Advertisement

Integrating eating disorder and weight gain prevention: a pilot and feasibility trial of INSPIRE

  • Courtney C. SimpsonEmail author
  • C. Blair Burnette
  • Suzanne E. Mazzeo
Original Article
  • 24 Downloads

Abstract

Purpose

The current study adapted evidence-based prevention programs to promote positive health behaviors among racially and ethnically diverse young adult women. Two successful programs (The Body Project and the Healthy Weight Intervention) were integrated to evaluate their feasibility, acceptability, and preliminary efficacy in reducing risk for both eating pathology and weight gain. Intervention features extended the previous prevention efforts by emphasizing broad appearance ideals to enhance relevancy for women of color and incorporating distress tolerance and emotion regulation skills training.

Method

Individuals were excluded if they met criteria for an eating disorder diagnosis and/or obesity, as this was a prevention project. 27 young adult women participated (M age = 18.59; SD = 1.01). The following racial/ethnic groups were represented: 48.1% White, 25.9% Asian, 22.2% Black, and 3.7% Latina. After each meeting, participants completed satisfaction measures and therapists assessed intervention feasibility. Participants also completed comprehensive questionnaires at pretest (baseline), posttest (8 weeks), and 4-week follow-up.

Results

Descriptive statistics and content analyses of open-ended questions indicated that the intervention was both acceptable and feasible. Hierarchical linear models evaluating within-subject change over time indicated reductions in several risk factors that were sustained at follow-up: eating pathology, appearance dissatisfaction, thin-ideal internalization, restrained eating, negative affect, emotion dysregulation, and fat intake. BMI did not change from pretest to posttest; however, BMI increased from posttest to follow-up (mean weight increase = 0.34 kg).

Conclusion

Results suggest that a prevention program designed to be more culturally sensitive is feasible and acceptable. Findings provide preliminary support for reducing the risk of eating pathology and promoting positive health behaviors.

Level of evidence

Time series with intervention, Level IV.

Trial registration

ClinicalTrails.gov ID: NCT03317587.

Keywords

Prevention Eating disorders Weight gain Body image Diversity 

Notes

Acknowledgements

The authors would like to offer sincere thanks to the individuals who contributed to the implementation of this study, including Melissa Kwitowski, Rachel Boutté, Alex Davies, Neha Goel, and Ashley MacPherson.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.

