Research Review: Effectiveness of universal eating disorder prevention interventions in improving body image among children: a systematic review and meta‐analysis

Abstract

Background: Increasingly, children are at risk of developing eating disorders. A systematic review and a metaanalysis were conducted to examine the effectiveness of universal eating disorder prevention interventions in improving body image, internalization of appearance ideals, and self-esteem among children aged 5-17 years old. Methods: Nine electronic databases were systematically searched from each database's point of inception to March 2019. The Cochrane Risk of Bias tool assessed each study's risk of bias, while the GRADE approach judged the overall evidence for each review outcome. A meta-analysis was conducted using the random-effect model to obtain standardized mean differences with 95% confidence intervals under the inverse variance method. Heterogeneity was assessed using I 2 statistic and Cochran's Q chi-squared test. Publication bias was assessed using funnel plots. Results: A total of 24 studies (22 trials) were included in this review. Universal interventions were found to be effective in improving children's body esteem, self-esteem, and internalization of appearance ideals at postintervention and at follow-up timepoints. Subgroup analyses found that girls benefited more from these interventions than boys. Multisessional interventions with an optimal duration of approximately one month were found to be more effective. Conclusions: The findings encourage the incorporation of universal preventive interventions into school curricula to benefit most children. Laypeople such as teachers can deliver these interventions, but content experts should address topics on body dissatisfaction. Due to the low quality of evidence, as accorded by the GRADE approach, current findings should be validated by future research.Children are at risk of developing eating disorders. Available supportive interventions have not been evaluated objectively for their effectiveness. Universal eating disorder prevention interventions improve body esteem, internalization of appearance ideals, and self-esteem.Girls are more susceptible to poor body image and might benefit from more intensive interventions compared to boys.Interventions need to be multisessional with longer durations. Future universal eating disorder prevention interventions need to include gender-specific topics that are delivered to separate genders.

Body talk in the digital age: A controlled evaluation of a classroom-based intervention to reduce appearance commentary and improve body image

“…Multiple interventions exist for improving adolescent body image and reducing eating disorder risk ( Chua et al, 2020 ; Lewis-Smith et al, 2019 ; Yager et al, 2013 ). These interventions are typically delivered in schools, since the classroom allows for inclusive and cost-effective delivery ( Chua et al, 2020 ; Yager et al, 2013 ).…”

“…Multiple interventions exist for improving adolescent body image and reducing eating disorder risk ( Chua et al, 2020 ; Lewis-Smith et al, 2019 ; Yager et al, 2013 ). These interventions are typically delivered in schools, since the classroom allows for inclusive and cost-effective delivery ( Chua et al, 2020 ; Yager et al, 2013 ). Effective interventions typically aim to foster cognitive dissonance and/or critical literacy through the verbalising of critiques of sociocultural appearance pressures and the rehearsal of strategies to protect the self from these pressures ( Lewis-Smith et al, 2019 ).…”

“…In controlled trials, interventions utilising these approaches have demonstrated effectiveness in improving some, but not all, measured dimensions of body image, body image risk (e.g. internalisation of appearance ideals) and disordered eating among adolescents ( Chua et al, 2020 ; Lewis-Smith et al, 2019 ; Yager et al, 2013 ).…”

“…A second issue with existing interventions is duration. Reviews and meta-analyses have consistently shown that multiple session interventions are most effective in improving adolescents’ body image ( Chua et al, 2020 ; Lewis-Smith et al, 2019 ; Yager et al, 2013 ). However, current educational policies have marginalised aspects of health education and allow little school-time for their delivery ( Tancred et al, 2017 ), meaning there may be practical reasons for preferring single-session interventions.…”

Disordered eating, body image concerns, and weight control behaviors in primary school aged children: A systematic review and meta‐analysis of universal–selective prevention interventions

“…This may be due to the limited number of studies (n = 13) and uncontrolled designs included in the review. More recently, a meta-analytic review (n = 24 studies) of universal prevention programs only in a broad range of ages from 5 to 17 years found these programs to be effective in improving body esteem, self-esteem, and internalization of appearance ideals in children and adolescents (Chua, Tam, & Shorey, 2020). However, this previous review synthesized data for both children and adolescents and included only interventions specifically delivered to children and adolescents, excluding other interventions such as those involving parents and teachers which may be more appropriate for younger groups.…”