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ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
1
ExcitingRecentDevelopmentsintheFieldofPrevention
[AppearsintheApril2015Gürze-SalucoreOnlineCatalogue]
MichaelP.Levine,Ph.D.,FAED
Part1ofthisseries(Gürze-SalucoreNewsletter,March2015)exploredthe
meaningsofpreventionandthecriteriafordeterminingwhetheraprevention
programworks,whileprovidingabroadsketchoftheempiricalbasisforthe
conclusionthatEDpreventioncanindeedworkand,infact,isabsolutelynecessary.
Providingasnapshotofthecurrentstateofpreventionresearchisdifficult,
givenhowextensivelythefieldhasgrownsince2000.APsychInfosearchinmid-
Marchof2015,lookingfor“preventionorpreventing”AND“eatingdisorders”inthe
title,yielded90articlesandbookchapterspublishedinEnglishsinceJanuaryof
2010,and255sinceJanuary2000.Thus,thepurposeofthisessayistodescribea
varietyofexcitingrecentdevelopmentsinEDprevention.Presentationofprograms
isorganizedaccordingtotheirplaceontheuniversalàselectiveàindicated
(targeted)preventionspectrum(seePart1)andthelevelofage/gradeofthe
intendedaudience.
Theprogramswereselectedbecauseresearchsupports—andinsome
instancesconfirms—thatthey“work”(seePart1).Formoredetailedinformation
aboutthemandaboutotherpromisinginterventions,readersarereferredtorecent
reviews,suchasthosebyBecker(2012),Levine,McVey,andPiran(2014),Piran,
McVey,andLevine(2014),Stice,Becker,andYokum(2013),andYager,Diedrichs,
Ricciardelli,andHalliwell(2013).
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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PreschoolandElementarySchool(Ages3-11)
Althoughtherearesomepromisingprograms(seereviewsbyLevine&
Smolak,2006,2009;seealsoBird,Halliwell,Diedrichs,&Harcourt,2013),todate
thereisnopreventionprogramforchildrenthatclearlyworks,usingthecriteria
discussedinPart1.
MiddleSchool(Ages12-14):Universal-SelectivePrograms
PlanetHealth
Thismultifacetedpreventionprogram,developedinBoston(USA),was
originallyintendedtopreventobesityinearlyadolescencebyalteringtheecologyof
theschooltodecreasetelevisionviewingandconsumptionofhigh-fatfoods,while
encouragingyouthtoconsumemorefruitsandvegetablesandtoincreaseboth
moderateandvigorousphysicalactivity(Austin,Field,Wiecha,Peterson,&
Gortmaker,2005).SchoolsparticipatinginPlanetHealthreceiveteacher-training
workshops,aswellaslessonsconsonantwithstate-mandatedcurriculaforphysical
educationandforawidevarietyofacademicsubjects.Projectleadersalsowork
withfamiliestomodifythehomeenvironmenttoreinforcePlanetHealth’sschool
programs.
Interestingly,intheinitialrandomizedcontrolledtrial(RCT)ofPlanetHealth
theprogramfailedtopreventdevelopment(i.e.,lowertheincidence)ofobesity,
althoughobesityprevalencewasreducedamongfemalestudents.However,Planet
Healthverysignificantlyreduced,overa2-yearperiod,initiationoftwoformsof
disorderedeatingbehavioringirls:purging(self-inducedvomiting)anduseofdiet
pills.StatisticalanalysesindicatedthatPlanetHealthcouldhaveprevented91%of
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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thenewcasesofpurginganddietpillusebygirlswhowerenotdietingatbaseline
(Austinetal.,2005).Thesepositiveresultsforgirls,butnotboys,werereplicated
(preventivefraction=67%)inasecond,verylargeRCTinvolvingover1400girls
andboysingrades6and7in16Massachusettsmiddleschools(Austinetal.,2007).
