Body Acceptance Promotion Eating Disorder Prevention Body Project
Jo Wilcox, M. A. Myron Veenstra, Ph. D. University of North Dakota
Fall 2010 UCC: Academic Standing Freshmen 3033 (22%) 21% Sophomores 2636 (19%) 23% Juniors 1919 (14%) 20% Seniors 3551(26%) 20% Graduate 2560 (19%) 10%
Fall 2010 UCC: Gender Males 7142 (52%) 45% Females 6557 (48%) 55%
The most potent risk factor for developing an eating disorder is being a woman 1. For all eating disorders combined, the median age of onset was between ages 18 and 212.
Anorexia Nervosa 5 x more prevalent among 13 -19 y. o. than other age groups. 3 x increase in incidence of AN in females ages 20 to 303, 4. 0. 9% life-time prevalence of AN among women 1. AN interferes with educational, vocational, and independent functioning 5. AN increases mortality rate and rates of persistent psychological problems 5.
Bulimia Nervosa Prevalence 1% for adult women and 1 -3% among adolescent and young adult women 3, 1 Greatest incidence of BN between the ages 16 - 206
Eating Disorder NOS 3% incidence in the general adult population 3 35 -50% of adolescent females seeking ED symptom treatment 3 Women ages 15 -17 with EDNOS, 2 -3 x more likely to experience depression, anxiety, and substance abuse as young adults 7 Subclinical eating disturbances predict onset of obesity, depression, substance abuse, among other health problems 8
Binge Eating Disorder Prevalence 2 -3% • 77% of those are women 3, 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
ACHA/NCHA (2010): Within the last 12 months, have any of the following (ED symptoms) affected your academic performance? 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% Thesis Disruption 0. 0% 0. 2% Total: 2. 9% 5. 3%
Theory of Pathogenesis Social comparison 1, 10 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
Body Image , Dissatisfaction, and Thin Ideal Internalization 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
Current Treatments ESTs: • Long-term outcomes for bulimia similar to no treatment: ~50% at 5 years 12 Prevention Programs: • Meta-analysis: 23% effectively reduced ED symptoms immediately and at follow-up 13 • 5% produced effects that lasted 1+ year(s) 13
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UCC 2006 -2007 Subclinical “I am concerned about my eating habits and my body image. ” 190 (30%) reported concern about eating 45 (24%) had subclinical disorder
Marketing an Eating Disorder Treatment Among UCC clients 2005 – 2006 – 2007 – 2008 – 2009 – 2010 % eating disorders diagnoses 3% 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 7 7 Eating Disorders 2/26 – 7 Awareness 3/2 Week Clients reporting Followed through on eating concern EDI-RF assessment 190 (23%) 129 (16%) Met Criteria for eating- disordered behaviors 45 (5%)
Body Project 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
Our Population Introductory Psychology or other Psychology Courses • Offer Extra Credit • Screeners • Online Extra Credit System (SONA Systems) 6 Semesters, 649 female students
Body Image 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
Eating Disordered Behavior 2. 8% laxatives ≥ 1/mo 5. 3% self-induce vomiting ≥ 1/mo 5. 9% took diet pills ≥ 1/mo 12. 6% fasted for 24 hr+ 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
Intervention Format 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)
Cognitive Dissonance What Action Thoughts/ Statements you say and argue for/against in front of peers makes you Disequilibrium or discomfort leads to change
Creating a Group Environment Agree to attendance Agree to confidentiality Agree to participation • All say “yes” Normalization of body image concern Course introduction/overview
Discussion: Establish “Thin Ideal” Magazine pictures – collect attributes of “perfect woman” • Traits in opposition • Is it really possible to attain this?
What is the Ideal Woman Like? 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
Discussion: Establish “Thin Ideal” 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?
Discussion: Establish “Thin 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?
Discussion 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 Plays 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
Arguing Against the Thin Ideal “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. ”
Homework Exercises 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
Homework Exercises 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?
Social Activism Come up with 5 things in your small group that you could do to resist the thin ideal.
Homework Exercises 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?
Personal Activism What could you do in your own life to reduce the impact of the thin ideal?
Homework Exercises 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.
Anecdotal Feedback 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
Active Control: Wellness Program 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.
Wellness/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
Special Activities/Topics Eating Healthy Equipment/Exercise training at Wellness Center Access to dietician and physical training staff Progressive Muscle Relaxation
Waitlist Group 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
Outcome Measures 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 Analyses 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
Univariate Analyses 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
BASS – Body Image
Overweight Preoccupation – Body Image
SATAQ – Body Image/Internalization
IBSS - Internalization
Positive Affect
Self-Esteem
Application of the program on the College Campus 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
Works Cited 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
Measures 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
Contact myron. veenstra@email. und. edu Slides will be available on ACHA site.
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