Modification of eating attitudes and behavior in adolescent girls: A controlled study

Abstract

Objective The aim of this study was to evaluate the effectiveness of a school‐based eating disorder prevention program designed to reduce dietary restraint and concern about shape and weight among adolescent girls. Method A total of 474 girls aged 13–14 years received the program as part of their normal school curriculum. An assessment‐only control group included 386 pupils. Measures of eating disorder features, self‐esteem, and knowledge were administered before and after the intervention and at 6‐month follow‐up. Results Immediately following the intervention, there was a small reduction in dietary restraint and attitudes to shape and weight in the index group, whereas there was no change in the control group. This reduction was not maintained at 6‐month follow‐up although the dietary restraint scores of the index group remained lower than those of the control group. Discussion This prevention program achieved change in eating attitudes and behavior, although the change was modest in size and not sustained. Focusing on a high‐risk subgroup of dieters might be a more fruitful primary prevention strategy. © 2001 by John Wiley & Sons, Inc. Int J Eat Disord 29: 107‐118, 2001.

Depression as a moderator of benefit from Media Smart: A school-based eating disorder prevention program

“…Rather they can experience significant improvements in a universal setting, avoiding problems of: stigmatization (Franko, 2001); impracticalities of having some students miss regular lesson time (Wilksch & Wade, 2009b); and, the difficulties associated with accurate identification of all high-risk students given how prevalent disturbed eating attitudes and behaviours are in adolescent populations. More broadly, these findings reinforce our previous conclusions of the program having a long-term benefit (Wilksch & Wade, 2009a) and are more promising than other studies where benefits have not been maintained over much shorter follow-up periods (Weiss & Wertheim, 2005) or where very limited benefits have been found (Stewart, Carter, Drinkwater, Hainsworth, & Fairburn, 2001). …”

Depression as a moderator of benefit from Media Smart: A school-based eating disorder prevention program

“…Rather they can experience significant improvements in a universal setting, avoiding problems of: stigmatization (Franko, 2001); impracticalities of having some students miss regular lesson time (Wilksch & Wade, 2009b); and, the difficulties associated with accurate identification of all high-risk students given how prevalent disturbed eating attitudes and behaviours are in adolescent populations. More broadly, these findings reinforce our previous conclusions of the program having a long-term benefit (Wilksch & Wade, 2009a) and are more promising than other studies where benefits have not been maintained over much shorter follow-up periods (Weiss & Wertheim, 2005) or where very limited benefits have been found (Stewart, Carter, Drinkwater, Hainsworth, & Fairburn, 2001). …”

The influence of a primary prevention program on eating‐related attitudes of Israeli female middle‐school students

“…Some authors argue that classroom discussions not only about clinical EDs per se, but also on topics associated with maladaptive eating and weight‐related conceptions, might increase the likelihood to develop an ED, whereas providing appropriate knowledge about nutrition, healthy dieting and exercising already at an early age might reduce the risk of developing disordered eating in adolescence (Smolak et al, 1998). However, our findings and those of others (Stewart et al, 2001) support the notion that provision of information about socio‐cultural influences on weight and shape ideals is not harmful (Cororve Fingeret et al, 2006), and that prevention programs should promote media literacy and skills to cope with these influences, along with increasing relevant knowledge. Indeed, at least some of these programs have positively affected eating‐related attitudes, and/or decreased unfavorable weight‐related influences of media and significant others (Dalle Grave et al, 2001; Neumark‐Sztainer et al, 1995b; O'Dea & Abraham, 2000; Phelps et al, 1999; Pokrajac‐Bulian et al, 2006; Smolak et al, 1998; Steiner‐Adair et al, 2002).…”

“…The literature concerning the long‐term attitudinal effects of eating‐related primary prevention programs in adolescent community samples is inconclusive (Cororve Fingeret, Warren, Cepeda‐Benito, & Gleaves, 2006). Whereas some studies (Dalle Grave et al, 2001; Pokrajac‐Bulian et al, 2006; Santonastaso et al, 1999; Steiner‐Adair et al, 2002), including ours, show attitudinal improvement that may last for 6–12 months, other studies (Killen et al, 1993; McVey et al, 2004; Neumark‐Sztainer et al, 1995b, 2000; O'Dea & Abraham, 2000; Stewart et al, 2001; Wade et al, 2003) have failed to show sustained change. Some studies have cautioned that eating‐related attitudes and behaviors might worsen following such interventions (Carter, Stewart, Dunn, & Fairburn, 1997), even though a careful review of eating prevention programs in randomized controlled trials has concluded that there is no sufficient evidence to suggest that harm has indeed resulted from any of the prevention programs reviewed (Pratt & Woolfenden, 2002).…”

