Body Acceptance PromotionEating Disorder Prevention

University of North Dakota

Freshmen 3033 (22%) 21%

Sophomores 2636 (19%) 23%

Juniors 1919 (14%) 20%

Seniors 3551 (26%) 20%

Graduate 2560 (19%) 10%

Males 7142 (52%) 45%

Females 6557 (48%) 55%

The most potent risk factor for developing an eating disorder is being a woman1.

For all eating disorders combined, the median age of onset was between ages 18 and 212.

5x more prevalent among13 -19 y.o. than other age groups.

3x increase in incidence of AN in females ages 20 to 303,4.

0.9% life-time prevalence of AN among women1.

AN interferes with educational, vocational, and independent functioning5.

AN increases mortality rate and rates of persistent psychological problems5.

Prevalence 1% for adult women and 1-3% among adolescent and young

adult women3,1

Greatest incidence of BN between the ages 16 - 206

3% incidence in the general adult population3

35-50% of adolescent females seeking ED symptom treatment3

Women ages 15-17 with EDNOS, 2-3x more likely to experience depression, anxiety, and substance abuse as young adults7

Subclinical eating disturbances predict onset of obesity, depression, substance abuse, among other health problems8

Prevalence 2-3%• 77% of those are women3,1

At 12 year follow-up:• 1/3 of individuals with BN or BED diagnoses

continued to meet ED criteria• 3.6% were classified as obese (BMI scores ≥

30)1

UND Reference Group

N/A 97.1% 94.8%

Experienced, w/o Affect

2.4% 4.0%

Lower Exam Grade 0.2% 0.6%

Lower Course Grade 0.2% 0.4%

Incomplete/drop 0.1% 0.1%

Thesis Disruption 0.0% 0.2%

Total: 2.9% 5.3%

58-80% of college-aged women have negative body image 9,10

Body dissatisfaction increases during and after transition from high school to college 10

ESTs:• Long-term outcomes for bulimia similar to

no treatment: ~50% at 5 years12

Prevention Programs:• Meta-analysis: 23% effectively reduced ED

symptoms immediately and at follow-up13

• 5% produced effects that lasted 1+ year(s)

13

“I am concerned about my eating habits and my body image.”

190 (30%) reported concern about eating

45 (24%) had subclinical disorder

Outreach programs (2007)

Date Self-assessments (SA)Week before

SAWeek of

SA Week after

Love your body week

1/29 – 2/2

2 4 7

Eating Disorders Awareness Week

2/26 – 3/2

7 7 7

Among UCC clients

2005 – 2006

2006 – 2007

2007 – 2008

2008 – 2009

2009 – 2010

% eating disorders diagnoses

3% 2% 1% 2% 1%

Clients reporting eating concern

Followed through on EDI-RF assessment

Met Criteria for eating- disorderedbehaviors

190 (23%) 129 (16%) 45 (5%)

Developed by Eric Stice• “Programs that Work”

Small & large-scale effectiveness trials

Independently evaluated• Decreased eating disorder rates • Decreased depression rates• Improved body satisfaction• Lowered levels of obesity at follow-up

Introductory Psychology or other Psychology Courses• Offer Extra Credit• Screeners• Online Extra Credit System (SONA Systems)

6 Semesters, 649 female students

65.8% felt moderately to extremely fat

61.3% moderate to extreme fear of fatness

56.8% self-judgments based on weight moderate to severe

54.4% self-judgments based on shape moderate to severe

2.8% laxatives ≥ 1/mo 5.3% self-induce vomiting ≥ 1/mo 5.9% took diet pills ≥1/mo 12.6% fasted for 24hr+ at a time ≥1/mo

• 3.3% ≥1/wk 15.3% take “dietary supplement” ≥1/mo

• 9.5% ≥1/wk 55.5% skipped meals ≥1/mo

• 37.3% ≥1/wk

Four, one-hour meetings, once a week Groups of 8 to 15 members, all female

students, ages 18-25 Two female facilitators Round-table seating with whiteboard Handouts provided Discussion-based content, homework

between sessions (debrief and review)

What you say and argue for/against in front of peers makes you

Disequilibrium or discomfort leads to change

Agree to attendance Agree to confidentiality Agree to participation

• All say “yes” Normalization of body image concern Course introduction/overview

Magazine pictures – collect attributes of “perfect woman”• Traits in opposition• Is it really possible to attain this?

Rich Thin, angular

features Pale Pure Shy Powerful Reserved

www.ralphlauren.com

Thin Tan Perfect skin Large breasts Long, wavy hair Outgoing Adventurous/Free

Spirit

www.victoriassecret.com

Were there other times in history when perfect woman different?

Where did the thin ideal come from?

How promoted to us?

How do such messages make you feel?

What happens if you achieve the ideal?• Really?

Differentiate healthy ideal from thin ideal

Costs of pursuing the thin ideal• Effect on health, relationships, society? • Who does benefit?

