Transcript Slide 1

Body Acceptance Promotion
Eating 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
N/A
97.1%
Reference Group
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%
Social
comparison
Compare self
to cultural
ideal
Thin ideal
Cultural
factors
Cultural
stigma of
fatness
Highly
palatable
unhealthy food
Body criticism
by self or
others
Increased
focus on food,
weight, shape
Thin ideal
internalization
Body
Dissatisfaction
 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
 45
(30%) reported concern about eating
(24%) had subclinical disorder
Among UCC clients
2005 –
2006
2006 –
2007
2007 –
2008
2008 –
2009
2009 –
2010
% eating disorders
diagnoses
3%
2%
1%
2%
1%
Outreach
programs
(2007)
Date
Self-assessments
(SA)
Week before
SA
Week of
SA Week
after
Love your body
week
1/29 –
2/2
2
4
7
Eating Disorders 2/26 –
Awareness Week 3/2
7
7
7
Clients reporting
eating concern
Followed through on
EDI-RF assessment
Met Criteria for
eating- disordered
behaviors
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
Action
Thoughts/
Statements
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
 Pale
 Pure
 Shy
 Powerful
 Reserved
www.ralphlauren.com
features
 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
• Really?
if you achieve the ideal?
 Differentiate
 Costs
healthy ideal from thin ideal
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., 2007
3: Adams & Sutker, 2004
4: Pawluck & Gorey, 1998
5: 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 BodySelf 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
[email protected]
Slides will be available on ACHA site.