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

“…Results provided support for the hypothesis that intervention effects of dissonance-based eating disorder prevention programs would be larger if implemented to body dissatisfied young women at high risk for eating disorders; this moderator affected three of the five outcomes (body dissatisfaction, negative affect, and eating disorder symptoms). Results converge with prior meta-analytic reviews that found that a broad array of eating disorder prevention programs produce larger effects when delivered to high-risk versus unselected participants and with evidence that several universal prevention programs were more effective for subgroups of high-risk participants than for the full sample (e.g., Buddeberg-Fischer, Klaghofer, Gnam, & Buddeberg, 1998;Stewart et al, 2001;Weiss & Wertheim, 2005). Collectively these data imply that the larger effects may occur because young women with body image concerns are more motivated to engage in the intervention, find the material more pertinent to their lives, and have more room for improvement because of their elevated risk.…”

Depression as a moderator of benefit from Media Smart: A school-based eating disorder prevention program

“…Rather they can experience significant improvements in a universal setting, avoiding problems of: stigmatization (Franko, 2001); impracticalities of having some students miss regular lesson time (Wilksch & Wade, 2009b); and, the difficulties associated with accurate identification of all high-risk students given how prevalent disturbed eating attitudes and behaviours are in adolescent populations. More broadly, these findings reinforce our previous conclusions of the program having a long-term benefit (Wilksch & Wade, 2009a) and are more promising than other studies where benefits have not been maintained over much shorter follow-up periods (Weiss & Wertheim, 2005) or where very limited benefits have been found (Stewart, Carter, Drinkwater, Hainsworth, & Fairburn, 2001). …”

The influence of a primary prevention program on eating‐related attitudes of Israeli female middle‐school students

“…Some authors argue that classroom discussions not only about clinical EDs per se, but also on topics associated with maladaptive eating and weight‐related conceptions, might increase the likelihood to develop an ED, whereas providing appropriate knowledge about nutrition, healthy dieting and exercising already at an early age might reduce the risk of developing disordered eating in adolescence (Smolak et al, 1998). However, our findings and those of others (Stewart et al, 2001) support the notion that provision of information about socio‐cultural influences on weight and shape ideals is not harmful (Cororve Fingeret et al, 2006), and that prevention programs should promote media literacy and skills to cope with these influences, along with increasing relevant knowledge. Indeed, at least some of these programs have positively affected eating‐related attitudes, and/or decreased unfavorable weight‐related influences of media and significant others (Dalle Grave et al, 2001; Neumark‐Sztainer et al, 1995b; O'Dea & Abraham, 2000; Phelps et al, 1999; Pokrajac‐Bulian et al, 2006; Smolak et al, 1998; Steiner‐Adair et al, 2002).…”

“…The literature concerning the long‐term attitudinal effects of eating‐related primary prevention programs in adolescent community samples is inconclusive (Cororve Fingeret, Warren, Cepeda‐Benito, & Gleaves, 2006). Whereas some studies (Dalle Grave et al, 2001; Pokrajac‐Bulian et al, 2006; Santonastaso et al, 1999; Steiner‐Adair et al, 2002), including ours, show attitudinal improvement that may last for 6–12 months, other studies (Killen et al, 1993; McVey et al, 2004; Neumark‐Sztainer et al, 1995b, 2000; O'Dea & Abraham, 2000; Stewart et al, 2001; Wade et al, 2003) have failed to show sustained change. Some studies have cautioned that eating‐related attitudes and behaviors might worsen following such interventions (Carter, Stewart, Dunn, & Fairburn, 1997), even though a careful review of eating prevention programs in randomized controlled trials has concluded that there is no sufficient evidence to suggest that harm has indeed resulted from any of the prevention programs reviewed (Pratt & Woolfenden, 2002).…”