HealthySchools-HealthyKids
Anotherpreventionprogramdesignedtoengagestaffandstudentsin
analyzingandchangingtheecologyofamiddleschoolwasdevelopedbyGailMcVey
andcolleaguesinToronto,Canada.HealthySchools-HealthyKids(McVey,Tweed,&
Blackmore,2007)providesandcoordinatesstudentlessonsforimprovingbody
image,trainingandcurriculumguidesforteachers,andworkshopsandnewsletters
forparents.Curricularmattersarefurtherintegratedwithsmall,gender-segregated
peersupportgroups,stafftraining,student-ledpublicserviceannouncements,anda
schoolplay.
At6-monthfollow-up,girlsandboysinthe7thgradewhoparticipatedin
HealthySchools-HealthyKidsreportedlessbodydissatisfactionthanacomparison
sample,whilegirlsattendingtheinterventionschoolsalsoreportedless
commitmenttotheslenderbeauty-idealandfewerskippedmeals.UnderMcVey’s
leadership,thesepromisingresultsandthecollaborationwithlocalstakeholders
throughwhichHealthySchools-HealthyKidswasdevelopedhavegeneratedfurther
systemicdevelopments.Prominentamongthemisaweb-basedsetofresources
(matchedtocurriculumexpectationsoftheOntarioandNovaScotiaMinistriesof
Education)forteachersandpublichealthprofessionalswhoworkwithgirlsand
boysages9-12years(Levine&McVey,2012).
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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MediaSmart
Notallexcitingdevelopmentsinuniversal-selectivepreventionatthemiddle
schoollevelareecologicalinnature.InAdelaide,SouthAustralia,SimonWilksch
andTraceyWade(2009)developedan8-lessonmedialiteracyprogramcalled
MediaSmart(seehttp://sparky.socsci.flinders.edu.au/researchonline/projects/5).
Thisinteractiveprogramhelpsgirlsandboystobecomeawareofandanalyzehow
massmediainfluencebodyimage,andthenencouragesstudentstogetinvolvedin
mediaactivismandadvocacy.AnRCT,conductedwithover500grade8students
(ages13-14)infourschools,revealedthat,comparedtothecontrolcondition,Media
Smartreducedweightandshapeconcernsanddietingat30-monthfollowupfor
girlsand6-monthfollowupforboys.Itappearsthat,forreasonsthatarenotyet
known,thismedialiteracyprogramhasamorepositiveeffectonstudentswhowere
initiallymoredepressed(Wilksch&Wade,2014).
ArecentlypublishedRCTwithover1,300grade7andgrade8studentsin
Australia(meanage=13.2)comparedMediaSmartnotonlytoano-intervention
controlcondition,butalsototwointerventionsfocusingonhealth-relatedlifeskills
andonthevalueofhelpingothers,respectively(Wilkschetal.,2014).Giventhefour
conditionseachforboysandgirls,andthepre-and-postassessmentsplus6-and12-
monthfollow-ups,theresultsofthis4X2X4mixeddesignarenoteasily
summarized.Itisfairtosay,however,thatMediaSmartwasthemosteffectivefor
girls,producingthehighestphysicalactivitylevelandthelowestcombinationof
weightandshapeconcerns,eatingconcerns,andperceivedsocialpressuresat
follow-up.Forboys,MediaSmartproducedthelowestinternalizationofmedia
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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messagesat12-monthfollow-upandthehighestactivitylevelat6-monthfollow-up.
AsWilkschetal.(2014)noted,thiscomparativeoutcomestudysupportsfurther
investigationofthevalueofMediaSmartinreducingsimultaneouslyriskfactorsfor
EDsandobesity.
AMM-EC
Forapproximately10yearsnow,RosaRaich,DavidSánchez-Carracedo,and
colleaguesinBarcelona,Spain,havebeencarefullydevelopingandrigorously
evaluatingapreventionprogramforgirlsandboysages12-14(González,Penelo,
Gutiérrez,&Raich,2011;Raich,Sánchez-Carracedo,&López-Guimerá,2008).The
SpanishacronymAMM-ECrepresentswhatSánchez-Carracedo(personal
communication,March14,2015)translatesas"Eating,FeminineBeautyIdealand
theMedia.HowtoTrainSecondarySchoolStudentstobeCritical.”Themostrecent
versionofAMM-ECusesapproximately6.5hours(5sessionsover4-5weeks)of
interactive,multimodalinstructiontocombinenutritioneducationwithacritical
analysisofthefollowing:femalebeautyidealsacrosshistoryandacrosscultures;
thediversityofactualweightsandshapes;howbusinessandadvertisingusemass
mediatoshapeandreinforceanarrowlydefinedandslenderbeautyideal;andwhat
studentscandotomaintainacriticalperspectiveandtouseletterwritingtobe
activistsinprotestingunrealisticandunhealthyadvertising(Gonzálezetal.,2011).
