Simon Mark Wilksch

Reduction of Shape and Weight Concern in Young Adolescents: A 30-Month Controlled Evaluation of a Media Literacy Program.

OBJECTIVE Recent eating disorder prevention efforts have targeted high-risk females in late adolescence (>15 years). Methodologically rigorous evaluations of prevention programs directed to younger, mixed-sex, universal audiences are largely absent. The primary objective was to evaluate a theoretically informed media literacy program delivered to a mixed-sex, universal, young adolescent audience. METHOD Five hundred forty Grade 8 students (mean age 13.62 years, SD 0.37 years) from 4 schools participated with a total of 11 classes receiving the 8-lesson media literacy program (126 girls and 107 boys) and 13 comparison classes receiving their normal school lessons (147 girls and 160 boys). Shape and weight concern (primary outcome variable) and seven additional eating disorder risk factors (e.g., dieting, media internalization) were measured with validated questionnaires at baseline, postprogram, and 6- and 30-month follow-up. RESULTS Linear mixed model analyses were conducted using a 2 (group: media literacy program, control) x 3 (time: postprogram, 6-month follow-up, 30-month follow-up) x 2 (sex: girls, boys) mixed within-between design, with baseline entered as a covariate. Main effects for group, favoring the media literacy program, were found for shape and weight concern (effect size [ES] = 0.29), dieting (ES = 0.26), body dissatisfaction (ES = 0.20), ineffectiveness (ES = 0.23), and depression (ES = 0.26). CONCLUSION Media literacy can be an effective intervention for reducing shape and weight concern and other eating disorder risk factors long-term in a universal mixed-sex, young adolescent population. More evaluations of methodologically sound prevention programs are required with this demographic.

A Preliminary Controlled Comparison of Programs Designed to Reduce Risk of Eating Disorders Targeting Perfectionism and Media Literacy

OBJECTIVE The primary objective was to compare the efficacy of two eight-lesson programs, targeting perfectionism and media literacy compared to control classes in reducing eating disorder risk. METHOD Students from six classes (N = 127, mean age 15.0 years, SD 0.4) and two schools participated. Linear mixed-model analyses were conducted by group (3: perfectionism, media literacy, control), time (2: postprogram, 3-month follow-up) and eating disorder risk status (2: high, low), with baseline observations included as a covariate. RESULTS An interaction effect favoring the perfectionism program at 3-month follow-up was found for concern over mistakes (effect size 0.45). A main effect for group, also favoring the perfectionism program, was found for personal standards (effect size 0.44). High-risk participants (i.e., those with high levels of shape and weight concern at baseline) benefited most from the perfectionism program with reliable change indices indicating favorable rates of improvement beyond chance on all of the variables, whereas the media literacy and control participants experienced a comparable rate of change during the course of the study. CONCLUSIONS Targeting perfectionism represents a promising prevention option that requires further investigation in children of mid-adolescence age, and further investigation is required to determine the demographic most likely to benefit from media literacy.

A longitudinal investigation of the impact of disordered eating on young women's quality of life

OBJECTIVE The extent to which subclinical levels of disordered eating affect quality of life (QOL) was assessed. METHOD Four waves of self-report data from Survey 2 (S2) to 5 (S5) of a national longitudinal survey of young Australian women (N = 9,688) were used to assess the impact of any level of disordered eating at S2 on QOL over the following 9 years, and to evaluate any moderating effects of social support and of depression. RESULTS At baseline, 23% of the women exhibited some level of disordered eating, and they scored significantly lower on both the physical and the mental component scores of the SF-36 at every survey; differences in mental health were still clinically meaningful at S5. Social support and depressive symptoms each acted as a moderator of the mental component scores. Women with both disordered eating and low social support, or disordered eating and depression, had the worst initial scores; although they improved the most over time, they still had the lowest scores at S5. Higher social support at baseline resulted in women with disordered eating being largely indistinguishable from women without disordered eating who had low social support. Lower levels of depression resulted in women with disordered eating having a significantly better QOL than women with high levels of depression, regardless of eating status. CONCLUSIONS This is the first study to examine the long-term impact of subclinical levels of disordered eating on QOL, and it suggests that even apparently minor levels of symptomatology are associated with significant and far-reaching deficits in well-being.

An investigation of temperament endophenotype candidates for early emergence of the core cognitive component of eating disorders

BACKGROUND This study was designed to investigate potential temperament endophenotypes for clinically significant importance of shape and weight. METHOD Seven temperament risk factors for eating disorders and the Eating Disorder Examination were assessed in 699 female twins aged 12-15 years. Each variable was evaluated against the following endophenotype criteria: associated with illness in the general population; found in non-affected family members at a higher rate than in the general population; and, heritable. RESULTS All seven variables were significantly associated with clinically significant importance of shape and weight, while thin-ideal internalization, ineffectiveness, body dissatisfaction and sensitivity to punishment were found at significantly elevated levels in non-affected twins, when controlling for sisters temperament score. These four variables had genetic correlations with importance of shape and weight, ranging from 0.48 to 0.95. CONCLUSIONS Future research should evaluate the stability of the identified endophenotypes and their utility for predicting significant growth in importance of shape and weight, and also whether different endophenotypes emerge when the importance of weight and shape reaches its peak in adolescents, around 15 to 16 years of age.