Human and animal rights statement

All procedures performed in the study involving human participants were in accordance with the ethical standards of the host institutional.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Fabricatore AN, Wadden TA (2006) Obesity. Annu Rev Clin Psychol 2:357–377.  https://doi.org/10.1146/annurev.clinpsy.2.022305.095249 CrossRefGoogle Scholar
  2. 2.
    Klump KL, Bulik CM, Kaye WH et al (2009) Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 42:97–103.  https://doi.org/10.1002/eat.20589 CrossRefGoogle Scholar
  3. 3.
    Luppino FS, Wit LMD, Bouvy PF et al (2010) Overweight, obesity, and depression. Arch Gen Psychiatry 67:220–229.  https://doi.org/10.1001/archgenpsychiatry.2010.2 CrossRefGoogle Scholar
  4. 4.
    Stice E, Marti CN, Rohde P (2013) Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol 122:445–457.  https://doi.org/10.1037/a0030679 CrossRefGoogle Scholar
  5. 5.
    Rancourt D, McCullough MB (2015) Overlap in eating disorders and obesity in adolescence. Curr Diab Rep 15:78.  https://doi.org/10.1007/s11892-015-0645-y CrossRefGoogle Scholar
  6. 6.
    Irving LM, Neumark-Sztainer D (2002) Integrating the prevention of eating disorders and obesity: feasible or futile? Prev Med (Baltim) 34:299–309.  https://doi.org/10.1006/pmed.2001.0997 CrossRefGoogle Scholar
  7. 7.
    Flegal KM, Kit BK, Orpana H, Graubard BI (2013) Association of all-cause mortality with overweight and obesity using standard body mass index categories. J Am Med Assoc 309:71–82.  https://doi.org/10.1001/jama.2012.113905 CrossRefGoogle Scholar
  8. 8.
    Hudson JI, Hiripi E, Pope HG, Kessler RC (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61:348–358.  https://doi.org/10.1016/j.biopsych.2006.03.040 CrossRefGoogle Scholar
  9. 9.
    Darby A, Hay P, Mond J et al (2009) The rising prevalence of comorbid obesity and eating disorder behaviors from 1995 to 2005. Int J Eat Disord 42:104–108.  https://doi.org/10.1002/eat.20601 CrossRefGoogle Scholar
  10. 10.
    Boutelle K, Neumark-sztainer D, Story M, Resnick M (2002) Weight control behaviors among obese, overweight, and nonoverweight adolescents. J Pediatr Psychol 27:531–540.  https://doi.org/10.1093/jpepsy/27.6.531 CrossRefGoogle Scholar
  11. 11.
    Da Luz FQ, Sainsbury A, Mannan H et al (2017) Prevalence of obesity and comorbid eating disorder behaviors in South Australia from 1995 to 2015. Int J Obes 41:1148–1153.  https://doi.org/10.1038/ijo.2017.79 CrossRefGoogle Scholar
  12. 12.
    Kass AE, Jones M, Kolko RP et al (2015) Universal prevention efforts should address eating disorder pathology across the weight spectrum: implications for screening and intervention on college campuses. Eat Behav 25:74–80.  https://doi.org/10.1016/j.eatbeh.2016.03.019 CrossRefGoogle Scholar
  13. 13.
    Neumark-Sztainer D, Wall M, Guo J et al (2006) Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J Am Diet Assoc 106:559–568.  https://doi.org/10.1016/j.jada.2006.01.003 CrossRefGoogle Scholar
  14. 14.
    Sim LA, Lebow J, Billings M (2013) Eating disorders in adolescents with a history of obesity. Pediatrics 132:e1026–e1030.  https://doi.org/10.1542/peds.2012-3940 CrossRefGoogle Scholar
  15. 15.
    Neumark-Sztainer D (2003) Obesity and eating disorder prevention: An integrated approach? Adolesc Med 14:159–173Google Scholar
  16. 16.
    Acosta A, Abu Dayyeh BK, Port JD, Camilleri M (2014) Recent advances in clinical practice challenges and opportunities in the management of obesity. Gut 63:687–695.  https://doi.org/10.1136/gutjnl-2013-306235 CrossRefGoogle Scholar
  17. 17.