InthemostrecentinaseriesofRCTs,Gonzálezetal.(2011)foundthat,
comparedtoano-interventioncondition,at30-monthfollow-uptheAMM-EC
programresultedinsignificantlylowerscoresondisorderedeatingattitudesand
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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behaviors,andonavalidatedmeasureofinternalizationofthepotentiallyvery
unhealthyweightandshapemessagesemanatingfrom“differentsocialagents
(advertising,verbalmessages,socialmodelsandsocialsituations)”(p.351).
SubsequentstatisticalanalysesbyEspinoza,Penelo,andRaich(2013)showedthat
theAMM-ECprogram,withorwithoutthenutritioneducationcomponent,produced
greaterbodysatisfactionthanwasseeninthecontrolgroupat30-monthfollow-up.
MiddleSchool:Selective-TargetedPrograms
and
HighSchool(Ages14–18):Universal-SelectivePrograms
Onceagain,althoughtherehavebeensomepromisingdevelopments(Levine
&Smolak,2006,2009;Yageretal.,2013),asyetthereisnoselective-targeted
preventionprogramforstudentsages12-14andnouniversal-selectiveprogramfor
highschoolstudents(ages14-18)thatclearlywork,usingthecriteriadiscussedin
Part1.
HighSchool:Indicated/TargetedPrograms
Stice’sBodyProject
Thebestknown,themostwidelyresearched,andthemostrigorously
evaluatednewprogramforEDpreventionisthedissonance-basedapproach
developedbyEricSticeandcolleaguesattheOregonResearchInstitute(USA).The
BodyProjectwasoriginallydesignedtoreduceriskfactorsandEDsymptomsin
youngwomen(ages18-25)whovolunteertoparticipatebecausetheyhavehigh
levelsofbodyimageconcernsorbulimicsymptoms.Thetheory,theextensive
evidencebase,andtheindividuallessonsforthisindicated(or“targeted”)
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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interventionarepresentedindetailina290-pagefacilitatorguide(Stice,Rohde,&
Shaw,2013).
Briefly,TheBodyProject’slessonsandhomeworkassignmentsseekto
generate“cognitivedissonance”byhavingparticipants—workinginfrontofagroup
andwithminimalinducementbyleadersorpeers—voluntarilywrite,make
statements,andbehaveinwaysthatcontradictandchallengeourculture’s(and
theirown)entrenchedinternalizationoftheslenderbeautyideal.Variousfocused
exercisescreatenumerousopportunitiesforparticipantstoengageinacritical
analysisofthenature,origins,andsocioculturalmechanisms,including“fattalk,”
thatpromotethisideal.Toreducedissonance,groupleadersusecognitive-
behavioralexercisesduringgrouptimeandhomeworkassignmentstoguideeach
participantandthegroupinaneffortfulcommitmenttocreatingandenacting
counterargumentstosociety’sglorificationofslendernessandvilificationoffat.One
paramountgoalistohelpparticipantstoresistimpossiblestandardsofself-
managementbybecoming“bodyactivists”(Becker,2012,p.174).
AnRCTconductedbyStice,Rohde,Shaw,andGau(2011)foundthat,
comparedwithcontrols,highschoolgirlswhoparticipatedintheBodyProject
showedgreaterdecreasesinbodydissatisfactionat2-yearfollowupandED
symptomsat3-yearfollowup.FurtheranalysesofthesedatabyStice,Marti,Rohde,
andShaw(2011)indicatedthattheCDprogramworkedbyreducingboth
internalizationofthethinidealandbodydissatisfaction.
