Reducing eating disorder onset in a very high risk sample with significant comorbid depression: A randomized controlled trial.
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OBJECTIVE: Eating disorders (EDs) are serious problems among college-age women and may be preventable. An indicated online eating disorder (ED) intervention, designed to reduce ED and comorbid pathology, was evaluated. METHOD: 206 women (M age = 20 ± 1.8 years; 51% White/Caucasian, 11% African American, 10% Hispanic, 21% Asian/Asian American, 7% other) at very high risk for ED onset (i.e., with high weight/shape concerns plus a history of being teased, current or lifetime depression, and/or nonclinical levels of compensatory behaviors) were randomized to a 10-week, Internet-based, cognitive-behavioral intervention or waitlist control. Assessments included the Eating Disorder Examination (EDE, to assess ED onset), EDE-Questionnaire, Structured Clinical Interview for DSM Disorders, and Beck Depression Inventory-II. RESULTS: ED attitudes and behaviors improved more in the intervention than control group (p = .02, d = 0.31); although ED onset rate was 27% lower, this difference was not significant (p = .28, NNT = 15). In the subgroup with highest shape concerns, ED onset rate was significantly lower in the intervention than control group (20% vs. 42%, p = .025, NNT = 5). For the 27 individuals with depression at baseline, depressive symptomatology improved more in the intervention than control group (p = .016, d = 0.96); although ED onset rate was lower in the intervention than control group, this difference was not significant (25% vs. 57%, NNT = 4). CONCLUSIONS: An inexpensive, easily disseminated intervention might reduce ED onset among those at highest risk. Low adoption rates need to be addressed in future research.
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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].”
All studies of indicated Internet-based eating disorder prevention programs used face-to-face assessments and two used external rewards (i.e., monetary compensation) which may prove difficult to implement in real-world settings.
“In addition, all studies used face-to-face assessments and two used external rewards (i.e., monetary compensation) [27, 29] which may prove difficult to implement in real-world settings.”
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].”
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.”
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”
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].”
In other studies with higher completion rates, participants were often provided with incentives for completing study assessments.
“in other studies with higher completion rates, participants were often provided with incentives for completing study assessments [27, 29]”
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The Female Athlete Body (FAB) study: Rationale, design, and baseline characteristics
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Self-citationThe Transition to College as a Risk Factor for Eating Disorders
Laboe, A. A., Shah, J., & Fitzsimmons‐Craft, E. E. (2023) · Springer eBooks · doi:10.1007/978-3-030-97416-9_27-1 · Cited by 6 · see citing works
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KNOWLEDGE AND PREVALENCE OF EATING DISORDER AMONG NURSING STUDENTS OF LALITPUR, NEPAL
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Selbsthilfe in der Behandlung von Essstörungen
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Self-citationPrevention of eating disorders: recent advances
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Characteristics of Anorexia Prevention Programmes. A Systematic Review
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The Transition to College as a Risk Factor for Eating Disorders
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User‐Centered Development of a Chatbot for Diverse Adolescents at High Risk for Eating Disorders
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Self-citationAcute, Longer-Term, and Transdiagnostic Outcomes After Digital Interventions for Eating Disorders
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Eating disorder risk identification through embedded electronic medical record prompting
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The Personal Relevance of Psychotherapy for Asian Americans
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- Authors
- Taylor, C. B., Kass, A. E., Trockel, M., Cunning, D., Weisman, H., Bailey, J., Sinton, M., Aspen, V., Schecthman, K., Jacobi, C., & Wilfley, D. E.
- Affiliations
- Stanford Medicine (US)
- Washington University in St. Louis (US)
- University of California, Santa Barbara (US)
- William & Mary (US)
- Technische Universität Dresden (DE)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2016-05
- Volume
- 84
- Issue
- 5
- Pages
- 402-414
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC4836995
- OpenAlex
- W2335806301
- Cited by
- 70
- References
- 47
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 3 · 2023: 9 · 2022: 8 · 2021: 9 · 2020: 7 · 2019: 8 · 2018: 9 · 2017: 8 · 2016: 2
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- W&M Publish (College of William & Mary) (submittedVersion)
- Funders
- National Institutes of Health (R01 MH081125, K24 MH070446, T32 HL007456, and T32 HS000078)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- eating disorder prevention, eating disorder onset, comorbid depression, female university students, weight and shape concerns, teasing, compensatory behavior, online intervention, vulnerable populations
- MeSH terms
- Adult, Feeding and Eating Disorders, Depression, Depressive Disorder, Female, Humans, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk, Waiting Lists, Comorbidity, Cognitive Behavioral Therapy, Internet, Overweight
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