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A study protocol for a preliminary randomised controlled trial assessing the acceptability and effectiveness of two eating disorders prevention interventions in Switzerland: The HEIDI BP-HW project.
Carrard, I, Bucher Della Torre, S
PloS one. 2021;(11):e0259796
Abstract
Because of the serious consequences of eating disorders on young women's lives and because of the lack of specialised care facilities, assessing and implementing evidence-based prevention interventions is necessary. Switzerland, like other Western countries, has high prevalence rates of eating disorders. However, no prevention interventions have been evaluated in this country so far. This paper presents the protocol of a preliminary study with the aim to evaluate the acceptability and effectiveness of two interventions, the Body Project (BP) and the Healthy Weight Program (HW), for female students from French-speaking Switzerland. These two interventions were chosen because they have been widely evaluated and they proved to be effective in various countries. They take place in groups and include four weekly sessions over one month. Because of the pandemic situation, the group sessions will take place online on an collaborative platform. The design is a three-arm randomised controlled study. Ninety female students aged 18-25 and presenting with at least moderate body dissatisfaction will be randomised into three groups: (1) one-month BP intervention, (2) one-month HW intervention, and (3) one-month waiting-list control group followed by the BP intervention. Assessments of body dissatisfaction, thin-ideal internalisation, dietary restraint, negative affect, and eating disorder psychopathology will be conducted before and after the interventions or waiting list and after a one-month follow-up. ANCOVA and ANOVA with repeated measures will be used to assess group differences and follow-up stability. Acceptability will be assessed with a questionnaire on participants' satisfaction with the interventions, group discussion at the end of the intervention, and with participants' rate of attendance to the group sessions. The study results will provide additional data on these two eating disorders prevention interventions and will suggest ways for their dissemination and further evaluation in Switzerland.
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Efficacy and acceptability of self-monitoring via a smartphone application versus traditional paper records in an intensive outpatient eating disorder treatment setting.
Keshen, A, Helson, T, Ali, S, Dixon, L, Tregarthen, J, Town, J
European eating disorders review : the journal of the Eating Disorders Association. 2020;(4):473-479
Abstract
OBJECTIVE Although self-monitoring is an important part of eating disorder treatment, non-adherence is commonly observed among patients asked to maintain paper food records. This study aims to compare the efficacy and acceptability of electronic self-monitoring via Recovery Record to self-monitoring via traditional paper records, in an intensive outpatient (IOP) eating disorder treatment for adults. METHOD Ninety patients were recruited from an IOP eating disorder clinic and randomly assigned to the experimental or control condition. Those in the control condition received the standard treatment delivered by the IOP programme, including the use of paper records for self-monitoring. Those in the experimental condition received the same treatment but used Recovery Record for self-monitoring. RESULTS The results did not demonstrate statistically significant group differences over time on eating disorder symptomatology, and there were no statistically significant group differences on acceptability or adherence. CONCLUSIONS Our pilot efficacy data do not support superiority of the app over paper records in an IOP setting, so proceeding to a larger efficacy trial is not warranted. Future studies should aim to determine whether the app is efficacious as an adjunct to less intensive treatment or to further explore adherence and acceptability outcomes in studies with larger sample sizes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02484794.
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Preventing eating disorders in young women: An RCT and mixed-methods evaluation of the peer-delivered Body Project.