Itisnoteworthythat,intheUnitedKingdom,EmmaHalliwellandPhillippa
Diedrichs(2014)havecreatedamodifiedversionofTheBodyProjectasauniversal-
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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selectiveclassroompreventionprogramfor12-to-13-year-oldgirls.Comparedtoa
wait-listcontrolcondition,thisrelativelybriefintervention(fourweekly20-min
sessions)didnotaffectself-reporteddietaryrestraint.However,itdidreduceboth
bodydissatisfactionandinternalizationofathinbodyidealbytheendofthe
intervention.Moreover,amonthlatergirlslearningthecriticalsocialperspective
thatisanessentialpartofTheBodyProjectwereabletoresisttheimmediate
negativeeffectsofmediaimagespresentedinthecontextofaseparateexperiment.
UniversityandCollege(Ages18-25):Universalà SelectivePrograms
Becker’sBodyProjectProgram
Sincetheearly2000s,CarolynBeckerandcolleaguesatTrinityUniversityin
SanAntonio,Texas(USA)havebeendevelopingauniversal-selectiveversionofthe
dissonance-basedBodyProjectpreventionprogram.Theirlineofprogram
developmentandoutcomeevaluationdiffersfromSticeetal.’sworkinfour
importantways(Becker,2012;Becker,Plasencia,Kilpela,Briggs,&Stewart,2014).
First,itwasdesignedtointegratepreventionwithBecker’sroleasprofessorin
teachingundergraduatesandpromotingundergraduateresearch.Second,it
expresslyfocusesonpreventioneffectiveness(vs.efficacy;seePart1ofthisseries)
inreal-lifesettings,includingminimalinvolvementofcostly,sometimesinfeasible
professionaltimecoupledwithlimitedavailabilityoffunds.Focusingon
effectivenesshasmadeiteasiertotrainavarietyofinterestedpartiesinthebasics
oftheprogramandhowtotransportittocollegiatesettingsthatdifferfromTrinity
University.
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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Third,Beckeretal.’sadaptationofTheBodyProjectaddsanecological
perspectivebyengagingyoungwomeninthecollegecommunity(e.g.,sorority
members)aspartnersinleadingtheprogramsandindetermininghowtheprogram
ispresentedinparticularsettings,andhowtheresultingknowledgeisused.Finally,
thisversionofTheBodyProjectalsoembodiesanecologicalapproachbyworking
hardtopromotesustainablechangesinpeerinteractions,healthypeernorms,and
peerleadership.Forexample,professionaland/orsororitypeerleaderswillhave
youngwomen,workingingroupsof7or8drawnfromdifferentsororities,apply
basicelementsoftheBodyProject.Leadershelpthewomentogenerate—and
advocatefor—suggestionsforpolicychangeswithinindividualsororitiesandthe
sororitysystem.Inthisregard,Beckerandcolleaguesrecentlydemonstratedthat
theyhavedevelopedaneffectiveinterventioninwhichtwocriticallyimportant
tasks—groupleaderforprogramimplementationandtrainerofsubsequentpeer
leaders—canbeshiftedfromveryexperiencedprofessionals(e.g.,Becker)toeither
graduatestudentsorundergraduatepeerleaders(Kilpelaetal.,2014).
Programcontent,includingthe9-hourtrainingforpeer-facilitators,andthe
resultsoftheverysuccessfulinitialevaluationstudiesaredescribedindetail
elsewhere(Becker,2012;Becker,Stice,Shaw,&Woda,2009;Beckeretal.,2014).
Morerecently,ithasbeenshownthatamodifiedversionofTheBodyProject
designedforgroupsoffemaleintercollegiateathletes(atvariouslevelsofriskfor
ED)producedsignificantreductionsinbulimicsymptoms,weightandshape
concerns,andnegativeemotionalityat1-yearfollow-up(Becker,McDaniel,Bull,
Powell,&McIntyre,2012).FurtherevaluationofTheBodyProject’seffecton
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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collegiatewomenwhoarenotathletesindicatesthat,aspredicted,long-term
reductionsinriskofEDsymptomsaremediatedbyreductionsinbody
dissatisfaction,whichinturnreflectreductionsinboththin-idealinternalization
andself-objectification(KroonVanDiest&Perez,2013).
