Efficacy Trial of a Selective Prevention Program Targeting Both Eating Disorders and Obesity Among Female College Students: 1- and 2-Year Follow-Up Effects

Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 12/2012; 81(1). DOI: 10.1037/a0031235
Source: PubMed

ABSTRACT Objective: Evaluate the effects of a prevention program targeting both eating disorders and obesity at 1- and 2-year follow-ups. Method: Female college students at risk for these outcomes because of body image concerns (N = 398) were randomized to the Healthy Weight 2 group-based 4-hr prevention program, which promotes lasting healthy improvements to dietary intake and physical activity and nutrition science health behavior change principles, or an educational brochure control condition. Results: Intervention participants showed significantly less body dissatisfaction and eating disorder symptoms and lower eating disorder onset through 2-year follow-up versus controls, but the former 2 effects were small. There were no main effects for body mass index (BMI), depressive symptoms, dieting, caloric intake, physical activity, or obesity onset. Moderator analyses revealed stronger eating disorder symptom effects for youths with initially elevated symptoms and lower pressure to be thin, stronger BMI effects for youths with initially elevated symptoms and BMI scores, and weaker eating disorder symptom effects for youths with initially elevated pressure to be thin. Conclusions: The 60% reduction in eating disorder onset over the 2-year follow-up was clinically significant and a novel effect for a prevention program, but the main effects on continuous outcomes were small, suggesting that adding nutrition science principles weakened the intervention efficacy. Effects on both eating disorder symptoms and BMI were greater for those with elevated eating disorder symptoms and BMI at pretest, implying that it might be useful to target these individuals in future trials. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