School-based eating disorder prevention: a pilot effectiveness trial of teacher-delivered Media Smart

This pilot study tested teacher‐delivered Media Smart, a school‐based eating disorder prevention program that has achieved significant benefits when delivered by health professionals.

Life Smart: A Pilot Study of a School-Based Program to Reduce the Risk of Both Eating Disorders and Obesity in Young Adolescent Girls and Boys

OBJECTIVE To develop and pilot Life Smart, an eight-lesson program aimed at reducing risk factors for both eating disorders and obesity. METHODS Grade 7 girls and boys (N = 115) from one independent school were randomly allocated to the Life Smart (two classes; N = 51) or control (three usual classes; N = 64) conditions. Risk factors were measured at baseline and post-program (5 weeks later). RESULTS Life Smart was rated as moderately enjoyable and valuable by participants. ANCOVAs with baseline as a covariate revealed a significant main effect for group favoring Life Smart for shape and weight concern (Effect Size [ES] = .54), with post-hoc testing finding girls particularly benefited on this variable (ES = .78). CONCLUSIONS Feedback was generally favorable, with some suggestions for even more interactive content. The program showed more promise with girls. Informed by these findings, the program underwent revisions and is now being evaluated in a randomized controlled trial.

Where did universal eating disorder prevention go

It was just 13 years ago that the future of the eating disorder prevention field appeared bleak. A 2000 review found that four studies had shown significant positive behavior change, four had shown a worsening of symptoms, while the vast majority had shown no effect at all, leading Austin (2000) to conclude a discouraging state of the field. This first wave of prevention efforts was frequently directed at universal audiences (inclusion of participants regardless of their level of risk of an eating disorder), such as intact school classes of young-adolescent girls and sometimes boys also. In the years that followed, the eating disorder prevention field moved away from evaluating programs with these universal audiences and has taken a more targeted approach with older (primarily university-aged), females screened to be at high risk of eating problems (e.g., significantly restricting food intake). This has been a fruitful shift where a 2007 meta-analysis found 51% of eating disorder prevention trials to have at least one significant beneficial impact (Stice, Shaw, & Marti, 2007) compared to just 20% of programs included in the 2000 review. Of the studies published since 2000 that were included in the 2007 metaanalysis, 20 were directed to high-risk, female-only audiences, while 12 were delivered as universal programs in school settings with only four of these including boys (Stice et al., 2007). The meta-analysis included moderators of program effect size and found significantly larger effects for programs delivered to: targeted audiences (versus universal samples); female-only

How perfectionism and ineffectiveness influence growth of eating disorder risk in young adolescent girls

While perfectionism is widely considered to influence risk for eating disorders, results of longitudinal studies are mixed. The goal of the current study was to investigate a more complex model of how baseline perfectionism (both high personal standards and self-critical evaluative concerns) might influence change in risk status for eating disorders in young adolescent girls, through its influence on ineffectiveness. The study was conducted with 926 girls (mean age of 13 years), and involved three waves of data (baseline, 6- and 12-month follow-up). Latent growth curve modelling, incorporating the average rate at which risk changed over time, the intercept (initial status) of ineffectiveness, and baseline perfectionism, was used to explore longitudinal mediation. Personal standards was not supported as contributing to risk but results indicated that the higher mean scores on ineffectiveness over the three waves mediated the relationship between higher baseline self-critical evaluative concerns and both measures of eating disorder risk. The relationship between concern over mistakes and change in risk was small and negative. These results suggest the usefulness of interventions related to self-criticism and ineffectiveness for decreasing risk for developing an eating disorder in young adolescent girls.

Interactive programme to enhance protective factors for eating disorders in girls with type 1 diabetes

This study evaluated the effectiveness of a pilot programme in enhancing protective factors for eating disorders in young girls with type 1 diabetes (T1D).

Prevention of disordered eating in adolescents: the role of perfectionism and media internalisation

There is extensive research into eating disorder risk factors, and recently the focus has moved to investigating the mechanisms underlying these factors. The current study examines the interrelationships between eating disorder symptoms and two proposed risk factors: perfectionism and media internalisation. This study uses data collected as part of the Prevention Across the Spectrum randomized controlled trial, which involves approximately 2000 Grade 7 and 8 adolescents across Australia. Students were randomly allocated to one of three eating disorder prevention programs or a control group. Students were assessed in 4 waves (pre-intervention, post-intervention, 6-month follow-up and 12-month follow-up) and the assessment included measures of perfectionism (Frost Multidimensional Perfectionism Scale), media internalisation (Sociocultural Attitudes Towards Appearance Questionnaire), and shape and weight concerns (Eating Disorder Examination Questionnaire). Preliminary analyses using a sample of baseline data suggest that the relationship between perfectionism and eating disorder symptoms is mediated by media internalisation, with differential effects depending upon the dimension of perfectionism and the outcome measure used in the analysis. Part two of this study will investigate the effects of the intervention programs on this relationship and outcome. The findings presented will have implications for our understanding of the development and prevention of eating disorder symptomatology. This abstract was presented in the Prevention stream of the 2013 ANZAED Conference.