UniversityandCollege:Selectiveà Indicated/TargetedPrograms
StudentBodiesTM
StudentBodiesTM(SB)isa6-week,8-lessonmultimediaon-lineprogramfor
collegewomenwhoareatmoderatetohighriskforED.SBisonecomponentofover
20yearsofpreventionprogramdevelopmentandresearchledbyC.BarrTaylorand
colleaguesatStanfordUniversity(California,USA)andbyCorinnaJacobiatthe
TechnischeUniversität(Dresden,Germany;seeBeinter,Jacobi,&Taylor,2012;
Sinton&Taylor,2010).Anexcitingaspectofthisworkisanongoingattemptto
makeSBpartofacampus-wideprogramthatusesavalidatedscreeningtoolto
identifyeachstudent’slevelofriskandthentailorsforthatstudenttheappropriate
levelofpreventionortreatment(Jones,Kass,etal.,2014)
SBisdesignedtopromotehealthyeatingandexercisingandtoreduce
prominentriskfactorssuchasbodydissatisfaction,perceivedpressurestobethin
emanatingfrompeersandmedia,internalizationoftheslenderideal,andweight
andshapeconcerns.Guidedbysocialcognitive,cognitive-behavioral,andfeminist-
criticalmodels,SBoffersinteractivepsychoeducationandcognitive-behavioral
exercises,whileencouragingparticipantstogiveandreceivesocialsupportin
moderatedon-linediscussions.
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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NumerousRCTsintheUSAandGermanyhaveshownthatSBandsimilar
interactiveInternet-basedprogramsareeffectiveoverfollow-upperiodsofupto2
years(Beintneretal.,2012;Sinton&Taylor,2010).Thestatisticalstrengthofthe
reductionsinbodydissatisfactionanddisorderedeatingattitudesandbehaviors
tendtobesmalltomoderate,andthussmallerthanthosetypicallygeneratedbyThe
BodyProject.Nevertheless,SBisparticularlyeffectiveforcollegeoruniversity
femalesathighriskforEDs(Sinton&Taylor,2010).
AnexpandedversionofSBhasbeendevelopedasatargetedprogramfor
integratingpreventionofobesityanddisorderedeatinginoverweightadolescents
(Jonesetal.,2008).StudentBodies-BingeEatingDisorders(SB-BED)features8more
lessonsthatconstituteacognitive-behavioralapproachtoweightreduction,
includingmanagementofover-andbingeeating.Theweb-basedSB-BEDhasbeen
usedsuccessfullywithoverweightadolescentsages14through16asastand-alone
program(Jonesetal.,2008)andaspartofaschool-and-family-basedecological
intervention(StayingFit)foradolescents,regardlessofweight,whohavehighlevels
ofweightandshapeconcerns(Jones,Lynch,etal.,2014).
Stice’sBodyProject
Asnotedabove,TheBodyProjectwasdevelopedforandvalidatedwith
femalecollegestudentsathighriskforED.Itspositiveeffects,sustainedovertime,
havebeendemonstratedinefficacyandeffectivenessstudiesbyresearchteamsat
differentuniversitiesandwithAfricanAmerican,AsianAmerican,Hispanic,and
Whiteparticipants(see,e.g.,Stice,Marti,&Cheng,2014).Severalstudiessupport,
butdonotconclusivelydemonstrate,thatdissonanceinductionanddissonance
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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reductionarepartlyresponsibleforthesepositiveeffects(Becker,2012;Levineet
al.,2014;Sticeetal.,2013).
