Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction

Resende, Thainá Richelli Oliveira; Almeida, Maurício; Alvarenga, Marle dos Santos; Brown, Tiffany A.; Carvalho, Paulo Victor Rodrigues de

doi:10.1007/s40519-021-01245-x

Cited by 9 publications

(11 citation statements)

References 56 publications

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“…Several of these effects extended through long follow-ups (up to 3-4 years; Stice et al, 2021). These effective results were confirmed in trials with significant medium/large effect size (d = .32-1.87: Almeida et al, 2021;García et al, 2010;Hudson et al, 2021;Resende et al, 2022; η 2 = .02-.19: Castillo et al, 2016;Rutsztein et al, 2019Rutsztein et al, , 2021Saucedo-Molina et al, 2018) included in this review that tested cognitive dissonance programs through short follow-ups (3-6 months), strongly suggesting that the ease of cultural adaptation of script content guarantees that dissonance elements are maintained even in other sociocultural contexts.…”

Section: Discussionmentioning

confidence: 76%

“…Trials that had significant effects ( d = .91–2.75) on measures of body image and/or ED risk factors were based on interactive programs with multiple sessions (de la Vega Morales & Gómez‐Peresmitré, 2012; Escoto Ponce de León et al, 2010; García & Gómez‐Peresmitré, 2006; García et al, 2010; Resende et al, 2022; Unikel‐Santoncini et al, 2019), meeting recommendations for the development of ED prevention programs (Stice et al, 2019). Regarding the content of the interventions, we highlight the frequent use of cognitive dissonance (García & Gómez‐Peresmitré, 2006; García et al, 2010; Resende et al, 2022; Unikel‐Santoncini et al, 2019). Dissonance‐based programs are based on group definitions of body ideals, discussions about the costs of pursuing this ideal, and behavioral exercises and challenges, including role plays (Stice et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…It is also recommended that prevention programs in Latin America place more emphasis on improving protective factors. Some trials showed that prevention programs can improve body appreciation (Almeida et al, 2021; Amaral et al, 2019; Hudson et al, 2021; Resende et al, 2022) and intuitive eating (Resende et al, 2022). It would also be optimal to use more robust designs (i.e., randomized controlled trials) and analysis (i.e., intent‐to‐treat analysis) and longer follow‐ups to produce more informative intervention effects (i.e., to demonstrate that program‐induced changes in risk factors ultimately contribute to a significant comparative reduction in ED onset).…”

Section: Discussionmentioning

confidence: 99%

“…Escoto Ponce de Le on et al, 2010;García & G omez-Peresmitré, 2006;García et al, 2010;Resende et al, 2022;Unikel-Santoncini et al, 2019), meeting recommendations for the development of ED prevention programs (Stice et al, 2019). Regarding the content of the interventions, we highlight the frequent use of cognitive dissonance (García & G omez-Peresmitré, 2006;García et al, 2010;Resende et al, 2022;Unikel-Santoncini et al, 2019). Dissonance-based programs are based on group definitions of body ideals, discussions about the costs of pursuing this ideal, and behavioral exercises and challenges, including role plays (Stice et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

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Eating disorders prevention programs in Latin American countries: A systematic review

Dunker

Carvalho

Amaral

2023

Intl J Eating Disorders

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Objective This systematic review evaluates and summarizes existing eating disorder (ED) prevention programs in Latin American countries. Methods A systematic literature search was conducted using the Cochrane Controlled Trial Register, PubMed, and Virtual Health Library databases up to and including July 31, 2022. All ED prevention studies published in English, Spanish or Portuguese were eligible, regardless of the study design, sample characteristics, and type of prevention programs. The Cochrane Collaboration Risk of Bias criteria were used to evaluate the quality of the included studies. Results Twenty‐two studies were included. Most were pilot studies that were nonrandomized, had a high risk of bias, were from Mexico and Brazil, and employed selective interventions. Dissonance‐based programs and social cognitive theory were the commonly used approaches in interventions, and most of them were tested in adolescent girls and women. Short follow‐ups were used, varying from 1 to 6 months. Many found significant decreases after the intervention and/or at follow‐up in ED/disordered eating risk behaviors/symptoms, negative affect, body‐ideal internalization, and body image disturbances. Conclusions This review highlights promising efforts to prevent EDs among Latin American countries. Some barriers in conducting research include funding restrictions, laws that do not allow remuneration or compensation for participants, and high costs of training. Nonetheless, the outcomes of the programs developed and evaluated so far are positive enough to merit further work on ED prevention. Efforts for future researchers should recruit samples with diverse characteristics, use robust designs and data analysis techniques, and expand the accessibility of prevention programs. Public Significance Statement The development of effective eating disorder (ED) prevention programs that can be broadly implemented is a public health priority. Nevertheless, there is limited evidence regarding the characteristics of ED prevention programs and their efficacy among Latin American countries. In the present study, we reviewed existing ED prevention programs adopted in Latin America, described their characteristics and outcomes, noted the limitations of available programs, and discussed the implications of these findings for efforts to prevent the development of EDs in Latin America. The outcomes of the programs developed and evaluated so far are positive enough to merit the development and rigorous evaluation of future programs and their broad dissemination in Latin American countries. PROSPERO registration number CRD42021275245.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Eating disorders prevention programs in Latin American countries: A systematic review