Vanderkruik, R, Gist, D, Dimidjian, S
Journal of consulting and clinical psychology. 2020;(12):1105-1118
Abstract
OBJECTIVES Young women are at increased risk for eating disorders during adolescence (age range = 16-19), and there is the need for effective, sustainable prevention programs delivered during this critical window of development. The Body Project is a dissonance-based program that reduces key risk factors for disordered eating. Few studies have evaluated the program or the participant experience when peer-delivered at the high school level. The objective of this study was to evaluate using mixed-methods the Body Project program when peer-delivered among high school women. METHOD Three studies were conducted among young women in high school in the United States: (a) an open trial evaluation of a peer-delivered Body Project program (n = 112), (b) a pilot randomized controlled trial (RCT) comparing the Body Project with assessment-only control (n = 74), and (c) a qualitative investigation of participants' experiences (n = 131). RESULTS Open trial participants reported significant reductions in eating disorder risk factors and improvements in mood and self-attitude constructs over the intervention period (ds = .32-.77, ps < .01). Intervention effects for Body Project participants in the RCT compared with control were significant for body dissatisfaction, thin ideal internalization, dietary restraint, self-compassion, body surveillance, and loneliness (ds = .55-1.38, ps < .02). Thematic analyses of qualitative data highlight considerations for program delivery and engagement, including insights about why women join the program and perspectives on peer leaders. CONCLUSIONS Findings support the effectiveness of the peer-delivered Body Project with high school-aged women and highlight key recommendations for increasing engagement and strengthening prevention programs among young women. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Promoting a Healthy Lifestyle through Mindfulness in University Students: A Randomized Controlled Trial.
Soriano-Ayala, E, Amutio, A, Franco, C, Mañas, I
Nutrients. 2020;(8)
Abstract
The present study explored the effects of a second-generation mindfulness-based intervention known as flow meditation (Meditación-Fluir) in the improvement of healthy life behaviors. A sample of university students (n = 51) in Spain were randomly assigned to a seven-week mindfulness treatment or a waiting list control group. Results showed that compared to the control group, individuals in the mindfulness group demonstrated significant improvements across all outcome measures including healthy eating habits (balanced diet, intake rate, snacking between meals, decrease in consumption by negative emotional states, increased consumption by negative emotional states, amount of consumption, meal times, consumption of low-fat products), tobacco, alcohol, and cannabis consumption, and resting habits. There were differences between males and females in some of these variables and a better effect of the treatment was evident in the females of the experimental group when compared to the males. The flow meditation program shows promise for fostering a healthy lifestyle, thus decreasing behaviors related to maladaptive eating, tobacco, alcohol, and cannabis consumption as well as negative rest habits in university students. This mindfulness program could significantly contribute to the treatment of eating disorders and addictions, wherein negative emotional states and impulsivity are central features of the condition.
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Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample.
Kesby, A, Maguire, S, Vartanian, LR, Grisham, JR
Journal of behavior therapy and experimental psychiatry. 2019;:101492
Abstract
BACKGROUND AND OBJECTIVES Intolerance of uncertainty (IU) is a transdiagnostic process contributing to the maintenance of anxiety disorders, and is a potential target for treatment. Recent literature has investigated IU as a cognitive process underpinning pathological fear and anxiety in Anorexia Nervosa (AN). The current study was designed to examine trait and state IU, and their relationship to restrictive eating disorder symptoms, anxiety, worry, cognitive rigidity and eating behaviour. METHODS A sample of undergraduate women (N = 85) completed measures of eating disorder symptoms, IU, cognitive rigidity and worry. Participants were randomised to complete an eating task under one of two conditions: the "certain" condition received a high-calorie meal and nutritional information, while the "uncertain" condition received the meal alone. During the meal, state IU and state anxiety were examined at three time-points (baseline, pre-eating, post-eating). RESULTS Trait IU was correlated with cognitive rigidity, worry, global eating disorder symptoms, and, in particular, dietary restraint. No differences emerged between conditions with respect to eating-related anxiety, or amount of food eaten. Controlling for condition and eating disorder symptoms, state IU predicted pre-eating anxiety. Beyond the contribution of condition, BMI and eating disorder symptoms, state IU predicted consumption, specifically greater dietary restriction. LIMITATIONS The study employed a non-clinical sample. CONCLUSIONS IU may be implicated in a rigid cognitive style, the anxiety response to energy-dense food, and restrictive eating behaviour. Should these findings be replicated in a clinical sample, then IU might emerge as an adjunctive treatment target for AN.
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A controlled study of an integrated prevention program for improving disordered eating and body image among Mexican university students: A 3-month follow-up.
