The Efficacy of a Universal School-Based Prevention Program for Eating Disorders among German Adolescents: Results from a Randomized-Controlled Trial

Abstract

Disordered eating is highly prevalent during adolescence and has a detrimental effect on further development. Effective prevention programs are needed to prevent unhealthy developmental trajectories. This study evaluated the efficacy of the POPS-program (POtsdam Prevention at Schools), a universal school-based eating disorder prevention program for adolescents. In a cluster-randomized design, we compared the intervention group receiving the prevention program to a waiting control group. Outcomes included indicators of disordered eating and relevant risk factors for eating disorders (body dissatisfaction, internalization of the thin ideal, perceived media pressure, perfectionism, emotional element of exercise, social comparison, and perceived teasing). Questionnaires were administered at the start of the intervention, 3 and 12 months post intervention. At baseline, 1112 adolescents aged 10 to 16 years participated (49% girls; 51% intervention group). Intention-to-treat analyses with the complete data set and per-protocol analyses as a completer analysis were performed. The intervention group showed a more favorable course compared to the control group regarding all observed risk factors for eating disorders except for perceived teasing. Effect sizes were small but comparable to other primary prevention programs. At 1-year follow-up, a small but significant effect on disordered eating was observed. Results of the per-protocol analyses were mostly confirmed by the intention-to-treat analyses. Results were promising for both genders although girls benefited more regarding disordered eating and internalization of the thin ideal. Further studies are warranted examining successful program elements and whether gender-specific programs are needed.

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

“…Full‐text screening excluded a further 206 articles, leaving 24 relevant articles to be included in this review. Eighteen were peer‐reviewed primary studies (Bird, Halliwell, Diedrichs, & Harcourt, ; Diedrichs et al, ; Dohnt & Tiggemann, ; Dunstan et al, ; Haines, Neumark‐Sztainer, Perry, Hannan, & Levine, ; Halliwell et al, ; McLean, Wertheim, Masters, & Paxton, ; McVey et al, ; Neumark‐Sztainer et al, ; Ross, Paxton, & Rodgers, ; Sanchez‐Carracedo et al, ; Sharpe et al, ; Steiner‐Adair et al, ; Warschburger & Zitzmann, ; Wilksch, ; Wilksch et al, ; Wilksch & Wade, , ), while six were unpublished dissertations (Batten, ; Fiissel, ; Haines, ; Kusel, ; Sharpe, ; Shepard, ). As both unpublished dissertations and published primary studies were obtained for two trials, the 24 included articles presented 22 trials (Haines et al, ; Sharpe et al, ).…”

Community Interventions to Promote Mental Health and Social Equity

“…Many studies examined the interplay among mental health services, social and structural determinants, and mental health outcomes. Some explicitly assessed social outcomes like intimate partner violence, housing retention, academic performance, parent-child interactions, “societal healing,” and other contributors to mental and social well-being [ 67 ••, 92 ••, 94 , 111 ].…”

Exploring the reciprocal relationships between adolescents' perceptions of parental and peer attachment and disordered eating: A multiwave cross‐lagged panel analysis

“…It would be of interest to implement programs that provide parents with the communication skills necessary to manage conflicts, so that the adolescent's normative process of autonomy is facilitated while the parent-child relationship is preserved (Allen & Tan, 2016). From a sociocultural perspective, dealing with the appearancerelated pressures from media, peers, and parents should be a key component of prevention programs (Warschburger, Helfert, & Krentz, 2011) and have shown beneficial long-term effects for both genders (Warschburger & Zitzmann, 2018). Given the influence of peers on eating behaviors, prevention efforts should consider school settings as well (O'Dea & Maloney, 2000).…”

“…Given the influence of peers on eating behaviors, prevention efforts should consider school settings as well (O'Dea & Maloney, 2000). From a sociocultural perspective, dealing with the appearancerelated pressures from media, peers, and parents should be a key component of prevention programs (Warschburger, Helfert, & Krentz, 2011) and have shown beneficial long-term effects for both genders (Warschburger & Zitzmann, 2018).…”