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    ABSTRACT: Many athletes struggle with disordered eating or eating disorders (ED) as they attempt to conform to demands or competition regulations that might be ill-suited to their physique. In this situation, participation in sports may lead to an array of health concerns that may adversely affect the athlete’s short and long-term health at a variety of performance levels and sports. The peak onset of ED is adolescence, when most athletic participation and competition takes place and athletes begin to focus on a particularly sport. For athletes, the biological changes occurring during adolescence might affect not only attitudes toward weight and shape, but also performance. To prevent the medical and psychological consequences related to ED, early intervention and identification is important. Aims: The overall aim of this thesis was to examine the effect of a one-year school-based intervention program to prevent the development of new cases of ED and symptoms associated with ED among adolescent male and female elite athletes (Paper II). An educational program was developed for coaches and included as a separate part of the intervention program. In Paper III, we examine the effect of the education program on the coaches’ knowledge about nutrition, weight regulation, and ED. In Paper I, we investigate the prevalence of ED among adolescent elite athletes compared to non-athletic controls. Finally, we wanted to design and validate a brief screening questionnaire with the ability to discriminate between athletes with and without an ED (Paper IV). Methods: First-year students (athletes) and their coaches at all the Norwegian Elite Sport High Schools (n=16) and first-year students (controls) at two randomly selected regular high schools participated in the three school year project period (2008 to 2011). In phase I (pretest) of the study all the schools were included and the students were screened for symptoms associated with ED and ED. In phase II, the Elite Sport High Schools were stratified (by size) and randomized to the intervention (n=9) or control group (n=7). The intervention group received the intervention program. Data from the athletes and their coaches at phase I and II, and data from the controls at phase I are included in this thesis. Paper I: In this cross-sectional study we used a two-tiered approach: self-reported questionnaire (part I) and clinical interview (part II). The questionnaire, including the Eating Disorder Inventory 2 (EDI-2) and questions related to ED, was completed by 611 athletes (90%) and 355 controls (84%). Subjects reporting symptoms associated with ED were classified as “at risk” for ED. In part II, all at-risk athletes (n=153), a random sample not at risk for ED (n=153), and a random sample of 50% of the controls classified as at risk (n=91) and not at risk (n=88) were invited to the clinical interview (Eating Disorder Examination) to screen for ED. Paper II: The 611 athletes participating in Paper I formed the basis of this randomized controlled trial (RCT). After the pretest (Paper I) all athletes (and coaches, Paper III) from each school were randomized to the same treatment arm (intervention or control). A final sample of 465 (93.8%) athletes was followed during high school. The athletes completed the questionnaire screening at pretest (Paper I), pottest 1 (after the intervention) and posttest 2 (9-months after intervention). Clinical interviews were conducted after pretest and at posttest 2 (one-year after intervention). Paper III: In this part of the RCT 76 coaches (93.8%) employed at and working with the first-year students at the Elite Sport High Schools were followed during the project period. At pretest and posttest (9-months after intervention) the coaches completed a questionnaire including questions concerning nutrition, weight-regulation, and ED. Paper IV: We conducted this prospective cross-sectional study in three phases. Phase I consist of data from the screening at pretest among the female athletes (Paper I). Based on the questionnaire screening we extracted items with good predictive abilities for an ED-diagnosis to the Brief ED in Athletes Questionnaire (BEDA-Q) version 1 and version 2. Version 1 consisted of 7-items from the EDI-Body dissatisfaction, EDI-Drive for thinness, and questions regarding dieting. In version 2, two items from the EDI-Perfectionism subscale were added. In phase II, the external predictive validity of version 1 was tested involving 54 age-matched elite athletes from an external dataset. In phase III, the predictive ability of posttest assessments was determined among athletes with no ED at pretest (n=53, 100%). Main results: 1) No new cases of ED in athletes at the intervention schools one-year after the intervention program, while 13% of the females and one male at the control schools developed ED. 2) Coaches at the intervention schools had higher scores on total knowledge, weight-regulation and ED compared to coaches at the control schools after intervention. The intervention also showed positive effects on the coaches’ subjective evaluation of their ED knowledge. 3) Higher prevalence of ED in adolescent elite athletes than controls (although more controls than athletes reported symptoms associated with ED. 4) BEDA-Q version 2 showed higher discriminative accuracy than version 1 in distinguishing athletes with and without an ED, and higher diagnostic accuracy in predicting new cases of ED than version 1. Conclusions: A one-year school-based intervention program can prevent new cases of ED and symptoms associated with ED in adolescent female elite athletes. The intervention part targeting the coaches with strategies of identification, management and prevention of ED produced significant effect of at least 9-months. It is confirmed that the prevalence of ED is higher among adolescent elite athletes than controls and higher in female than male adolescent elite athletes. Finally, BEDA-Q containing 9-items reveal promising psychometric and predictive features to distinguish between adolescent female elite athletes with and without ED. Key words: athletes, coaches, eating disorders, prevalence, prevention, screening, instrument, intervention
    02/2015, Degree: PhD
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    ABSTRACT: This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations. Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review. Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10-19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures. Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low. Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have not often included mental health measures (n=7). It is recommended that future interventions incorporate mental health and well-being measures to identify any potential mechanisms influencing adolescent weight-related outcomes, and equally to ensure interventions are not causing harm to adolescent mental health. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 01/2015; 5(1):e006586. DOI:10.1136/bmjopen-2014-006586 · 2.06 Impact Factor
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    ABSTRACT: Evaluate a selective obesity prevention program promoting use of cognitive reappraisals to reduce reward region response and increase inhibitory region response to high-fat/high-sugar foods and reduce intake of fat and sugar to prevent blunted reward region response to intake of such foods.Subjects/Methods Young adults at risk for future weight gain by virtue of weight concerns (N = 148) were randomized to this new prevention program (Minding Health), an alternative prevention program promoting participant-driven gradual reductions in caloric intake and increases in physical activity (Healthy Weight), or an obesity education video control condition, completing assessments at pre-, post-, and 6-month follow-up. A subset of Minding Health and control participants completed an fMRI scan at pre- and post-assessing neural response to images of high-fat/sugar foods and to receipt and anticipated receipt of a high-fat/sugar food.ResultsMinding Health participants showed significantly greater reductions in body fat than controls and caloric intake from fat and sugar than Healthy Weight participants. Minding Health participants also showed greater activation of an inhibitory control region and reduced activation of an attention/expectation region in response to palatable food images relative to pretest and controls. However, Healthy Weight participants showed greater reductions in BMI and eating disorder symptoms than Minding Health participants.Conclusions Although the Minding Health intervention produced some of the hypothesized effects, it did not produce lasting reductions in body fat or BMI and showed limited effects on neural responsivity, implying it will be vital to increase the efficacy of this new prevention program.
    Physiology & Behavior 10/2014; DOI:10.1016/j.physbeh.2014.10.022 · 3.03 Impact Factor


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Dec 29, 2014