An Evaluation of an Internet-delivered Eating
Disorder Prevention Program for Adolescents and
JENNIFER BRUNING BROWN, J.D., Ph.D., ANDREW J. WINZELBERG, Ph.D.,
LIANA B. ABASCAL, M.A., AND C. BARR TAYLOR, M.D.
Purpose: To evaluate the effectiveness of Student Bod-
ies, an Internet-delivered eating disorder prevention pro-
gram for adolescents, and a supplemental program for
Methods: One hundred fifty-two 10th grade females
completing a health course at a private sectarian school,
and 69 of their parents were assigned to either the
Internet-delivered intervention group or to a comparison
group (students) or wait-list control group (parents).
Student participants completed subscales of the Eating
Disorder Inventory, Eating Disorder Examination-Ques-
tionnaire, and a content knowledge test. Parents com-
pleted the Parental Attitudes and Criticism Scale.
Results: The main effects of the intervention were
assessed pre- to post- and post- to follow-up using
ANCOVA, with the baseline assessment of the indepen-
dent variable as the covariate. Students using the pro-
gram reported significantly reduced eating restraint and
had significantly greater increases in knowledge than
did students in the comparison group. However, there
were no significant differences at follow-up. Parents
significantly decreased their overall critical attitudes to-
ward weight and shape.
Conclusion: The program demonstrates the feasibility
of providing an integrated program for students and
their parents with short-term positive changes in paren-
tal attitudes toward weight and shape. © Society for
Adolescent Medicine, 2004
Unhealthy dieting behaviors and dieting concerns
are common in children and adolescents. By middle
school, 20% to 50% of American girls say they feel
too fat , and 20% to 40% of girls feel overweight
and are trying to lose weight . In a recent large
sample, Field et al found that 32% of preadolescent
and adolescent girls were trying to lose weight
although less than 20% were overweight according
to their body mass index (BMI) scores .
Over-concern with weight and shape has been
shown to be a risk factor for the development of
eating disorders [4,5]. For example, 9th and 10th
grade girls (aged 13–16 years at baseline) were fol-
lowed for up to 3 years . Of those without sub-
clinical or clinical eating disorders at baseline but
with the highest weight concerns, approximately
10% developed partial- or full-syndrome eating dis-
orders in the course of follow-up. Those with low
weight concerns did not develop such disorders,
suggesting that weight and shape concerns may be
topics to address when trying to reduce a young
woman’s risk of developing eating disorders in the
future . Full-syndrome eating disorders affect 1%
From the Department of Psychiatry and Behavioral Sciences, Stan-
ford University, Stanford, California (J.B.B., A.J.W., C.B.T.); and Joint
Doctoral Program in Clinical Psychology, San Diego State University/
University of California, San Diego, San Diego, California (L.B.A.).
Address correspondence to: Dr. Andrew Winzelberg, Department of
Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry
Road, Stanford, CA, 94305-5722. E-mail: firstname.lastname@example.org
Manuscript accepted October 6, 2003.
JOURNAL OF ADOLESCENT HEALTH 2004;35:290–296
© Society for Adolescent Medicine, 20041054-139X/04/$–see front matter
doi:10.1016/j.jadohealth.2003.10.010Published by Elsevier Inc., 360 Park Avenue South, New York, NY 10010
goals of the program, they may have been hesitant to
admit to having critical attitudes toward their
Overall, this research supports the argument that
eating disorder prevention programs can be helpful,
while extending further the argument that preventa-
tive efforts should focus not only on individual
factors but should also be integrated into an individ-
ual’s cultural, environmental, and familial context. In
light of this, more comprehensive eating disorder
prevention programs are needed, coupled with re-
search approaches that examine the role of parents,
schools, and communities in decreasing disordered
eating attitudes and behaviors.
This is the first intervention that has attempted to
change students’ family environment. Future pro-
grams must continue to encourage students to resist
harmful messages, but they also must begin to help
actively create healthier norms within the school and
family environments. Prospective studies might use
the encouraging results from this study as a starting
point for integrating student and parent prevention
Grant support came from the McKnight Foundation (95-531) and
the National Institute of Mental Health (MH60453).
1. Koff E, Rierdan J. Perceptions of weight and attitudes toward
eating in early adolescent girls. J Adolesc Health 1991;12:307–
2. Smolak L, Levine MP. Toward an empirical basis for primary
prevention of eating problems with elementary school chil-
dren. Eat Disord J Treat Prev 1994;2:293–307.
3. Field AE, Camargo CA Jr, Taylor CB, et al. Overweight,
weight concerns, and bulimic behaviors among girls and boys.
J Am Acad Child Adolesc Psychiatry 1999;38:754–60.