ArecentstudybyStice,Durant,Rohde,andShaw(2014)demonstrateshow
farthislineofresearchhasadvanced.FemalecollegestudentsatriskforEDdueto
highlevelsofbodydissatisfactionwererandomlyassignedtooneoffourconditions:
TheBodyProject,anInternet-basedversionofTheBodyProject(eBodyProject),or
oneoftwoconditionsthatcontrolledfortheimpactofrelevanteducation.As
comparedtocontrolconditions,theeBodyProjectreducedEDriskfactorsand
symptomsatboth1-and2-yearfollow-up,althoughthesmalltomoderateeffectsof
theInternetprogramweresignificantlylessthanthehigh-moderateeffectsofthe
standardBodyProject.AsStice,Durant,etal.(2014)note,thefindingthattheeBody
Projectproducedlargeweightreductioneffectsrelativetocontrols,andgreater
effectsthanTheBodyProject,haspotentiallyimportantimplicationsforcombined
obesityandEDprevention,
HealthyWeightIntervention
Sticeandcolleaguesinitiallydevelopedahealthyweightmanagement
intervention(HWI)toserveasastrongplacebo-controlinRCTsevaluatingthe
effectsofTheBodyProjectoncollegewomenatriskforED.TheHWIuses
psychoeducation,motivationalinterviewing,andbehaviormodificationtechniques
tofacilitatemodestbutsustainedchangesinknowledge,attitudes,andbehavior
thattogethercanreplacerestrictivedietingandchaoticeatingwithabalanceddiet
andregularexercise.
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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Aseriesofstudies(seeBeckeretal.,2009,e.g.,forareview)demonstrated
that,likeTheBodyProject,at1-yearfollow-uptheHWIproducessignificant
reductionsinEDriskfactors,EDsymptoms(includingbingeeating),andthe
probabilityofbecomingobese.AsisthecaseforTheBodyProject,theHWIalso
reducestheincidenceofclinicallysignificanteatingpathologyat3-yearfollow-up.
AlthoughthecomparativeeffectivenessofTheBodyProjectandtheHWIisa
complicatedissue(Levineetal.,2014),itappearsthattheHWIistheindicated
preventionprogramofchoiceforat-riskadolescentgirlsandemergingadultwomen
whoatprogramoutsethaveahigherBMIandatendencytowardemotionaleating
(Stice,Marti,Shaw,&O’Neill,2008).
IntheBeckeretal.(2012)studydescribedabove,femaleintercollegiate
athletesatvaryinglevelsofEDriskparticipatedinapeer-ledversionoftheHWI.
Thepreventionresultswerejustaspositiveat1-yrfollow-upasthoseforBecker’s
modifiedformoftheBodyProject,butthemodifiedHWIprogramwasmore
acceptabletoathletes.AsBeckeretal.(2012)observed,thisgreateracceptanceof
theHWImayreflecttheathletes’greaterfocusonperformance,relativetobody
imageandtosport-specificornon-specificthinideals.
ConclusionsandFutureDirections
WhatWorks?
Thisreviewsupportsthefollowingbasicconclusions,drawingonPart1’s
extensiveandstrictcriteriafordeterminingwhetherapreventionprogram“works”:
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
14
• Therearecurrentlyseveraleffectivepreventionprogramsformiddleschool
girlsandboys(ages12-14).Thesecanreasonablybecategorizedas
universal-selectiveinterventions(seePart1).
• TheBodyProject,adissonance-basedprogram,iseffectiveforhighschool
females(age14-18)whoareatriskforanEDduehigherlevelsofnegative
bodyimage.Giventhegirls’age,theirgender,andourculturalstandards,
coupledwiththeirlevelofrisk,thisprogramcanreasonablybecategorized
asaselective-indicatedintervention.
• TheBodyProject,deliveredinatraditionalgroupformalorovertheweb,is
oneofthreeselective-indicatedpreventionprogramsthatareeffectivefor
femaleundergraduateswhoareathighriskforanED.Theothertwoare
StudentBodiesandtheHealthyWeightIntervention.
• Becker’speer-led,ecologicalversionofthedissonance-basedTheBody
Projectisaneffective,practicalpreventionprogramforgroupsof
undergraduatewomeninsororitiesandonintercollegiateathleticteams.
Thesewomenatelevatedriskforavarietyofdevelopmentalandperhaps
environmentalreasons,sothisprogramisprobablybestcategorizedas
universal-selective.