Castillo, I, Solano, S, Sepúlveda, AR
European eating disorders review : the journal of the Eating Disorders Association. 2019;(5):541-556
Abstract
Obesity and eating disorders are currently two significant health problems in Mexico. The aim of this study was to examine the effects of an integrated prevention program on university students through an exploratory controlled study that targeted specific predisposing factors of disordered eating and obesity related to healthy eating, physical activity, body image satisfaction and perceived pressure to be thin. A total of 388 university students participated (264 females and 124 males) and were assigned either to an intervention condition or one of the two control conditions (study skills vs. nonintervention); each comprised of a total of eight workshops lasting 90 min. The program did not have any effect on the male students. In contrast, there was an interaction effect for time and group in thin-ideal internalization (η2 = 0.04) and in disordered eating attitudes/behaviours (η2 = 0.03); both showed improvements over time only among the female sample. Though, the effect size was insignificant, which means that the effectiveness of this integrated prevention program was limited. Integrated prevention approaches to eating and weight-related problems are still nascent in Mexico, and further research in this field is warranted so as to fine tune future prevention programs.
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"Healthy Habits, Healthy Girls-Brazil": an obesity prevention program with added focus on eating disorders.
Leme, ACB, Philippi, ST, Thompson, D, Nicklas, T, Baranowski, T
Eating and weight disorders : EWD. 2019;(1):107-119
Abstract
PURPOSE To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized controlled trial for girls targeting shared risk factors for obesity and disordered eating. METHODS Total of 253 girls, mean of 15.6 (0.05) years from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. "Healthy Habits, Healthy Girls-Brazil (H3G-Brazil)", originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6 months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention prior to follow-up assessment. A conservative significance level was set at p < 0.01. RESULTS Beneficial effects were detected for PA social support (F = 6.005, p = 0.01), and healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731, p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy weight control behaviors (OR = 1.92, 95% CI 1.15-3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects were detected. CONCLUSION H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an intervention among low-income girls in Brazil. TRIAL REGISTRATION Level I: cluster randomized controlled trial.
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A Web-Based Intervention (MotivATE) to Increase Attendance at an Eating Disorder Service Assessment Appointment: Zelen Randomized Controlled Trial.
Denison-Day, J, Muir, S, Newell, C, Appleton, KM
Journal of medical Internet research. 2019;(2):e11874
Abstract
BACKGROUND Early assessment and treatment of eating disorder patients is important for patient outcomes. However, up to a third of people referred for treatment do not access services and 16.4% do not attend their first scheduled assessment appointment. MotivATE is a fully automated, novel, Web-based program intended to increase motivation to change eating disorder behaviors, designed for delivery at the point of invitation to an eating disorder service, with the aim of increasing service attendance. OBJECTIVE This paper assesses the impact of MotivATE on attendance at assessment when compared with treatment-as-usual. METHODS A Zelen randomized controlled design was used. All individuals referred to a specialist eating disorder service, Kimmeridge Court in Dorset, UK, over the course of a year (October 24, 2016-October 23, 2017) were randomized to treatment-as-usual only or treatment-as-usual plus an additional letter offering access to MotivATE. Attendance at the initial scheduled assessment appointment was documented. Logistic regression analysis assessed the impact of MotivATE on attendance at assessment. Additional analyses based on levels of engagement with MotivATE were also undertaken. RESULTS A total of 313 participants took part: 156 (49.8%) were randomized to treatment-as-usual and 157 (50.2%) were randomized to receive the additional offer to access MotivATE. Intention-to-treat analysis between conditions showed no impact of MotivATE on attendance at assessment (odds ratio [OR] 1.35, 95% CI 0.69-2.66, P=.38). Examination of the usage data indicated that only 53 of 157 participants (33.8%) in the MotivATE condition registered with the Web-based intervention. An analysis comparing those that registered with the intervention with those that did not found greater attendance at assessment in those that had registered (OR 9.46, 95% CI 1.22-73.38, P=.03). CONCLUSIONS Our primary analyses suggest no impact of MotivATE on attendance at the first scheduled assessment appointment, but secondary analyses revealed limited engagement with the program and improved attendance in those who did engage. It is unclear, however, if engagement with the program increased motivation and, in turn, attendance or if more motivated individuals were more likely to access the intervention. Further research is required to facilitate engagement with Web-based interventions and to understand the full value of MotivATE for users. TRIAL REGISTRATION ClinicalTrials.gov NCT02777944; https://clinicaltrials.gov/ct2/show/NCT02777944 (Archived by WebCite at http://www.webcitation.org/75VDEFZZ4).