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

“…Results provided support for the hypothesis that intervention effects of dissonance-based eating disorder prevention programs would be larger if implemented to body dissatisfied young women at high risk for eating disorders; this moderator affected three of the five outcomes (body dissatisfaction, negative affect, and eating disorder symptoms). Results converge with prior meta-analytic reviews that found that a broad array of eating disorder prevention programs produce larger effects when delivered to high-risk versus unselected participants and with evidence that several universal prevention programs were more effective for subgroups of high-risk participants than for the full sample (e.g., Buddeberg-Fischer, Klaghofer, Gnam, & Buddeberg, 1998;Stewart et al, 2001;Weiss & Wertheim, 2005). Collectively these data imply that the larger effects may occur because young women with body image concerns are more motivated to engage in the intervention, find the material more pertinent to their lives, and have more room for improvement because of their elevated risk.…”

Depression as a moderator of benefit from Media Smart: A school-based eating disorder prevention program

“…Rather they can experience significant improvements in a universal setting, avoiding problems of: stigmatization (Franko, 2001); impracticalities of having some students miss regular lesson time (Wilksch & Wade, 2009b); and, the difficulties associated with accurate identification of all high-risk students given how prevalent disturbed eating attitudes and behaviours are in adolescent populations. More broadly, these findings reinforce our previous conclusions of the program having a long-term benefit (Wilksch & Wade, 2009a) and are more promising than other studies where benefits have not been maintained over much shorter follow-up periods (Weiss & Wertheim, 2005) or where very limited benefits have been found (Stewart, Carter, Drinkwater, Hainsworth, & Fairburn, 2001). …”

The influence of a primary prevention program on eating‐related attitudes of Israeli female middle‐school students

“…Some authors argue that classroom discussions not only about clinical EDs per se, but also on topics associated with maladaptive eating and weight‐related conceptions, might increase the likelihood to develop an ED, whereas providing appropriate knowledge about nutrition, healthy dieting and exercising already at an early age might reduce the risk of developing disordered eating in adolescence (Smolak et al, 1998). However, our findings and those of others (Stewart et al, 2001) support the notion that provision of information about socio‐cultural influences on weight and shape ideals is not harmful (Cororve Fingeret et al, 2006), and that prevention programs should promote media literacy and skills to cope with these influences, along with increasing relevant knowledge. Indeed, at least some of these programs have positively affected eating‐related attitudes, and/or decreased unfavorable weight‐related influences of media and significant others (Dalle Grave et al, 2001; Neumark‐Sztainer et al, 1995b; O'Dea & Abraham, 2000; Phelps et al, 1999; Pokrajac‐Bulian et al, 2006; Smolak et al, 1998; Steiner‐Adair et al, 2002).…”

“…The literature concerning the long‐term attitudinal effects of eating‐related primary prevention programs in adolescent community samples is inconclusive (Cororve Fingeret, Warren, Cepeda‐Benito, & Gleaves, 2006). Whereas some studies (Dalle Grave et al, 2001; Pokrajac‐Bulian et al, 2006; Santonastaso et al, 1999; Steiner‐Adair et al, 2002), including ours, show attitudinal improvement that may last for 6–12 months, other studies (Killen et al, 1993; McVey et al, 2004; Neumark‐Sztainer et al, 1995b, 2000; O'Dea & Abraham, 2000; Stewart et al, 2001; Wade et al, 2003) have failed to show sustained change. Some studies have cautioned that eating‐related attitudes and behaviors might worsen following such interventions (Carter, Stewart, Dunn, & Fairburn, 1997), even though a careful review of eating prevention programs in randomized controlled trials has concluded that there is no sufficient evidence to suggest that harm has indeed resulted from any of the prevention programs reviewed (Pratt & Woolfenden, 2002).…”

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

“…Results provided support for the hypothesis that intervention effects of dissonance-based eating disorder prevention programs would be larger if implemented to body dissatisfied young women at high risk for eating disorders; this moderator affected three of the five outcomes (body dissatisfaction, negative affect, and eating disorder symptoms). Results converge with prior meta-analytic reviews that found that a broad array of eating disorder prevention programs produce larger effects when delivered to high-risk versus unselected participants and with evidence that several universal prevention programs were more effective for subgroups of high-risk participants than for the full sample (e.g., Buddeberg-Fischer, Klaghofer, Gnam, & Buddeberg, 1998;Stewart et al, 2001;Weiss & Wertheim, 2005). Collectively these data imply that the larger effects may occur because young women with body image concerns are more motivated to engage in the intervention, find the material more pertinent to their lives, and have more room for improvement because of their elevated risk.…”