Future directions for equity-centered body image and eating disorders prevention work.

This article concludes the special issue, , by reflecting on some of the shared themes as the bases for guiding improvements, if not innovations, in future research. Overall, the articles in this collection highlight the progress achieved within eating disorders prevention in recent years, while addressing many of the existing-and sometimes glaring-gaps within the field. While these manuscripts represent important steps forward, they also offer conceptual frameworks and methodological roadmaps for future developments in the field.

Developing a justice-focused body image program for U.S. middle schoolers: a school-based community-engaged research process.

We describe a community-engaged research process to co-create and implement an evidence-informed, diversity-focused body image program for early adolescents. Our team included middle school staff, students, and teachers, and university faculty and students. Team members had a diverse range of intersecting cis- and transgender, racial, sexuality, and disability identities.

Expert peer facilitation of the EVERYbody Project: A randomized-controlled evaluation of a diversity-focused, dissonance-based, universal body image program for college students.

Objective: A novel peer facilitation model was used to deliver a two session, dissonance-based, inclusive body image intervention that critically examines how internalized size-based oppression intersects with race, class, gender, sexuality, and ability.

Method: The EVERYbody Project was open to all college students and delivered by "expert" peer facilitators with body image and diversity experience and advanced facilitation skills. Recruitment was halted due to COVID-19; 90 students in the Northwest US (M age = 19.

Inclusive dissonance-based body image interventions for college students: Two randomized-controlled trials of the EVERYbody Project.

Objectives: Two randomized-controlled studies explored the feasibility, acceptability, and efficacy of the EVERYbody Project, a gender-inclusive, diversity-focused, dissonance-based body image intervention for college students.

Method: Trial 1 (N = 98; 80% female, 14% male, and 6% gender-expansive) piloted the two-session intervention delivered by an expert (faculty or staff) and peer cofacilitators compared to a waitlist control. Trial 2 (N = 141; 79% female, 15% male, and 6% gender-expansive) utilized peer leaders, comparing the EVERYbody Project to a video and expressive writing intervention.

A qualitative examination of adolescent and parent perspectives on early identification and early response to eating disorders.

This qualitative study examined adolescent and caregiver perspectives on identification and early response in emerging eating disorders. Fifteen female-identified adolescents with an eating disorder diagnosis ( age = 15.20 years; 93% White; 20% Hispanic) and 12 caregivers (all biological parents: 1 father, 11 mothers; age = 51.

The influence of gender on the evaluation of anorexia nervosa.

A stereotype exists that anorexia nervosa (AN) is a "female" disorder. As a result, men with AN may face harsher stigmatization from their peers or go undiagnosed. The shifting standards model provides a framework to explore how gender stereotypes impact perceptions of AN.

Should body image programs be inclusive? A focus group study of college students.

Objective: Most evidence-based body image programs for college students (e.g., the Body Project) are designed for female-only audiences, although body dissatisfaction is not limited to female-identified individuals.

The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self-directed behavior, and self-discrepancy within the mediation model.

Objective: The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy.

Method: Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment.

Weight bias internalization in treatment-seeking overweight adults: Psychometric validation and associations with self-esteem, body image, and mood symptoms.

Internalized weight bias has been previously associated with impairments in eating behaviors, body image, and psychological functioning. The present study explored the psychological correlates and psychometric properties of the Weight Bias Internalization Scale (WBIS) among overweight adults enrolled in a behavioral weight loss program. Questionnaires assessing internalized weight bias, anti-fat attitudes, self-esteem, body image concern, and mood symptoms were administered to 90 obese or overweight men and women between the ages of 21 and 73.

A naturalistic examination of social comparisons and disordered eating thoughts, urges, and behaviors in college women.

Objective: We examined the effects of body, eating, and exercise social comparisons on prospective disordered eating thoughts and urges (i.e., restriction thoughts, exercise thoughts, vomiting thoughts, binge eating urges) and behaviors (i.

Restrictive eating in anorexia nervosa: Examining maintenance and consequences in the natural environment.

Objective: This study examined negative and positive affect in relation to restrictive eating episodes (i.e., meals/snacks perceived as restrictive) and whether restrictive eating was associated with likelihood of subsequent eating disorder behaviors (i.