    Fairburn CG (2005) Evidence-based treatment of anorexia nervosa. Int J Eat Disord 37:S26–S30.  https://doi.org/10.1002/eat.20112 CrossRefGoogle Scholar
  18. 18.
    Stice E, Marti CN, Spoor S et al (2008) Dissonance and healthy weight eating disorder prevention programs: long-term effects from a randomized efficacy trial. J Consult Clin Psychol 76:329–340.  https://doi.org/10.1037/0022-006X.76.2.329 CrossRefGoogle Scholar
  19. 19.
    Stice E, Rohde P, Shaw H, Gau JM (2018) An experimental therapeutics test of whether adding dissonance-induction activities improves the effectiveness of a selective obesity and eating disorder prevention program. Int J Obes 42:462–468.  https://doi.org/10.1038/ijo.2017.251 CrossRefGoogle Scholar
  20. 20.
    Le LKD, Barendregt JJ, Hay P, Mihalopoulos C (2017) Prevention of eating disorders: a systematic review and meta-analysis. Clin Psychol Rev 53:46–58.  https://doi.org/10.1016/j.cpr.2017.02.001 CrossRefGoogle Scholar
  21. 21.
    Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 128:825–848.  https://doi.org/10.1037//0033-2909.128.5.825 CrossRefGoogle Scholar
  22. 22.
    Schaefer LM, Burke NL, Thompson JK (2018) Thin-ideal internalization: how much is too much? Eat Weight Disord.  https://doi.org/10.1007/s40519-018-0498-x Google Scholar
  23. 23.
    Becker CB, Stice E (2017) From efficacy to effectiveness to broad implementation: evolution of the body project. J Consult Clin Psychol 85:767–782.  https://doi.org/10.1037/ccp0000204 CrossRefGoogle Scholar
  24. 24.
    Stice E, Rohde P, Shaw H, Gau JM (2017) Clinical-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: acute effectiveness of these delivery modalities. J Consult Clin Psychol 85:883–895.  https://doi.org/10.1037/ccp0000211 CrossRefGoogle Scholar
  25. 25.
    Stice E (2001) A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect. J Abnorm Psychol 110:124–135.  https://doi.org/10.1037/0021-843X.110.1.124 CrossRefGoogle Scholar
  26. 26.
    Schaefer LM, Burke NL, Anderson LM et al (2018) Comparing internalization of appearance ideals and appearance-related pressures among women from the United States, Italy, England, and Australia. Eat Weight Disord.  https://doi.org/10.1007/s40519-018-0544-8 Google Scholar
  27. 27.
    Stice E, Shaw H, Becker CB, Rohde P (2008) Dissonance-based interventions for the prevention of eating disorders: using persuasion principles to promote health. Prev Sci 9:114–128.  https://doi.org/10.1007/s11121-008-0093-x CrossRefGoogle Scholar
  28. 28.
    Stice E, Shaw H, Burton E, Wade E (2006) Dissonance and healthy weight eating disorder prevention programs: a randomized efficacy trial. J Consult Clin Psychol 74:263–275.  https://doi.org/10.1037/0022-006X.74.2.263 CrossRefGoogle Scholar
  29. 29.
    Stice E, Rohde P, Shaw H, Marti CN (2013) Efficacy trial of a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain among female college students: 1- and 2-year follow-up effects. J Consult Clin Psychol 80:164–170.  https://doi.org/10.1037/a0026484 CrossRefGoogle Scholar
  30. 30.
    Shaw HE, Stice E, Becker CB (2010) Preventing eating disorders. Child Adolesc Psychiatr Clin 18:199–207.  https://doi.org/10.1016/j.chc.2008.07.012 CrossRefGoogle Scholar
  31. 31.
    Warren CS, Gleaves DH, Cepeda-Benito A et al (2005) Ethnicity as a protective factor against internalization of a thin ideal and body dissatisfaction. Int J Eat Disord 37:241–249.  https://doi.org/10.1002/eat.20102 CrossRefGoogle Scholar
  32. 32.
    Grabe S, Hyde JS (2006) Ethnicity and body dissatisfaction among women in the United States: a meta-analysis. Psychol Bull 132:622–640.  https://doi.org/10.1037/0033-2909.132.4.622 CrossRefGoogle Scholar
