Reducing Eating Disorder Risk Factors Among College-Aged Males
Condition: Eating Disorder
MeSH terms: Feeding and Eating Disorders
Study type: Interventional

Summary: 
      The purpose of the present study was to investigate the acceptability and efficacy of a
      cognitive dissonance-based (DB) intervention in reducing eating disorder and muscle
      dysmorphia risk factors in men with body dissatisfaction. The investigators hypothesized that
      the program would reduce eating disorder risk factors to a greater degree compared to wait
      list control and that these effects would be maintained at 1 month follow-up.
    

Detailed description: 
      BACKGROUND & PURPOSE The current project sought to examine the acceptability and efficacy of
      a cognitive dissonance-based (DB) eating disorder prevention program for college-aged men
      with body image concerns. Eating disorders represent a public health problem for which
      efficacious, disseminable treatments largely remain unknown, particularly for males.
      Epidemiological data support the increasing prevalence of eating disorders and body image
      concerns among men; however, few programs have been developed to address concerns relevant to
      men, and many men feel uncomfortable in programs that identify eating disorders as a "female"
      problem. Given that eating disorders are particularly difficult to treat, disseminable
      interventions that can target high-risk groups prior to eating disorder onset may be the best
      way to reduce the public health burden associated with eating disorders. As body image
      concerns represent the most potent and consistent risk factor for developing eating disorders
      in males and females, men with body image concerns represent one such high-risk, but
      underserved, group.

      Recent prevention research has used DB principles to challenge thin-ideal internalization to
      decrease the likelihood of developing an eating disorder in female youth. Additionally, the
      investigators recently adapted and evaluated a DB program for gay males (The PRIDE Body
      Project), who represent another high-risk group among men. Dissonance theory states that when
      individuals engage in counter-attitudinal behavior they experience psychological discomfort,
      leading them to alter their attitudes to be congruent with their behavior. Several studies
      have supported the efficacy of DB programs in reducing eating disorder risk among females and
      results from The PRIDE Body Project extends the efficacy of these programs to gay males.
      These DB interventions have utilized peer co-leaders, capitalizing on the importance of peer
      influences on eating behaviors among college-aged females and males.

      To date, other than The PRIDE Body Project, no studies have examined eating disorder
      prevention interventions for high-risk groups of males. Notably, the success of The PRIDE
      Body Project and several lines of research support that adapting a DB program may also be
      helpful in reducing eating disorder risk among young men with body image concerns. First,
      internalization of the mesomorphic ideal plays a central role in risk for developing eating
      pathology in males. Thus, an intervention targeting internalization of this body ideal may be
      particularly helpful for males. Second, studies support that peers influence body
      dissatisfaction and disordered eating in males concurrently and prospectively through
      socialization. This suggests that men, regardless of sexual orientation, may benefit from a
      peer-led DB program to address body image concerns. This work could fill a critical gap in
      the care provided to a growing demographic among those who suffer from eating disorders.

      Thus, the aim of the present study was to determine the acceptability and efficacy of
      adapting a cognitive DB intervention for use in college-aged men with body image concerns.
      112 men with body image concerns were recruited to participate in a randomized controlled
      trial (RCT), in which they were randomized into either a DB intervention (n=52) or wait list
      control (WL) condition (n=60).

      The investigators hypothesized that: (1) The men in the DB group would show significantly
      greater reductions on all measures compared to men in the WL group; and (2) Differences
      between groups would be maintained at 4-week follow-up.

      DESIGN Participants Participants (n=112) were recruited through introductory and upper
      division psychology classes at Florida State University (FSU), through the psychology
      research participant pool, and advertisements around the campus and local community. Based on
      retention rates in The PRIDE Body Project, the investigators estimated a 75% retention rate.
      Analyses support that the expected sample size should provide sufficient power to detect
      group differences, based on effect sizes from previous DB studies.

      Procedure All participants first completed an eligibility phone screen to determine whether
      they met study eligibility criteria. Participants who qualified for and were interested in
      participating in the study were directed to complete the online consent form.

      This intervention was adapted from a two-session DB intervention that the investigators
      developed for gay men, which was originally adapted for women to address risk factors
      specific to males with body image concerns, regardless of sexual orientation. Participants
      completed baseline measures assessing eating disorder and muscle dysmorphia risk factors,
      which were selected based on demonstrated reliability and validity in previous studies,
      particularly for use in men.

      The two, 2-hour intervention sessions were spaced one week apart. Intervention groups
      included 4-10 members each and took place at the FSU psychology building. The investigator
      and an undergraduate peer co-leader facilitated all intervention groups. During Session 1,
      participants: (a) defined the male "body-ideal", (b) discussed the origin/perpetuation of the
      "body-ideal", (c) brainstormed costs of pursuing the "ideal", (d) participated in verbal
      challenges countering the "body-ideal" message, and (e) were assigned homework assignments.
      In Session 2 participants: (a) reviewed homework, (b) engaged in role plays to counter
      pursuit of the "body-ideal" (c) discussed ways to challenge and avoid negative "body talk"
      (d) listed ways to resist pressures to pursue this ideal both individually and at the
      university level (termed "body activism") and (e) selected an exit exercise to practice
      positive body talk. All intervention sessions were audiotaped to ensure facilitator adherence
      to the protocol.

      Baseline measures were repeated for both conditions immediately post-intervention/after a
      one-week interval and 4-weeks post-intervention/after a five-week interval, to assess
      immediate and longer-term effects.

      Data Analytic Plan The data analytic approach utilized hierarchical linear modeling (HLM), to
      control for repeated assessments of participants nested within groups.
    

Intervention name(s): The Body Project: More Than Muscles
Intervention type(s): Behavioral
Intervention description(s): Participants complete a variety of activities designed to counter internalization of the lean, muscular body ideal for men.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: prevention; eating disorder; men; intervention; muscle dysmorphia; peer-led