Andrew J. Winzelberg

Effectiveness of an Internet-Based Program for Reducing Risk Factors for Eating Disorders

This study evaluated an Internet-delivered computer-assisted health education (CAHE) program designed to improve body satisfaction and reduce weight/shape concerns--concerns that have been shown to be risk factors for the development of eating disorders in young women. Participants were 60 women at a public university randomly assigned to either an intervention or control condition. Intervention participants completed the CAHE program Student Bodies. Measures of body image and disordered eating attitudes were assessed at baseline, postintervention, and 3-month follow-up. At follow-up, intervention participants, compared with controls, reported a significant improvement in body image and a decrease in drive for thinness. This program provides evidence for the feasibility and effectiveness of providing health education by means of the Internet.

The analysis of an electronic support group for individuals with eating disorders

Electronic newsgroups, functioning as electronic support groups, now proliferate on the Internet and commercial computer networks. Little is known about the functioning and efficacy of these groups. A discourse analysis was performed on 306 messages posted to an eating disorder electronic support group. The most common message content involved self-disclosure (31%) followed by requests for information (23%), and the direct provision of emotional support (16%). Six themes were identified in the content of the messages. The majority of members participated in the group during the evening and late night at a time when traditional sources of support have limited availability or are not available. Members of the electronic support group used the same assistance strategies as do face-to-face support group members. These groups offer an innovative approach to providing low cost self-help services to individuals. Recommendations to clinicians and researchers are offered.

Reduction of Overweight and Eating Disorder Symptoms via the Internet in Adolescents: A Randomized Controlled Trial

PURPOSE Overweight in adolescence is a significant problem which is associated with body dissatisfaction and eating disorder (ED) behaviors. Cost-effective methods for early intervention of obesity and prevention of ED are important because of the refractory nature of both. This multisite RCT evaluated an Internet-delivered program targeting weight loss and ED attitudes/behaviors in adolescents. METHODS A total of 80 overweight adolescents 12-17 years of age completed Student Bodies 2 (SB2), a 16-week cognitive-behavioral program, or usual care (UC). RESULTS Body mass index (BMI) z-scores were reduced in the SB2 group compared with the UC group from baseline to post-intervention (p = .027; eta(p)(2) = .08). The SB2 group maintained this reduction in BMI z-scores at 4-month follow-up, but significant differences were not observed because of improvement in the UC group. The SB2 group evidenced greater increases in dietary restraint post-intervention (p = .016) and less improvement on shape concerns at follow-up (p = .044); however these differences were not clinically significant. No other statistically significant differences were noted between groups on ED attitudes or behaviors. The SB2 participants reported using healthy eating-related and physical activity-related skills more frequently than UC participants post-intervention (p = .001) and follow-up (p = .012). CONCLUSIONS Findings suggest that an Internet-delivered intervention yielded a modest reduction in weight status that continued 4 months after treatment and that ED attitudes/behaviors were not significantly improved. Group differences on weight loss were not sustained at 4-month follow-up because of parallel improvements in the groups. Future studies are needed to improve program adherence and to further explore the efficacy of Internet-delivery of weight control programs for adolescents.

An interactive psychoeducational intervention for women at risk of developing an eating disorder

This study evaluated a synchronous Internet-delivered intervention (chat room) for improving eating habits and body image in college-age women at risk for developing an eating disorder. Sixty at-risk women (mean age = 18.9, SD = 2.4; 65.0% Caucasian, 19% Latino/Hispanic, 8% Asian/Pacific Islander, 3% African American, 5% other; mean body mass index = 25.6, SD = 5.7) were randomly assigned to intervention (n = 30) or control (n = 30) groups. Once a week for 8 weeks, participants used a private chat room for a 1-hr moderated discussion focused on improving body image and eating behaviors. Additional treatment components included psychoeducation, asynchronous support, homework, and summaries. Assessments were conducted at baseline, posttreatment, and 10 weeks after posttreatment. Participants indicated high satisfaction with the intervention mode. Intervention participants significantly reduced eating pathology and improved self-esteem over controls at follow-up. These findings suggest that synchronous, Internet-delivered programs are efficacious and have potential to reduce problematic attitudes and behaviors that may lead to eating disorders among college-age women.

The adverse effect of negative comments about weight and shape from family and siblings on women at high risk for eating disorders

OBJECTIVE. Our purpose with this work was to examine the relationship between negative comments about weight, shape, and eating and social adjustment, social support, self-esteem, and perceived childhood abuse and neglect. METHODS. A retrospective study was conducted with 455 college women with high weight and shape concerns, who participated in an Internet-based eating disorder prevention program. Baseline assessments included: perceived family negative comments about weight, shape, and eating; social adjustment; social support; self-esteem; and childhood abuse and neglect. Participants identified 1 of 7 figures representing their maximum body size before age 18 and parental maximum body size. RESULTS. More than 80% of the sample reported some parental or sibling negative comments about their weight and shape or eating. Parental and sibling negative comments were positively associated with maximum childhood body size, larger reported paternal body size, and minority status. On subscales of emotional abuse and neglect, most participants scored above the median, and nearly one third scored above the 90th percentile. In a multivariate analysis, greater parental negative comments were directly related to higher reported emotional abuse and neglect. Maximum body size was also related to emotional neglect. Parental negative comments were associated with lower reported social support by family and lower self-esteem. CONCLUSIONS. In college women with high weight and shape concerns, retrospective reports of negative comments about weight, shape, and eating were associated with higher scores on subscales of emotional abuse and neglect. This study provides additional evidence that family criticism results in long-lasting, negative effects.