  33. 33.
    Rakhkovskaya LM, Warren CS (2014) Ethnic identity, thin-ideal internalization, and eating pathology in ethnically diverse college women. Body Image 11:438–445.  https://doi.org/10.1016/j.bodyim.2014.07.003 CrossRefGoogle Scholar
  34. 34.
    Crago M, Shisslak CM, Estes LS (1996) Eating disturbances among American minority groups: a review. Int J Eat Disord 19:239–248.  https://doi.org/10.1002/(SICI)1098-108X(199604)19:3%3c239:AID-EAT2%3e3.0.CO;2-N CrossRefGoogle Scholar
  35. 35.
    Stice E, Becker CB, Yokum S (2013) Eating disorder prevention: current evidence-base and future directions. Int J Eat Disord 46:478–485.  https://doi.org/10.1002/eat.22105 CrossRefGoogle Scholar
  36. 36.
    Horney AC, Stice E, Rohde P (2015) An examination of participants who develop an eating disorder despite completing an eating disorder prevention program: implications for improving the yield of prevention efforts. Prev Sci 16:518–526.  https://doi.org/10.1007/s11121-014-0520-0 CrossRefGoogle Scholar
  37. 37.
    Stice E, Shaw HE (2002) Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. J Psychosom Res 53:985–993.  https://doi.org/10.1016/S0022-3999(02)00488-9 CrossRefGoogle Scholar
  38. 38.
    Goossens L, Braet C, Van Vlierberghe L, Mels S (2009) Loss of control over eating in overweight youngsters: the role of anxiety, depression and emotional eating. Eur Eat Disord Rev 17:68–78.  https://doi.org/10.1002/erv.892 CrossRefGoogle Scholar
  39. 39.
    Hawkins RC, Clement PF (1984) Binge eating: measurement problems and a conceptual model. In: Hawkins RC, Fremous WJ, Clement PF (eds) The binge purge syndrome: diagnosis, treatment, and research. Springer, New YorkGoogle Scholar
  40. 40.
    Sánchez-Carracedo D, Neumark-Sztainer D, López-Guimerà G (2012) Integrated prevention of obesity and eating disorders: barriers, developments and opportunities. Public Health Nutr 15:2295–2309.  https://doi.org/10.1017/S1368980012000705 CrossRefGoogle Scholar
  41. 41.
    Ferrari M (2015) Understanding the feasibility of integrating the eating disorders and obesity fields: the beyond obesity and disordered eating in youth (BODY) Study. Eat Weight Disord 20:257–269.  https://doi.org/10.1007/s40519-014-0172-x CrossRefGoogle Scholar
  42. 42.
    Stice E, Marti CN, Durant S (2011) Risk factors for onset of eating disorders: evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 49:622–627.  https://doi.org/10.1016/j.brat.2011.06.009 CrossRefGoogle Scholar
  43. 43.
    Whiteside U, Chen E, Neighbors C et al (2007) Difficulties regulating emotions: do binge eaters have fewer strategies to modulate and tolerate negative affect? Eat Behav 8:162–169.  https://doi.org/10.1016/j.eatbeh.2006.04.001 CrossRefGoogle Scholar
  44. 44.
    Linehan MM (2014) DBT® skills training manual, 2nd edn. Guilford Press, New YorkGoogle Scholar
  45. 45.
    Sparling PB (2007) Obesity on campus. Prev Chronic Dis 4:A72Google Scholar
  46. 46.
    Campbell DT, Stanley JC (1963) Experimental and quasi-experimental designs for research. Rand McNally, ChicagoGoogle Scholar
  47. 47.
    Stice E, Telch CF, Rizvi SL (2000) Development and validation of the Eating Disorder Diagnostic Scale: a brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychol Assess 12:123–131.  https://doi.org/10.1037/1040-3590.12.2.123 CrossRefGoogle Scholar
  48. 48.
    Stice E, Fisher M, Martinez E (2004) Eating disorder diagnostic scale: additional evidence of reliability and validity. Psychol Assess 16:60–71.  https://doi.org/10.1037/1040-3590.16.1.60 CrossRefGoogle Scholar