Effectiveness of a peer-delivered dissonance-based program in reducing eating disorder risk factors in high school girls.

Objective: This pilot study investigated the feasibility, acceptability, and effectiveness of a peer-led dissonance-based eating disorders (ED) prevention/risk factor reduction program with high school girls.

Method: Ninth grade girls (n = 50) received the peer-led program within the school curriculum. A quasi-experimental design was used to assess changes in ED risk factors preintervention and postintervention compared with waitlist control.

Therapeutic alliance in a randomized clinical trial for bulimia nervosa.

Objective: This study examined the temporal relation between therapeutic alliance and outcome in two treatments for bulimia nervosa (BN).

Method: Eighty adults with BN symptoms were randomized to 21 sessions of integrative cognitive-affective therapy (ICAT) or enhanced cognitive-behavioral therapy (CBT-E). Bulimic symptoms (i.

Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa.

This study examined predictors of psychological change among 80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of treatment effects.

From efficacy to effectiveness: comparing outcomes for youth with anorexia nervosa treated in research trials versus clinical care.

This study examined outcomes for 84 youth with anorexia nervosa (AN) who received family-based treatment (FBT) in a research trial (randomized trial care [RTC]: n = 32) compared to fee-for-service care (specialty clinical care [SCC]: n = 52) at an outpatient eating disorder clinic. Weight was collected up to 12 months post-baseline. Survival curves were used to examine time to weight restoration as predicted by type of care, baseline demographic and clinical characteristics, and their interaction.

Family functioning in two treatments for adolescent anorexia nervosa.

Objective: Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from multiple family members' perspectives.

Method: Participants were 121 adolescents with AN ages 12-18 from a randomized-controlled trial comparing family-based treatment (FBT) to individual adolescent-focused therapy (AFT).

Subjective and objective binge eating in relation to eating disorder symptomatology, depressive symptoms, and self-esteem among treatment-seeking adolescents with bulimia nervosa.

This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment-seeking adolescents with bulimia nervosa. We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self-esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self-esteem; however, the SBE group had significantly greater depression.

Preventing eating disorder pathology: common and unique features of successful eating disorders prevention programs.

Over the past two decades, the field of eating disorders has made remarkable strides in identifying, evaluating, and disseminating successful prevention programs. The current review identifies and discusses nine distinct eating disorders prevention programs that reduce existing eating disorder pathology or prevent the onset of future pathology. Each program was evaluated in one or more controlled trial with a follow-up period of at least six months.

Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa.

The main aims of this study were to describe change in psychological outcomes for adolescents with anorexia nervosa across two treatments, and to explore predictors of change, including baseline demographic and clinical characteristics, as well as weight gain over time. Participants were 121 adolescents with anorexia nervosa from a two-site (Chicago and Stanford) randomized controlled trial who received either family-based treatment or individual adolescent supportive psychotherapy. Psychological symptoms (i.

Community-based behavioral weight-loss treatment: long-term maintenance of weight loss, physiological, and psychological outcomes.

Obesity is a significant public health problem, and sustainable long-term treatments are needed. This study examined a community-based model of weight-loss treatment. Ninety participants were recruited from eight community organizations (mean age: 49.

Weight-loss history as a predictor of obesity treatment outcome: prospective, long-term results from behavioral, group self-help treatment.

Weight-loss history was examined as a predictor of outcome in group self-help obesity treatment. Participants (n = 128; 83% women; mean body mass index = 34.2 kg/m(2); mean age = 47.

Reducing obesity stigma: the effectiveness of cognitive dissonance and social consensus interventions.

Obese individuals experience pervasive stigmatization. Interventions attempting to reduce obesity stigma by targeting its origins have yielded mixed results. This randomized, controlled study examined the effectiveness of two interventions to reduce obesity stigma: cognitive dissonance and social consensus.

Anti-fat prejudice reduction: a review of published studies.

Prejudice against those who are perceived as 'fat' or obese (anti-fat prejudice) is rife, increasing, and associated with negative outcomes for those targeted for such treatment. The present review sought to identify and describe published research on interventions to reduce anti-fat prejudice. A systematic search of relevant databases (e.