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Adolescent girls with body dissatisfaction (N = 481, SD = 1.4) were randomized to a dissonance-based thin-ideal internalization reduction program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Dissonance participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment and lower risk for eating pathology onset through 2- to 3-year follow-up than did assessment-only controls. Dissonance participants showed greater decreases in thin-ideal internalization, body dissatisfaction, and psychosocial impairment than did expressive writing controls. Healthy weight participants showed greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment; less increases in weight; and lower risk for eating pathology and obesity onset through 2- to 3-year follow-up than did assessment-only controls. Healthy weight participants showed greater decreases in thin-ideal internalization and weight than did expressive writing controls. Dissonance participants showed a 60% reduction in risk for eating pathology onset, and healthy weight participants showed a 61% reduction in risk for eating pathology onset and a 55% reduction in risk for obesity onset relative to assessment-only controls through 3-year follow-up, implying that the effects are clinically important and enduring.

This meta-analytic review summarizes obesity prevention programs and their effects and investigates participant, intervention, delivery, and design features associated with larger effects. A literature search identified 64 prevention programs seeking to produce weight gain prevention effects, of which 21% produced significant prevention effects that were typically pre to post effects. Larger effects emerged for programs targeting children and adolescents (versus preadolescents) and females, programs that were relatively brief, programs solely targeting weight control versus other health behaviors (e.g., smoking), programs evaluated in pilot trials, and programs wherein participants must self-select into the intervention. Other factors, including mandated improvements in diet and exercise, sedentary behavior reduction, delivery by trained interventionists, and parental involvement, were not associated with significantly larger effects. A Meta-Analytic Review of Obesity Prevention Programs for Children and Adolescents: The Skinny on Interventions that WorkObesity in adulthood results in an increased risk for future death from all causes, coronary heart disease, atherosclerotic cerebrovascular disease, and colorectal cancer, as well as serious medical problems, including hyperlipidemia, hypertension, gallbladder disease, and diabetes mellitus (Calle, Thun, Petrelli, Rodriguez, & Heath, 1999). Obesity in childhood and adolescence is also associated with serious medical problems, including high blood pressure, adverse lipoprotein profiles, diabetes mellitus, atherosclerotic cerebrovascular disease, coronary heart disease, colorectal cancer, and death from all causes, as well as lower educational attainment and poverty (Dietz, 1998). The prevalence of obesity has increased sharply over the last three decades; currently 65% of adults are classified as overweight or obese (Hedley et al., 2004). The prevalence of obesity has risen even more sharply among adolescents and young adults (Hedley et al., 2004), which is alarming because obesity persists into adulthood for 70% of obese adolescents (Magarey, Daniels, Boulton, & Cockington, 2003). Obesity also carries a high fiscal cost; roughly $100 billion per year is spent on obesityrelated health care (Wolf, 1998).Unfortunately, successful treatments for obesity have been elusive. For adults, the current treatment of choice only results in about a 10% reduction in body weight and virtually all patients regain this weight within a few years of treatment . Obesity treatments for children and adolescents have yielded similar effects, though behavioral familybased interventions have produced more persistent weight loss effects (Epstein, Valoski, Wing, Correspondence should be addressed to Eric Stice, who is currently at Oregon Research Institute, 1715 Franklin Blvd., Eugene, Oregon, 97403. Email: estice@ori.org. Eric Stice, Heather Shaw, Department of Psychology, University of Texas at Austin. C. Nathan Marti, Department of Educational Administration, University of Tex...

This meta-analytic review summarizes the effects of depression prevention programs for youth and investigates participant, intervention, provider, and research design features associated with larger effects. We identified 47 trials that evaluated 32 prevention programs, producing 60 intervention effect sizes. The average effect for depressive symptoms from pre-to-post (r = .15) and pre-to-followup (r = .11) were small, but 13 (41%) prevention programs produced significant reductions in depressive symptoms and 4 (13%) produced significant reductions in risk for future depressive disorder onset relative to control groups. Larger effects emerged for programs targeting high-risk individuals, samples with more females, samples with older adolescents, programs with a shorter duration and homework assignments, and programs delivered by professional interventionists. Intervention content (e.g., a focus on reducing negative cognitions or problem solving training) and design features (e.g., use of random assignment and structured interviews) were unrelated to effect sizes. Results suggest that depression prevention efforts would produce a higher yield if they incorporate factors associated with larger intervention effects (e.g., used selective programs with a shorter duration that include homework). Keywords depression prevention; adolescents; meta-analytic reviewCorrespondence should be addressed to Eric Stice, at Oregon Research Institute, 1715 Franklin Blvd., Eugene, Oregon, 97403. Email: estice@ori.org. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/ccp. NIH Public AccessAuthor Manuscript J Consult Clin Psychol. Author manuscript; available in PMC 2010 June 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMajor depression is one of the most common psychiatric problems faced by adolescents, is marked by a recurrent course and elevated psychiatric comorbidity, and increases risk for future suicide attempts, academic failure, interpersonal problems, unemployment, and legal problems (Klein, Torpey, & Bufferd, 2008). Thus, numerous researchers have designed and evaluated depression prevention programs. Most prevention programs have targeted factors that have been found to increase risk for future onset of depression or increases in depressive symptoms that have emerged from prospective studies, including negative cognitions, infrequent pleasant activities, social skill deficits, and problem solving skill deficits (e.g., Clarke et al., 1992;Hankin, Abramson, & Siler, 2001;Lewinsohn et al., 199...