  49. 49.
    Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16:363–370.  https://doi.org/10.1002/1098-108X(199412)16:4%3c363:AID-EAT2260160405%3e3.0.CO;2-%23 Google Scholar
  50. 50.
    Goldfein J, Devlin MJ, Kamenetz C (2005) Eating disorder examination-questionnaire with and without instruction to assess binge eating in patients with binge eating disorder. Int J Eat Disord 37:107–111.  https://doi.org/10.1002/eat.20075 CrossRefGoogle Scholar
  51. 51.
    Cooper Z, Fairburn C (1987) The eating disorder examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 6:1–8.  https://doi.org/10.1002/1098-108X(198701)6:1%3c1:AID-EAT2260060102%3e3.0.CO;2-9 CrossRefGoogle Scholar
  52. 52.
    Luce KH, Crowther JH (1999) The reliability of the eating disorder examination self-report questionnaire version (EDE-Q). Int J Eat Disord 25:349–351.  https://doi.org/10.1002/(SICI)1098-108X(199904)25:3%3c349:AID-EAT15%3e3.0.CO;2-M CrossRefGoogle Scholar
  53. 53.
    Luce KH, Crowther JH, Pole M (2008) Eating disorder examination questionnaire (EDE-Q): norms for undergraduate women. Int J Eat Disord 41:273–276.  https://doi.org/10.1002/eat.20504 CrossRefGoogle Scholar
  54. 54.
    Cash TF, Szymanski ML (1995) The development and validation of the Body-Image Ideals Questionnaire. J Pers Assess 64:466–477.  https://doi.org/10.1207/s15327752jpa6403_6 CrossRefGoogle Scholar
  55. 55.
    Stice E, Ziemba C, Margolis J, Flick P (1996) The dual pathway model differentiates bulimics, subclinical bulimics, and controls: testing the continuity hypothesis. Behav Ther 27:531–549.  https://doi.org/10.1016/S0005-7894(96)80042-6 CrossRefGoogle Scholar
  56. 56.
    Van Strien T, Frijters JER, van Staveren WA et al (1986) The predictive validity of the Dutch restrained eating scale. Int J Eat Disord 5:747–755.  https://doi.org/10.1002/1098-108X(198605)5:4%3c747:AID-EAT2260050413%3e3.0.CO;2-6 CrossRefGoogle Scholar
  57. 57.
    Gratz KL, Roemer L (2004) Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 26:41–54.  https://doi.org/10.1023/B:JOBA.0000007455.08539.94 CrossRefGoogle Scholar
  58. 58.
    Watson D, Clark LA (1992) Affects separable and inseparable: on the hierarchical arrangement of the negative affects. J Pers Soc Psychol 62:489–505.  https://doi.org/10.1037/0022-3514.62.3.489 CrossRefGoogle Scholar
  59. 59.
    Block G, Gillespie C, Rosenbaum EH, Jenson C (2000) A rapid food screener to assess fat and fruit and vegetable intake. Am J Prev Med 18:284–288.  https://doi.org/10.1016/S0749-3797(00)00119-7 CrossRefGoogle Scholar
  60. 60.
    Block G, Woods M, Potosky A, Clifford C (1990) Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol 43:1327–1335.  https://doi.org/10.1016/0895-4356(90)90099-B CrossRefGoogle Scholar
  61. 61.
    Sallis JF, Haskell WL, Wood PD et al (1985) Physical activity assessment methodology in the Five-City project. Am J Epidemiol 121:91–106.  https://doi.org/10.1093/oxfordjournals.aje.a113987 CrossRefGoogle Scholar
  62. 62.
    Dishman RK, Steinhardt M (1988) Reliability and concurrent validity for a 7-d re-call of physical activity in college students. Med Sci Sports Exerc 20:14–25CrossRefGoogle Scholar
  63. 63.
    Elo S, Kyngas H (2007) The qualitative content analysis process. J Adv Nurs 62:107–115.  https://doi.org/10.1111/j.1365-2648.2007.04569.x CrossRefGoogle Scholar
  64. 64.
    Gueorguieva R, Krystal JH (2004) Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Arch Gen Psychiatry 61:310.  https://doi.org/10.1001/archpsyc.61.3.310 CrossRefGoogle Scholar
  65. 65.
