Reducing eating disorder onset in a very high risk sample with significant comorbid depression: A randomized controlled trial.

Abstract

Objective Eating disorders (EDs) are serious problems among college-age women and may be preventable. An indicated on-line eating disorder (ED) intervention, designed to reduce ED and comorbid pathology, was evaluated. Method 206 women (M age = 20 ± 1.8 years; 51% White/Caucasian, 11% African American, 10% Hispanic, 21% Asian/Asian American, 7% other) at very high risk for ED onset (i.e., with high weight/shape concerns plus a history of being teased, current or lifetime depression, and/or non-clinical levels of compensatory behaviors) were randomized to a 10-week, Internet-based, cognitive-behavioral intervention or wait-list control. Assessments included the Eating Disorder Examination (EDE to assess ED onset), EDE-Questionnaire, Structured Clinical Interview for DSM Disorders, and Beck Depression Inventory-II. Results ED attitudes and behaviors improved more in the intervention than control group (p = 0.02, d = 0.31); although ED onset rate was 27% lower, this difference was not significant (p = 0.28, NNT = 15). In the subgroup with highest shape concerns, ED onset rate was significantly lower in the intervention than control group (20% versus 42%, p = 0.025, NNT = 5). For the 27 individuals with depression at baseline, depressive symptomatology improved more in the intervention than control group (p = 0.016, d = 0.96); although ED onset rate was lower in the intervention than control group, this difference was not significant (25% versus 57%, NNT = 4). Conclusions An inexpensive, easily disseminated intervention might reduce ED onset among those at highest risk. Low adoption rates need to be addressed in future research.

Online prevention of disordered eating in at-risk young-adult women: a two-country pragmatic randomized controlled trial

“…SB did not perform as well as previous findings (e.g., Jacobi et al , 2012; Taylor et al, 2016), though findings are diffficult to interpret given very low completion rates. The most likely reason for this was the absence of a personalized online moderator, which has previously been recommended as an important for internet interventions to work (Andersson et al , 2009).…”

“…SB and MS-T are 9-module programs that follow the principles of effective prevention, such as interactive content and targeting prospectively identified ED risk factors (Stice et al , 2007). Consistent with previous SB trials (Taylor et al , 2016), both programs released modules weekly via a password-protected mobile internet-platform and both programs were a pure self-help format (no online therapist moderator). The SB program was delivered in its usual form on a mobile platform but without moderation.…”

“…A comparison of guided vs self-help versions of SB (conducted concurrently to the current trial) found the guided group had significantly lower weight concerns and lower odds of remaining at high risk of an ED than the non-guided group at post-intervention (M age=20.1 years: Kass et al , 2014). While a recent RCT for those at ‘very high risk’ of an eating disorder (Taylor et al , 2016) found amongst participants with high shape and weight concerns, ED onset was significantly lower in the SB group compared to controls ( SB=2 0% vs controls= 42%).…”

“…SB has been evaluated in eleven RCTs, seven in the USA (Bruning Brown et al , 2004, Celio et al , 2000, Kass et al , 2014, Low et al , 2006, Taylor et al , 2006, Taylor et al , 2016, Winzelberg et al , 2000, Winzelberg et al , 1998) and four in Germany (Jacobi et al , 2005, 2007, Jacobi et al , 2012). These samples have included young-adult or late adolescent females from college and high-school settings.…”

Efficacy of a Parent-Based, Indicated Prevention for Anorexia Nervosa: Randomized Controlled Trial (Preprint)

“…Along with low engagement rates in the intervention, the study was also characterized by high drop-out rates, i.e., over 50% in the control group and 65.6% in the intervention group. These rates exceed drop-out rates of both targeted intervention trials for ED in general [48,49] and of those reported for family-based treatment trials for AN which average between 15-25% [50][51][52].…”