In this trial adolescent girls with body dissatisfaction (N=481; M age=17) were randomized to an eating disorder prevention program involving dissonance-inducing activities that reduce thin-ideal internalization, a prevention program promoting healthy weight management, an expressive writing control condition, or an assessment-only control condition. Dissonance participants showed significantly greater reductions in eating disorder risk factors and bulimic symptoms than healthy weight, expressive writing, and assessment-only participants and healthy weight participants showed significantly greater reductions in risk factors and symptoms than expressive writing and assessmentonly participants from pretest to posttest. Although these effects faded over 6-month and 12-month follow-up, dissonance and healthy weight participants showed significantly lower binge eating and obesity onset and reduced service utilization through 12-month follow-up, suggesting both interventions have public health potential. Keywordsprevention; body dissatisfaction; dieting; negative affect; eating disorders; obesity Dissonance and Healthy Weight Eating Disorder Prevention Programs: A Randomized Efficacy TrialOne in ten adolescent females experience threshold or subthreshold bulimia nervosa (Lewinsohn, Streigel-Moore, & Seeley, 2000;Stice, Killen, Hayward, & Taylor, 1998). This disorder is characterized by a chronic course, medical complications, and functional impairment, and increases risk for future onset of obesity, depression, suicide attempts, anxiety disorders, substance abuse, and health problems (Johnson, Cohen, Kasen, & Brook, 2002;Stice, Cameron, Killen, Hayward, & Taylor, 1999;Wilson, Becker, & Heffernan, 2003). Unfortunately, less than 25% of individuals with this disorder receive treatment (Johnson et al., 2002) and only 30% of patients assigned to the treatment of choice show symptom remission that persists for at least 4-weeks (Agras, Walsh, Fairburn, Wilson, & Kraemer, 2000). Thus, much effort has been devoted to developing prevention programs for this eating disturbance. Although numerous programs have been evaluated in controlled trials, only a few have produced intervention effects for eating disorder symptoms. A meta-analysis found that only 6 of the 38 eating disorder prevention programs that have been evaluated produced reductions NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript in current or future symptoms that persisted over follow-up, which ranged from 1-24 months . Neumark-Sztainer, Butler, and Palti (1995) evaluated a 10-hour universal intervention, which was offered to all female students in participating schools, which presented information on healthy weight control behaviors, body image, eating disorders, causes of eating disorders, and social pressure resistance skills. It produced significant improvements in eating disorder symptoms at 1-month follow-up; in dieting and binge eating at 6-month follow-up; and in binge eating at 24-month follow-up relative to assessment-only...

This meta-analytic review found that 51% of eating disorder prevention programs reduced eating disorder risk factors and 29% reduced current or future eating pathology. Larger effects occurred for programs that were selected (versus universal), interactive (versus didactic), multisession (versus single session), solely offered to females (versus both sexes), offered to participants over 15 years of age (versus younger ones), and delivered by professional interventionists (versus endogenous providers). Programs with body acceptance and dissonance-induction content and without psychoeducational content and programs evaluated in trials using validated measures and a shorter follow-up period also produced larger effects. Results identify promising programs and delineate sample, format, and design features associated with larger effects, which may inform the design of more effective prevention programs in the future.

This meta-analysis of eating disorder prevention programs found that intervention effects ranged from an absence of any effects to reductions in current and future eating pathology. Certain effects persisted as long as 2 years and were superior to minimal-intervention control conditions. Larger effects occurred for selected (vs. universal), interactive (vs. didactic), and multisession (vs. single session) programs; for programs offered solely to females and to participants over age 15; for programs without psychoeducational content; and for trials that used validated measures. The results identify promising prevention programs and delineate sample, format, and design features that are associated with larger effects, but they suggest the need for improved methodological rigor and statistical modeling of trials and enhanced theoretical rationale for interventions.

Although investigators have postulated that the thin ideal for women espoused in the media is related to the high rates of eating disorders among females, little research has examined the relation between media exposure and eating pathology. This study assessed the relation of media exposure to eating disorder symptoms and tested whether gender-role endorsement, ideal-body stereotype internalization, and body satisfaction mediated this effect. In data from 238 female undergraduates, structural equation modeling revealed a direct effect of media exposure on eating disorder symptoms. Furthermore, mediational linkages were found for gender-role endorsement, ideal body stereotype internalization, and body satisfaction. The results support the assertion that internalization of sociocultural pressures mediate the adverse effects of the thin ideal.