Dunker

Carvalho

Amaral

2023

Intl J Eating Disorders

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“…It is noteworthy that poor mental health has been associated with body image concerns in Latin American countries, including low self-esteem (Amaral and Ferreira, 2017 ; Bolívar-Suárez et al, 2021 ), depressive symptoms (Amaral and Ferreira, 2017 ; Delgado-Floody et al, 2021 ; León-Paucar et al, 2021 ), poor psychological well-being (Amaral and Ferreira, 2017 ; Lemes et al, 2018 ; Matias et al, 2020 ), mental health concerns (Pinheiro et al, 2007 ; Silva et al, 2011 ), and eating disorder symptoms (Compte et al, 2015 ; Amaral and Ferreira, 2017 ; de Carvalho et al, 2017 ; de Carvalho and Ferreira, 2020 ). Although effective interventions to decrease body image concerns have been developed for Latin Americans (Castillo et al, 2019 ; Almeida et al, 2021 ; Rutsztein et al, 2021 ; Resende et al, 2022 ), there is still a critical need to position body image as a priority in public mental health policies, and again several of these programs address body image as a risk factor within eating disorder prevention. This may be particularly challenging in Latin America countries, given difficulties faced in their operationalization, financing, and adaptation to sociocultural realities (Leiva-Peña et al, 2021 ).…”

Section: Empirical Evidence Across Countriesmentioning

confidence: 99%

Body image as a global mental health concern

Rodgers

Laveway

Campos

et al. 2023

Camb. prisms Glob. ment. health

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Body image concerns related to weight or other dimensions of appearance are now prevalent on a global scale. This paper reviews the theoretical frameworks that account for the global similarities and regional differences in rates and presentation of body image concerns, as well as reviewing the extant data. Given the harmful consequences of body image concerns in terms of mental and physical health, their global burden is high. Interventions to mitigate these concerns at the individual and systemic level are warranted.

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A meta‐analytic review of impact of measurement choice on RCTs to reduce appearance internalization

Mol

Thompson

Fuller‐Tyszkiewicz

2023

Intl J Eating Disorders

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ObjectivePrior reviews have shown that interventions targeting internalization of appearance standards are generally efficacious, though there is considerable heterogeneity in estimates across studies. This updated review of the literature evaluates whether efficacy estimates from RCTs systematically vary as a function of three related outcome measures (internalization, awareness, and perceived pressure regarding appearance standards).MethodsSeven electronic databases were systematically searched from inception to February 8, 2023. The Cochrane Risk of Bias tool assessed each study's risk of bias. Studies included were randomized‐controlled trials evaluating body image/eating disorder prevention or intervention programs targeting internalization as a focal point of treatment. Effect sizes were meta‐analyzed and meta‐regression analyses were conducted investigating the impact of outcome measure choice on study effect size at post‐intervention and follow‐up.ResultsThirty‐seven studies (N = 4809 participants) were included. The meta‐analytic findings as expected found interventions efficacious at reducing internalization post‐intervention (d = −0.47, 95% CI [−0.60 to −0.34], k = 44), and at follow‐up (d = −0.28, 95% CI [−0.39 to −0.17], k = 43), but also highly heterogenous (I2 = 52–67%). Operationalization of internalization moderated results at follow‐up but not post‐intervention timepoints, with awareness measures (compared with internalization measures) producing weaker effect sizes. Exploratory analyses found bigger effects when internalization was compared with all other measurement categories combined, suggesting possible issues with statistical power in main analyses.DiscussionMixed present findings suggest need for further evaluation of measurement effects on efficacy, and possible caution in choice of outcome measure for internalization‐based interventions.Public significance statementThis review provides some preliminary evidence that choice of survey measures used in randomized controlled trials can impact our judgments about whether a trial reduces the extent to which participants endorse unrealistic appearance standards. Accuracy in measurement of this efficacy of trials is crucial, given the role that internalized appearance standards play in onset and maintenance of eating disorders.

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Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction

Cited by 9 publications

References 56 publications

Eating disorders prevention programs in Latin American countries: A systematic review

Eating disorders prevention programs in Latin American countries: A systematic review

Body image as a global mental health concern

A meta‐analytic review of impact of measurement choice on RCTs to reduce appearance internalization

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