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Remission of loss of control eating and changes in components of the metabolic syndrome.
Shank, LM, Tanofsky-Kraff, M, Radin, RM, Shomaker, LB, Wilfley, DE, Young, JF, Brady, S, Olsen, CH, Reynolds, JC, Yanovski, JA
The International journal of eating disorders. 2018;(6):565-573
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Abstract
OBJECTIVE Pediatric loss of control (LOC) eating prospectively predicts the worsening of metabolic syndrome components. However, it is unknown if remission of LOC eating is associated with improvements in metabolic health. Therefore, we conducted a secondary analysis of a trial that enrolled adolescent girls with LOC eating, examining whether LOC remission (vs. persistence) at end-of-treatment was associated with changes in metabolic syndrome components at 6-month follow-up. METHOD One hundred three adolescent girls (age 14.5 ± 1.7 years; BMI-z 1.5 ± 0.3; 56.3% non-Hispanic White, 24.3% non-Hispanic Black) with elevated weight (75th-97th BMI %ile) and reported LOC eating were assessed for metabolic syndrome components at baseline and again six months following the interventions. The main effects of LOC status at end-of-treatment (persistence vs. remission) on metabolic syndrome components (waist circumference, lipids, glucose, and blood pressure) at 6-month follow-up were examined, adjusting for baseline age, depressive symptoms, LOC frequency, fat mass, and height, as well as race, change in height, change in fat mass, and the baseline value of each respective component. RESULTS Youth with LOC remission at end-of-treatment had lower glucose (83.9 ± 6.4 vs. 86.5 ± 5.8 mg/dL; p = .02), higher high-density lipoprotein cholesterol (50.3 ± 11.8 vs. 44.8 ± 11.9 mg/dL; p = .01), and lower triglycerides (84.4 ± 46.2 vs. 96.9 ± 53.7 mg/dL; p = .02) at 6-month follow-up when compared with youth with persistent LOC, despite no baseline differences in these components. No other component significantly differed by LOC eating status (ps > .05). DISCUSSION Reducing LOC eating in adolescent girls may have a beneficial impact on some components of the metabolic syndrome.
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Physician Weight-Related Counseling Is Unrelated to Extreme Weight Loss Behaviors Among Overweight and Obese Adolescents.
Bravender, T, Lyna, P, Coffman, CJ, Bodner, ME, Østbye, T, Alexander, SC, Lin, PH, Pollak, KI
Clinical pediatrics. 2018;(8):954-957
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Abstract
Some physicians may be hesitant to counsel overweight and obese adolescents about weight because of concerns that such counseling may result in extreme weight loss behaviors and the subsequent development of eating disorders. We compared self-reported extreme weight loss behaviors in 535 overweight/obese adolescents prior to receiving weight-related counseling during primary care visits, and again after 3 months. We found no change in fasting (7.7% vs 6.3%, P = .45), and decreases in diet pill use (4.1% vs 1.7%, P = .003) and laxative use/vomiting (2.6% vs 1.0%, P = .02). Three months following their medical appointment, patients were also less likely to report trying to lose weight in general (80.0% vs 75.6%, P = .04). Physicians should be reassured that providing weight-related counseling to their obese adolescents is unlikely to induce extreme weight loss behaviors. Frequent counseling may be required in order to help patients maintain motivation to attain a healthy weight.