    Meyers LS, Gamst G, Guarino AJ (2016) Applied multivariate research: design and interpretation, 3rd edn. Sage Publications Inc., Thousand OaksGoogle Scholar
  66. 66.
    Bryk AS, Raudenbush SW (1992) Hierarchical linear models: applications and data analysis methods. Sage Publications, Newbury ParkGoogle Scholar
  67. 67.
    Kilpela LS, Schaumberg KE, Hopkins LB, Becker CB (2017) Mechanisms of action during a dissonance-based intervention through 14-month follow-up: the roles of body shame and body surveillance. Body Image 23:171–175.  https://doi.org/10.1016/j.bodyim.2017.10.003 CrossRefGoogle Scholar
  68. 68.
    Sherwood NE, Jeffery RW, French SA et al (2000) Predictors of weight gain in the Pound of Prevention study. Int J Obes Relat Metab Disord 24:395–403.  https://doi.org/10.1038/sj.ijo.0801169 CrossRefGoogle Scholar
  69. 69.
    St Jeor S, Brunner R, Harrington M et al (1997) A classification system to evaluate weight maintainers, gainers, and losers. J Am Diet Assoc 97:481–488.  https://doi.org/10.1016/S0002-8223(97)00126-0 CrossRefGoogle Scholar
  70. 70.
    Thompson JK, Stice E (2001) Thin-ideal internalization: mounting evidence for a new risk factor for body-image disturbance and eating pathology. Curr Dir Psychol Sci 10:181–183.  https://doi.org/10.1111/1467-8721.00144 CrossRefGoogle Scholar
  71. 71.
    Betz DE, Ramsey LR (2017) Should women be “All About That Bass?”: diverse body-ideal messages and women’s body image. Body Image 22:18–31.  https://doi.org/10.1016/j.bodyim.2017.04.004 CrossRefGoogle Scholar
  72. 72.
    Stice E, Rohde P, Butryn ML et al (2015) Effectiveness trial of a selective dissonance-based eating disorder prevention program with female college students: effects at 2- and 3-year follow-up. Behav Res Ther 71:20–26.  https://doi.org/10.1016/j.brat.2015.05.012 CrossRefGoogle Scholar
  73. 73.
    Vella-Zarb RA, Elgar FJ (2009) The “freshman 5”: a meta-analysis of weight gain in the freshman year of college. J Am Coll Heal 58:161–166.  https://doi.org/10.1080/07448480903221392 CrossRefGoogle Scholar
  74. 74.
    Stice E, Rohde P, Shaw H, Marti CN (2012) Efficacy trial of a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain among female college students. J Consult Clin Psychol 80:164–170.  https://doi.org/10.1037/a0026484 CrossRefGoogle Scholar
  75. 75.
    Rohde P, Desjardins CD, Arigo D et al (2018) Mediators of two selective prevention interventions targeting both obesity and eating disorders. Behav Res Ther 106:8–17.  https://doi.org/10.1016/j.brat.2018.04.004 CrossRefGoogle Scholar
  76. 76.
    Gardner CD, Trepanowski JF, Gobbo LCD et al (2018) Effect of low-fat VS low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion the DIETFITS randomized clinical trial. JAMA 319:667–679.  https://doi.org/10.1001/jama.2018.0245 CrossRefGoogle Scholar
  77. 77.
    Slavin J, Lloyd B (2012) Health benefits of fruits and vegetables. Adv Nutr 3:506–516.  https://doi.org/10.3945/an.112.002154.506 CrossRefGoogle Scholar
  78. 78.
    Stice E, Presnell K, Gau J, Shaw H (2007) Testing mediators of intervention effects in randomized controlled trials: an evaluation of two eating disorder prevention programs. J Consult Clin Psychol 75:20–32.  https://doi.org/10.1037/0022-006X.75.1.20 CrossRefGoogle Scholar
  79. 79.
    Sylvia LG (2015) A practical guide to measuring physical activity. J Acad Nutr Diet 114:199–208.  https://doi.org/10.1016/j.jand.2013.09.018.A CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PsychologyVirginia Commonwealth UniversityRichmondUSA
  2. 2.Departments of Psychology and PediatricsVirginia Commonwealth UniversityRichmondUSA

Personalised recommendations