The Impact of a Dissonance-Based Eating Disorders Intervention on Implicit Attitudes to Thinness in Women of Diverse Sexual Orientations

Abstract

Dissonance-based body image programs have shown long-term effectiveness in preventing eating disorders and reducing risk factors for eating disorders in women. Here we report on the potential for one such intervention to impact on implicit attitudes toward thinness as well as an explicit measure of eating attitudes, across a sexually diverse group of young women. The Succeed Body Image Programme was adapted to remove heteronormative assumptions and was delivered to a final sample of 56 undergraduate women who reported their sexual orientation as either “predominantly heterosexual” (our term; 1 or 2 on a 7-point Kinsey scale, n = 38) or non-heterosexual (3–7 on the Kinsey scale, n = 18). Before and after the intervention, they completed the Eating Attitudes Test-26, and an associative reaction time task based on the Implicit Association Test, in which bodies of low and higher weight were paired with socially desirable or undesirable traits. A total of 37 predominantly heterosexual women completed a control intervention in which they read NHS leaflets on eating disorders and healthy weight. Results showed that the intervention made predominantly heterosexual participants less prone, versus control, to associating thinness with positive traits on the IAT and all women completing the intervention reported a lower level of disordered eating attitudes at post- than pre-test. Non-heterosexual women, however, showed a non-significant increase in thin-bias on the IAT, perhaps due to their low baseline. These results imply that intensive dissonance-based programs can change attitudes at the automatic, implicit level as well as merely giving women tools to overcome those implicit attitudes.

Efficacy of virtual delivery of a dissonance-based eating disorder prevention program and evaluation of a donation model to support sustained implementation.

“…It is also important to confirm that prevention programs produce larger effects than a credible alternative intervention because it provides evidence that the reductions in outcomes are not simply due to expectancies, demand characteristics, or nonspecific effects. Further, the Body Project is the only eating disorder prevention program that has been shown to affect objective measures, which also provides evidence that intervention effects are not driven by expectancies and demand characteristics: In controlled trials, it has reduced brain reward region response to thin models (Stice et al, 2015), positive implicit attitudes toward thin models (Kant et al, 2019), and attentional bias for thin models (Tobin et al, 2022). Finally, it is the only eating disorder prevention program that has shown efficacy for various racial and ethnic groups in numerous countries, for heterosexual and sexual minority females and males, and for a broad range of ages (e.g., AlShebali et al, 2021; Brown & Keel, 2015; Brown et al, 2017; Casasnovas et al, 2021; Rohde et al, 2017; Rodriguez et al, 2008; Shaw et al, 2020; Stice et al, 2021; Unikel-Santoncini et al, 2019), implying that it might be a particularly good candidate for broad implementation.…”

Feasibility of a virtually delivered eating disorder prevention program for young females with type 1 diabetes

“…Consistent with this theory, reductions in pursuit of the thin beauty ideal mediated the effects of the Body Project on ED symptom reduction (Stice, Presnell, Gau, & Shaw, 2007). The Body Project reduced brain reward region response to thin models (Stice, Yokum, & Waters, 2015), positive implicit attitudes toward the thin beauty ideal (Kant, Wong‐Chung, Evans, Stanton, & Boothroyd, 2019), and attentional bias for the thin beauty ideal (Tobin, 2020).…”

Implicit and Explicit Anti‐Fat Attitude Change Following Brief Cognitive Dissonance Intervention for Weight Stigma

“…This suggests that targeting implicit attitudes is important for behavior change. Implicit attitudes about race, gender, and foods can be changed through interventions requiring little awareness (e.g., exposure to stigmatized group members) as well as through more deliberate attitudinal change interventions (e.g., purposely interacting with out-group members and finding similarities between them and the self) (17,29,30). Moreover, shifts in implicit attitudes in addition to explicit attitudes may be necessary to decrease weight-stigmatizing behavior given its normative nature (1).…”