WhyandHowPreventionWorks
Itislikelythat,ingeneral,effectiveEDpreventionprogramsworkby
reducingkeyproximalriskfactorssuchasinternalizationoftheslenderbeauty
ideal,bodydissatisfaction,andnegativeemotionality.Morespecifically,dissonance-
basedprogramsprobablyworkinavarietyofways,buttheycertainlyexerttheir
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
15
positiveeffectbygeneratingdissonanceandthenprovidingparticipantswith
cognitive-behavioralskillsforreducingdissonanceandforincreasingresistanceto
negativesocioculturalmessagesglorifyingthinnessandvilifyingbodyfatandfat
people.
Areviewoftheeffectiveprogramshighlightedinthisessay,coupledwitha
reviewofpromisingprogramsdevelopedduringtheyears1990-2005(Levine&
Smolak,2006),indicatesthatthereisgreatvarietyinthenatureofsuccessful
programs.Thismakesithardtogeneralizeabouttheirkeyingredients.Usinga
prototypicalapproach,mycolleaguesandIbelievethatthemoresuccessful
programsreviewedhereandelsewhere(e.g.,Levine&Smolak,2006;Piran,2010)
tendtohave4ormoreofthefollowing7Cs(Levineetal.,2014):
• TheprogrampromotesaCriticalSocialPerspectivethatfostersawareness
andanalysisofsocioculturalriskfactorsoperatingatthecultural(e.g.,
media),subcultural(e.g.,sportsordance),peer,andfamilylevels.
• Ithelpschildren,youth,andyoungadultsdevelopvariousCompetenciesfor
resistingunhealthysocioculturalinfluencesandforpromotinghealthand
resilience.
• ItbuildsConnections(e.g.,fosteringdialogue)betweenparticipants
themselvesandbetweenparticipantsandbothpeerleaders,influential
adults,andthecommunity.
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
16
• Itenablesenablesparticipantstousetheircriticalsocialperspective,their
developingcompetencies,andtheirconnectionstomakeChoicesaboutways
toChangenegativesocioculturalinfluences.
• IthelpsyoungpeopledevelopandextendtheConfidencenecessarytomake
health-promotingchangesinthemselves,theirpeerrelationships,andtheir
cultures.Theprogram,inessence,helpsyoungpeopleandthosewho
supportthemtofindtheCouragetopursuepositivegoals,despiteongoing
anxietyanddoubt,andinthefaceofinevitablecriticism.
FutureDirections
Itisnowaclichétostatethatthereisstillmuchtobedoneindevelopingand
evaluatingprogramsforpreventingEDs.Yet,itsrepetitiondoesnotmakeitanyless
true.Thisreviewsuggeststhat,ataminimum,highpriorityareasforfurtherwork
arefurtherdevelopmentofeffective(1)prevention,acrossthespectrum,forpre-
schoolandelementaryschoolchildren;(2)selective-targetedpreventionformiddle
schoolstudents;(3)universal-selectivepreventionforhighschoolstudents;and(4)
prevention,acrossthespectrum,foryoungadultsinthemilitary,inthefitnessand
bodybuildingworlds,andinnon-collegiatecommunitiesingeneral.Thisdoesnot
meanthattherearenotheoreticalorempiricalguidelinesforpreventioninthese
areas(Levine&Smolak,2006,2009;Yageretal.,2013).Itmeansthatwearefar
fromhavingprogramsthatclearlyworkaccordingtostrictscientificcriteria(see
Part1).
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
17
Whateverthefocusofnewdevelopments,threeotherareasshouldbehigh
priorities.First,weneedtocontinuecreatingprogramsformalesaswellasfemales.
Second,weneedtoblendcurrentecologicalapproachestoprevention(Beckeretal.,
2009;McVeyetal.,2007;Piran,2010)withapublichealthperspectivesoasto
emphasizetheimportanceofcollectiveactionandsocialjusticeintransforming
dominantculturalbeliefsandpracticesintohealthierpracticesregardingweight,
shape,gender,andself-management(Levine&McVey,2012;Piranetal.,2014).The
thirdareafollowsfromthesecond.Sincesimilarpsychosocialfactorsareoperating
inothermentalhealthproblems,weneedworkonpreventionprogramsthatseek
tochange,forexample,depressionandsubstanceabuse,alongwitheatingdisorders
(Beckeretal.,2014;Levine,2014).
ExcitingRecentDevelopmentsinPreventionMichaelP.Levine
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