4. Herzog DB, Hopkins JD, Burns CD. A follow-up study of 33
subdiagnostic eating disordered women. Int J Eat Disord
5. The McKnight Investigators. Risk factors for the onset of
eating disorders in adolescent girls: Results of the McKnight
Longitudinal Risk Factor Study. Am J Psychiatry 2003;160:
6. Killen J, Taylor CB, Hayward C, et al. Weight concerns
influence the development of eating disorders: A 4-year pro-
spective study. J Consult Clin Psychol 1996;64:936–40.
7. Taylor CB, Altman T. Priorities in prevention research for
eating disorders. Psychopharmacol Bull 1997;33:413–7.
8. Fairburn CG, Beglin SJ. Studies of the epidemiology of bulimia
nervosa. Am J Psychiatry 1990;147:401–8.
9. Drewnowski A, Yee D, Kurth C, Krahn D. Eating pathology
and DSM-III-R bulimia nervosa: A continuum of behavior.
Am J Psychiatry 1994;151:1217–9.
10. Centers for Disease Control and Prevention. Guidelines for
school health programs to promote lifelong healthy eating.
MMWR Recomm Rep 1996;45:1–41.
11. Neumark-Sztainer D, Story M. Dieting and binge eating
among adolescents: What do they really mean? J Am Diet
12. Levine MP, Smolak L, Hayden H. The relation of sociocultural
factors to eating attitudes and behaviors among middle school
girls. J Early Adolesc 1994;14:471–90.
13. Levine MP, Piran N. Reflections, conclusions, and future
directions. In: Piran N, Levine MP, Steiner-Adair C (eds).
Preventing Eating Disorders: A Handbook of Interventions
and Specific Challenges. New York, NY: Brunner/Mazel,
14. Franko DL. Rethinking prevention efforts in eating disorders.
Cogn Behav Pract 2001;8:265–70.
15. Smolak L, Levine MP, Schermer F. A controlled evaluation of
an elementary school primary prevention program for eating
problems. J Psychosom Res 1998;44:339–53.
16. Striegel-Moore RG, Kearney-Cooke A. Exploring parents’ at-
titudes and behaviors about their children’s physical appear-
ance. Int J Eat Disord 1994;15:377–85.
17. Pike KM, Rodin J. Mothers, daughters and disordered eating.
J Abnorm Psychol 1991;100:198–204.
18. Cohen DM. Family factors in the development of disordered
eating in young women. Diss Abstr Int 1996;57:2173.
19. Stice E, Agras WS, Hammer LD. Risk factors for the emergence
of childhood eating disturbances: A five-year prospective
study. Int J Eat Disord 1998;25:375–87.
20. Taylor CB, Altman T, Shisslak C, et al. Factors associated with
weight concerns in adolescents. Int J Eat Disord 1998;24:31–42.
21. Garner DM, Olmsted MP. Eating Disorder Inventory Manual.
New York, NY: Psychological Assessment Resources, 1984.
22. Fairburn CG, Beglin SJ. Assessment of Eating Disorders:
Interview or self-report questionnaire? Int J Eat Disord 1994;
23. Killen JD, Hayward C, Wilson DM, et al. Factors associated
with eating disorder symptoms in a community sample of 6th
and 7th grade girls. Int J Eat Disord 1994;15:357–67.
24. Cash TF. Body-Image Therapy: A Program for Self-Directed
Change. New York, NY: Guilford, 1991.
25. Davis R, Olmsted M. Cognitive-behavioral group treatment
for bulimia nervosa: Integrating psychoeducation and psycho-
therapy. In: Harper-Giuffre K, MacKenzie R (eds). Group
Psychotherapy for Eating Disorders, 1st edition. Washington,
DC: American Psychiatric Press, 1992:71–103.
26. Luce KH, Crowther JH. The reliability of the Eating Disorder
Examination-Self-Report Questionnaire Version (EDE-Q). Int J
Eat Disord 1999;25:349–51.
27. Shoemaker C, van Strien T, van der Staak C. Validation of the
eating disorders inventory in a nonclinical population using
transformed and untransformed responses. Int J Eat Disord
28. Celio AA, Winzelberg AJ, Wilfley D, et al. Reducing risk
factors for eating disorders: Comparison of an Internet- and a
classroom-delivered psychoeducational program. J Consult
Clin Psychol 2000;68:650–7.
29. Winzelberg AJ, Eppstien D, Eldredge KL, et al. Effectiveness
of an Internet-based program for reducing risk factors for
eating disorders. J Consult Clin Psychol 2000;68:346–50.
30. Springer EA, Winzelberg AJ, Perkins R, Taylor CB. Effects of a
body image curriculum for college students on improved
body image. Int J Eat Disord 1999;26:13–20.
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