Overview of Effective and Efficacious Eating Disorder Prevention Programs
A recent meta-analytic review found that 51 % of ED prevention programs reduced ED risk factors and 29% reduced current or future eating pathology (Stice, Shaw, & Marti, 2007), although fewer produced effects that persisted through follow-up (reviewed later when specific interventions are discussed). Larger intervention effects tended to occur for programs that were selected (vs. universal), interactive (vs. didactic), multisession (vs. single session), solely offered to female participants (vs. both sexes), offered to participants older than age 15 (vs. younger ones), and delivered by professional interventionists (vs. endogenous providers). Programs with body acceptance and dissonance-induction content and without psychoeducational content and programs evaluated in trials using validated measures also produced larger effects.
Universal Prevention Programs
To our knowledge, three universal prevention programs have produced reductions in select ED symptoms that have persisted through at least 6-month follow-up relative to assessment-only control conditions. Neumark-Sztainer, Butler, and Palti (1995) evaluated a didactic psychoeducational intervention that presented information on healthy weight control behaviors, body image, EDs, putative causes of EDs, and social pressure resistance skills. Their intervention significantly reduced the frequency of self-reported binge eating relative to an assessment-only control condition but did not affect other eating-disordered behaviors (Neumark-Sztainer et al., 1995).
Stewart, Carter, Drinkwater, Hainsworth, and Fairburn (2001) evaluated an interactive program focused on resisting cultural pressures for thinness, determinants of body weight, body acceptance, effects of cognitions on emotions, nature and consequences of EDs, self-esteem enhancement, stress management, and healthy weight control behaviors. Their intervention produced significant effects for ED symptoms at both posttest and 6-month follow-up relative to an assessment-only control group.
Austin, Field, Wiecha, Peterson, and Gortmaker (2005) evaluated a 26-hour universal prevention program that promotes less media use, a healthy diet, and regular exercise. Their intervention significantly reduced unhealthy weight control behaviors (e.g., vomiting, diet pill use) and body mass index scores among female, but not male, preadolescents relative to controls (Austin et al., 2005).
Although the effects of universal ED prevention programs are encouraging, a meta-analytic review found that universal prevention programs typically produce smaller intervention effects than selective prevention programs (Stice, Shaw, & Marti, 2007). Moreover, the effects of these three universal prevention programs have not been replicated by the original investigators or by independent investigators, nor have these prevention programs been shown to significantly outperform credible alternative interventions. As such, the empirical support for these three prevention programs is very limited.