The effect of a meditation training in stress levels in secondary school teachers

Teachers experience a high level of stress and burnout. Meditation training, which has previously been found to help individuals manage stress, may be an ideal low-cost stress management technique for teachers. A pilot study was run to test the effectiveness of meditation training for student teachers. Subjects were recruited from a university teaching credential program and assigned to either a meditation training or control group. Subjects in the meditation training were taught the RISE response, which includes a simple meditation technique using sound as a focusing device and three corollary techniques. The program prescribed a formal meditation practice period while the three corollary practices were to be used at any time to remind subjects to focus attention. Subjects assigned to the meditation group attended four 45-minute meditation training sessions. The meditation group subjects were found to significantly reduce their stress symptoms in the post-test measurements when compared to the control group in the domains of emotional manifestations, gastronomic distress and behavioral manifestations. Copyright

Reliability of self-report: paper versus online administration

This investigation compared online and paper administration of self-report measures of weight and shape concerns, mood, weight and height. The former was designed as a screening instrument for adolescent students to determine risk for eating disorders. Participants were female sophomores (N=74) from a San Francisco Bay area private high school. A counterbalanced designed was used to control for order effects. Four classes were randomly assigned to one of four conditions: (1) online-paper; (2) paper-online; (3) online-online; and (4) paper-paper. Participants completed self-report questionnaires twice, online and/or on paper, separated by 1 week. Agreement between online and paper assessment of weight and shape concerns and BMI ranged from 0.73 to 0.97 and 0.80 to 1.0, respectively. Agreement for positive mood ranged from 0.58 to 0.85 and negative mood from 0.59 to 0.82. Mean scores for weight and shape concerns and mood variables were significantly lower at the second testing. Online and paper assessment of weight and shape concerns was significantly correlated. However, there was a significant time effect. Mood was less stable and correlations between the two modes of self-report were less correlated. Online assessment may be beneficial and appropriate for many settings.

Do Adherence Variables Predict Outcome in an Online Program for the Prevention of Eating Disorders

Unlike traditional interventions, Internet interventions allow for objective tracking and examination of the usage of program components. Student Bodies (SB), an online eating disorder (ED) prevention program, significantly reduced ED attitudes/behaviors in college-aged women with high body image concerns, and reduced the development of EDs in some higher risk subgroups. The authors investigated how adherence measures were associated with ED attitudes and behaviors after treatment. Female SB participants (n = 209) completed the Eating Disorders Examination-Questionnaire (EDE-Q; C. G. Fairburn & S. J. Beglin, 1994) at baseline, posttreatment, and 1-year follow-up. Total weeks participation and frequency of utilizing the online Web pages/journals predicted pre- to posttreatment changes in EDE-Q Restraint but not in other ED symptoms. In participants with some compensatory behaviors, discussion board and booster session use were associated with increased weight/shape concerns during follow-up. In overweight participants, higher online Web page/journal use was related to decreased EDE-Q Eating Concern scores during follow-up. This is the first study to investigate the relationship between adherence to specific program components and outcome in a successful Internet-based intervention. Results can be used to inform future development and tailoring of prevention interventions to maximize effectiveness and facilitate dissemination.

Reduktion von Risikofaktoren für gestörtes Essverhalten

Zusammenfassung. Eine erhohte Bedeutsamkeit von Figur und Gewicht sowie Diatverhalten gehoren zu den am besten bestatigten und bedeutungsvollsten Risikofaktoren, die bei jungen Frauen zu einem erhohten Risiko fur spatere Essstorungssymptome oder -syndrome fuhren. Praventive Interventionen sollten daher versuchen, diese Faktoren zu reduzieren, um die Wahrscheinlichkeit der Entwicklung einer Essstorung zu verringern. Die vorliegende Untersuchung beschreibt die Uberprufung der Wirksamkeit eines fur den deutschen Sprachraum adaptierten Internet-gestutzten Praventionsprogramms (“Student Bodies“) zur Reduktion von Risikofaktoren fur gestortes Essverhalten bzw. Essstorungen. 100 Studentinnen von zwei Universitaten wurden per Zufall entweder einer Interventionsgruppe oder einer Wartekontrollgruppe zugewiesen. Die Dauer der Intervention betrug 8 Wochen. Zum Post-Zeitpunkt konnte die Wirksamkeit des adaptierten Programms im Vergleich zur Kontrollgruppe gut bestatigt werden. Die Effekte waren deutlich hoher fur eine...