Effectiveness of the Body Project eating disorder prevention program for different racial and ethnic groups and an evaluation of the potential benefits of ethnic matching.

Abstract

Objective: Provide an adequately powered tests of whether a group-delivered dissonance-based eating disorder prevention program (Body Project) is similarly effective for different racial and ethnic groups and evaluate whether an improved match between minority participant race/ethnicity and fellow group members is associated with larger effects. Method: Study 1 examined data from 539 young women from seven high schools and four universities and Study 2 examined data from 1,195 young women and men from 50 universities who completed the Body Project, focusing on pretest-to-posttest reductions in outcomes. Results:In Study 1, reductions in thin-ideal internalization, body dissatisfaction, dieting, negative affect, and eating disorder symptoms did not significantly differ for White versus Asian, Black, and Native Americans, though we did not have power to contrast racial and ethnic minority groups. In Study 2, only one intervention effect was weaker for a minority group relative to Whites (Black vs. White participants showed smaller reductions in thin-ideal internalization), but there was evidence that intervention effects were significantly larger for Hispanic versus White and Black participants, and to a lesser extent for Hispanic versus Asian and Native Americans; these differences were partially driven by differences in pretest risk across ethnic groups. Ethnic/racial matching was not associated with larger effects. Conclusions: Results suggest that the Body Project produced relatively similar effects for racial/ethnic minority groups relative to White participants, that the effects were sometimes larger for Asian and Hispanic participants, and that recruiting Black participants at higher risk may contribute to larger effects for this racial group. What is the public health significance of this article?This study tested whether intervention effects for a group-delivered dissonance-based eating disorder prevention program varied as a function of race and ethnicity using data from two large U.S. samples. Although some baseline differences were found suggesting lower risk for eating disorders for Black participants and higher risk for eating disorders for Hispanic participants, the Body Project produced similar effects for racial and ethnic minority groups relative to White participants, though there was evidence that it produced larger effects for Hispanic versus White and Black participants. There was no evidence that an improved match between the race/ethnicity of minority participants and their fellow group members was associated with larger intervention effects.

Implementation factors that predict larger effects from a peer educator delivered eating disorder prevention program at universities.

“…Regarding research directions, it would be useful for future randomized trials to manipulate the factors that were found to correlate with larger intervention effects (e.g., virtual vs. in-person administration of the Body Project ) because experiments permit firmer inferences. It would also be useful for future studies to investigate other methods of increasing the intervention effects of eating disorder prevention programs, such as by reducing alternative cognitive risk factors for eating disorders, other than thin-ideal internalization, that show more potent relations to future onset of eating disorders and predict all four types of eating disorders (e.g., appearance overvaluation and fear of weight gain vs. pursuit of the thin beauty ideal; Stice et al, 2021). More broadly, it would be useful to conduct systematic research regarding how to optimize the intervention effects of prevention programs for other health and mental health problems.…”

“…To our knowledge, it is the only prevention program that has reduced future onset of a psychiatric disorder, produced effects in both efficacy and effectiveness trials, produced effects that persist for 3 years, outperformed credible alternative interventions, and produced independently replicated effects (Stice et al, 2019). It is also the only eating disorder prevention program that has significantly reduced eating disorder risk factors and symptoms in randomized trials for various racial and ethnic groups in several countries, heterosexual and nonheterosexual females and males, and participants ranging in age from 11 to 64 in trials at middle schools, high schools, and universities (AlShebali et al, 2021;Brown & Keel, 2015;Brown et al, 2017;Casasnovas et al, 2019;Rodriguez et al, 2008;Rohde et al, 2014Rohde et al, , 2017Shaw et al, 2020;Stice et al, 2021;Unikel-Santoncini et al, 2019). These results imply that it might be a particularly good candidate for broad implementation.…”

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

“…The Body Project consisted of four weekly 1-hr group sessions with five to nine participants delivered by peer educators using a scripted intervention manual. This version of the intervention was developed for implementation by peer educators or clinicians and was used in past trials (Stice, Rohde, et al, 2017, 2020, 2021). Participants voluntarily engaged in verbal, written, and behavioral exercises in which they critiqued the thin appearance ideal in session and completed home exercises.…”

Ethnoracial status, intersectionality with gender, and psychotherapy utilization, retention, and outcomes.

“…One meta-analysis found a large effect size for client preferences and moderate effect size for client perceptions of therapists that favor matching but a very small effect size (.09) for psychotherapy outcomes (Cabral & Smith 2011). Another recent study by Stice et al (2021) did not find evidence that ethnoracial matching within a sample with body shape concerns (N = 1,195) was associated with larger intervention effects. As such, we did not form a priori hypotheses for an effect of client-therapist match on psychotherapy outcomes.…”