eating disorders would likely require a more invasive and interactive intervention than used in the present study (see Stice and Shaw 2004 ).”

“More recently, however, emphasis has been placed on understanding the risk factors for less severe body image and eating problems in order to prevent and intervene in the development of full syndrome disorders (Stice & Shaw, 2004).”

“Numerous papers document the progression of eating disorder prevention efforts (e.g., see Stice & Shaw, 2004, for a meta-analytic review).”

“Thus, its components were designed to modify some ED risk factors identified prospectively [11, 12] based on Bandura’s Social Cognitive model [13] and the Media Literacy perspective [14].”

“…of the measurement tools into question because the changes in female and male body image stereotypes in the media are not matched to newer psychometric analyses that can show whether the scales provide acceptable reliability and validity within the population to be studied (Stice & Shaw, 2004).”

“…the use of dietary changes and physical activity to manage weight (Shi et al., 2007), healthy weight management programs that emphasize each of these lifestyle factors (Stice & Shaw, 2004) may aid in ‘‘fine-tuning’’ knowledge and addressing risks for both adolescent eating disorders and obesity.”

“The intervention, GoG, was designed to be consistent with recommendations from previously conducted meta-analyses.(25,44) Figure 1.”

“Although the first wave of interventions designed to reduce body dissatisfaction and disordered eating was largely unsuccessful (for review, see Levine and Smolak 2010), over the past decade interventions have documented increasing success in improving adolescent girls’ body image (Stice and Shaw 2004).”

“Keywords: Eating disorders, E-health, prevention.”

“There are promising findings for the efficacy of eating disorder (ED) prevention programs (e.g., Shaw et al. 2009; Stice and Shaw 2004; Stice et al. 2007).”

“As boys in general bear a lower risk for developing eating disorders than girls (Stice and Shaw 2004) and girls tend to show more salience regarding disordered eating behavior (Warschburger 2009), the greater effects for girls are comprehensible.”

“Some prevention studies have reported clear beneficial effects, whereas others have not, and many of the studies on these prevention programs lack scientific rigor [125].”

“Stice and Shaw (2004) noted that many moderating factors can affect intervention outcomes such as participants’ condition, demographic variables, program format, content, number of sessions and measures used.”

“Universal interventions cater to all individuals (eg, healthy and high-risk), while selective interventions target only high-risk populations ( Stice & Shaw, 2004 ).”

“Moreover, although meta-analyses on other problems such as smoking and eating disorder suggested superior effects for longer interventions to very brief interventions (Rooney and Murray, 1996; Stice and Shaw, 2004), larger effects emerged for shorter than longer interventions in a meta-analysis for adolescent depressi…”

“Preventive approaches targeting these risk factors and early ED symptoms are effective in both reducing ED-related attitudes and symptoms (Stice and Shaw, 2004; Stice et al., 2007) and the onset of ED syndromes (Taylor et al.”

“Two well-known meta-analyses (Stice and Shaw, 2004; Stice et al., 2007) have summarized the effects of over 80 international programs for the prevention of eating disorders.”

“ANCOVA is the recommended analysis for the inferential test of intervention effects [65].”

“Past research has shown that brief, one-time interventions are usually less effective than longer or multi-session interventions (Stice & Shaw, 2004).”

“BE is of specific concern because it has been associated with the development of obesity and is implicated in the development of eating disorders (Stice & Shaw, 2004).”

“First, for example, the NUT component, unlike the ML component, has a basically psychoeducational format, a format that has already shown itself to be of little effectiveness in producing lasting changes in eating attitudes and behaviors (Littleton & Ollendick, 2003; Stice & Shaw, 2004).”

“active groups focusing on risk factors that have been researched as predictors of eating disorders.(131) The effects of these programs offered to high-risk individuals have been shown to be more effective than universal programs offered to all available participants.”

“Finding significant ecreases in thin-ideal internalization is considered an important tep in the development of an eating disorder prevention program iven that successful programs often decrease attitudinal risk facors and promote healthy behaviors (Stice & Shaw, 2004).”

“…chosen for the current study as changes that occur during this stage of development are thought to be more enduring (Trzesniewski, Donnellan, & Robins, 2003), and once individuals enter adolescence their attitudes become more established and therefore more difficult to change (Stice & Shaw, 2004).”

“…seen as interactive, allowing participants to engage with the program content and complete exercises that enhance skill acquisition; and those that are multisession, encouraging participants to reflect on program content and receive advice on skill utilization between sessions (Stice & Shaw, 2004).”

“…EDs can be associated with lasting positive outcomes, even with relatively brief interventions (Becker, Bull, Schaumberg, Cauble, & Franco, 2008; Fairburn, Walsh, Agras, Wilson, & Stice, 2004; McVey, Gusella, Tweed, & Ferrari, 2008; Stice, Marti, Spoor, Presnell, & Shaw, 2008; Stice & Shaw, 2004).”

“Beyond assessment, cognitive interactive interventions which acknowledge and confront the U.S. standard of female beauty and teach attitudinal change (Stice & Shaw, 2004) are also warranted for Mexican American women.”

“There have been a multitude of approaches to the prevention of eating disorders, yet successful prevention has proven both demanding and controversial ( Stice & Shaw, 2004 ).”

“Stice and Shaw (2004) defend the position that selective interventions carried out with adolescents as early as 15 years of age and aimed at specific risk groups can produce significantly more pronounced and lasting effects than those of universal interventions.”