Are you one of those people?• Given the costs, does it make sense to

pursue it?

Challenging “Fat Talk”• “she really let herself go,” “your so thin

how do you do it?”• How can you stop this talk? • Can talk impact how you think about your

body?

Future pressure to be thin• Anticipate how to deal with pressure

Role play obsession with thin ideal:• “I just saw an ad for a new diet pill. I’m

going to order it so I can finally be as thin as I want”

• “She doesn’t have the body to be wearing that outfit.”

• Give counter-statements• Debrief

“I am thinking of going on a diet, want to join me?”

“Swimsuit season is just around the corner, and so I think I will start skipping breakfasts to take off some extra weight.”

Write letter to an adolescent girl struggling with body image• Costs

Self-Affirmation • Write down 10 positive qualities• Was it difficult to come up with things?

Why?• Midwest modesty

Verbal Challenge• Real-life thin ideal statements • Actual vs. ideal response?

10 things to resist the thin ideal • Example: Do not buy fashion magazines• Take one from list and do it

Was it difficult? Barriers? Could this make a difference?

Come up with 5 things in your small group that you could do

to resist the thin ideal.

Behavioral Challenge• Do something not done currently due to

body image concerns• Why do this?• Debrief:

Was it as bad as you thought it would be? Did others react? What learned?

What could you do in your own life to reduce the impact of the thin ideal?

Redo: Letter to an adolescent girl• Additional costs?

Redo: Self-Affirmation exercise• Positive Body Talk:

With a friend/family member, talk about your positives Keep a journal of the things your body allows you to do Make a pact with another to avoid negative body talk No complaints about your body – replace them with

positive statements Next time you get a compliment, accept it.

What has the class done for you• Others struggling with same problems• Feel more comfortable with self• Change in how talk about own and others’

bodies

Change from active control in manual

Same four-week group set up

Same size and facilitation

Addresses healthy activity levels and stress management at each meeting.

Addresses special topics each week.

Healthy Lifestyle – focusing mostly in this course on emotional and physical dimensions

Weekly Physical Activity Principles

Weekly Stress Management Principles

Goals set are individually tailored, monitored by facilitators, re-evaluated

Eating Healthy

Equipment/Exercise training at Wellness Center

Access to dietician and physical training staff

Progressive Muscle Relaxation

No group contact

Chosen by• Random selection• No availability • Late sign-up• Did not attend assigned groups

Given option to participate in later semesters in active groups

Demographics Multidimensional Body-Self Relations

Questionnaire (MBSRQ) Positive and Negative Affect Scale (PANAS) Weight Control Survey Ideal Body Stereotype Scale (IBSS) Body Image Quality of Life Inventory (BIQLI) Sociocultural Attitudes Toward Appearance

Questionnaire (SATAQ) Depression Anxiety Stress Scales (DASS) Self-Esteem Scale (SES) Eating Screen

Multivariate Repeated Measures Analysis• Significant interaction of pre/post * group

Appearance Evaluation Health Orientation Body Area Satisfaction Perceived Weight Class Overweight Preoccupation Ideal Body Stereotype Scale Sociocultural Attitudes Toward Attractiveness Quest. Positive Affect Depression Self-Esteem

Multiple Analyses – Bonferroni Correction (p<.002)

At Post-Test: • MBSRQ (Body Image)

BASS Weight Preoccupation

• IBSS (internalization)• SATAQ (body image/internalization)• PANAS – Positive Affect• Self-Esteem

Extra Credit Offerings for classes such as Intro to Psych

Larger groups, break into smaller groups

Sign-up at Love Your Body Week

Sorority – condensed two-meeting group

1: Treasure, Claudino, & Zucker, 2010

2: Hudson et al., 20073: Adams & Sutker,

20044: Pawluck & Gorey,

19985: Pope, Hudson,

Yurgelun-Todd, & Hudson, 1984

6: Keski-Rahkonen et al., 2009

7: Patton, et al. (2008) 8: Stice, Marti, Spoor,

Presnell, & Shaw, 2008

9: Twamley & Davis, 1999

10: Vohs, Heatherton, & Marcia, 2001

11: Seidel, Presnell, & Rosenfield, 2009

12: Fairburn, Cooper, Doll, Norman, & O'Connor, 2000

13. Stice, Shaw, & Marti, 2007

Body Image Quality of Life Inventory (BIQLI) – Cash, T.F. & Flemming, E.C. (2002)

Depression Anxiety Stress Scales (DASS) – Lovibond & Lovibond (1995)

Eating Screen – Stice, E., Fisher, M., Martinez, E. (2004)

Ideal Body Stereo Type Scale (IBSS) – Stice, E.

Multidimensional Body-Self Relations Questionnaire (MBSRQ) – Cash,T.F.

Self-Esteem Scale (SES) - Rosenberg

Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ) – Thompson et al. (2004)

Weight Control Survey – Journal of American College Health

myron.veenstra@email.und.edu

Slides will be available on ACHA site.