The level of evidence is downgraded by study limitations and imprecise results.
A Cochrane review [Abstract] 1 included 12 studies with a total of 3092 children and adolescents (10 - 20 years). Subjects were randomised to a prevention program group or a control group. In all but three studies, programs were school-based. None of the pooled comparisons indicated evidence of harm.
In studies focusing on "eating attitudes and behaviours and adolescent issues”, there were no significant differences in body mass index (BMI) between the control and intervention groups at 12- and 14-month follow-up (weighted mean difference, WMD -0.10, 95% CI -0.45 to 0.25; 4 trials, n=1235). Eating Attitude Test (EAT-26 and EAT-40) showed no significant differences (standardised mean difference, SMD 0.01, 95% CI -0.13 to 0.15; 4 trials, n=792) at post-intervention (6 or 12 months). Neither were there significant differences, when comparing BMI or EAT for control and intervention groups for participants identified to be at "high risk" for developing eating disorders (2 trials, n=86). Scores on the Bulimia subscale on the Eating Disorder Inventory (EDI) showed no significant differences (2 trials, no=955) The two studies focusing on "media literacy and advocacy", the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) in its standard or in a modified form in another study at post-intervention (3- and 6-months respectively) were the only ones to show a significant difference between intervention and control groups. They resulted in less internalisation or acceptance of societal ideals relating to appearance (SMD -0.28, 95% CI -0.51 to -0.05; n=293). Interventions focusing on improving self-esteem, no significant differences were found between groups in scores on the Close Friendships (WMD -0.01, 95% CI -0.09 to 0.06; 2 trials, n=524) and Social Acceptance (WMD -0.03, 95% CI -0.10 to 0.04; 2 trials, n=531) subscales of the Self-Perception Profile at three-month follow-up.
A selective prevention program 2 targeting both eating disorder symptoms and unhealthy weight gain in American female college students at high-risk for these outcomes because of body image concerns included 398 women (mean age 18.4 years). Subjects were randomized to the “Healthy Weight” group or an educational brochure control condition. The prevention program promoted gradual lasting healthy improvements to dietary intake and physical activity and consisted of 4 weekly 1-hour group sessions with 6-10 participants. At posttest, intervention participants compared to controls showed significantly greater reductions in eating disorder symptoms (DSM-IV) (means 8,27 vs 6,11) and in body dissatisfaction (The Body Dissatisfaction Scale) and, greater increases in physical activity (The Paffenbarger Activity Questionnaire), but not at 6-mo follow-up (eating disorder symptoms: means 6,43 vs 6,05).
In the 1- and 2-year follow-ups of the above study 3, intervention group (n=184) showed significantly less body dissatisfaction and eating disorder symptoms compared to controls (n=186), however effects were small. Eating disorder onset through 2-year follow-up was lower in the intervention group (3.4% of intervention participants vs 8.5% of controls; hazard ratio =2.24). There were no main effects for body mass index (BMI), depressive symptoms, dieting, caloric intake, physical activity, or obesity onset.
Date of latest search: 2014-01-24
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