Evaluating Body Acceptance Programs for Young Men
Condition: Body Image Disturbance; Eating Disorder Symptom; Dysmorphia; Eating Disorders
MeSH terms: Feeding and Eating Disorders
Study type: Interventional

Summary: 
      While eating disorders in males are often overlooked, up to 7 million men in the United
      States will experience an Eating Disorder in their lifetime. Critically, men are less likely
      to seek treatment for an Eating Disorder compared to females. Therefore, prevention programs
      that target male-specific Eating Disorder risk factors prior to the development of an eating
      or appearance-related disorder are crucial in reducing eating disorders in this population.
      Preliminary work by our group established the initial efficacy of a novel program, the Body
      Project: More than Muscles (MTM) compared to assessment-only control. This study will
      replicate and extend this research by comparing MTM to a time and attention-matched control
      used in previous eating disorder prevention work, media advocacy (MA).
    

Detailed description: 
      Although often overlooked, Eating Disorders in men are a serious and deadly public health
      problem, affecting up to 7 million men in the United States. Efficacious, promulgated Eating
      Disorder treatments largely remain unknown, particularly for males. Over recent decades, men
      have faced increasing social pressures to obtain an unrealistically lean and muscular
      physique, which have contributed to body dissatisfaction and unhealthy eating and weight
      control behaviors among men, including symptoms of both Eating Disorders and muscle
      dysmorphia (body image disturbance characterized by the unhealthy pursuit of muscularity.
      Despite the impairment and distress associated with these conditions, males are less likely
      to seek treatment than females, in part due to stigma. Importantly, for those men who do seek
      help, existing treatments are targeted mostly towards females, rarely address male-specific
      risk factors, and are ineffective for over 50% of patients. Thus, well-accepted, easily
      replicable preventative programs that target male-specific Eating Disorder risk factors prior
      to disorder onset are critical to reduce the public health burden and disparities associated
      with eating disorders in men.

      Research supports that for men, pressures from media, friends, partners, and family to pursue
      a lean, muscular body can lead to body-ideal internalization -- the belief that one's
      self-worth and value are defined by physical appearance. This can lead to dissatisfaction
      with muscularity and body fat, which in turn, contributes to eating disorder and muscle
      dysmorphia-related attitudes and behaviors. Thus, targeting internalization of the lean,
      muscular ideal portrayed in media culture would be important for reducing both Eating
      Disorder and muscle dysmorphia symptoms for men.

      While studies have targeted body-ideal internalization in groups of women using
      dissonance-based interventions, until recently, no programs had been developed to address
      internalization of the lean, muscular body ideal for men. Our group recently developed and
      evaluated the Body Project: More than Muscles (MTM) in a randomized controlled trial (RCT) to
      target eating disorder and muscle dysmorphia risk factors in body-dissatisfied men. Results
      demonstrated significantly greater decreases in body-ideal internalization, dietary
      restraint, drive for muscularity, bulimic symptoms (e.g., binge eating, self-induced
      vomiting, laxatives, fasting, and/or excessive exercise), and muscle dysmorphia symptoms for
      men in the MTM intervention compared to assessment-only controls, both pre- to
      post-intervention and at 1-month follow-up. Further, body-ideal internalization mediated
      intervention outcomes for bulimic and muscle dysmorphia symptoms, supporting that the
      intervention's effects were exerted through reducing internalization of lean, muscular ideal
      images portrayed in media.

      While initial results for MTM are promising, prior to disseminating this program to a wider
      audience, the present study will replicate and extend effects observed in the previous trial
      by comparing the intervention to a time- and attention-matched media advocacy (MA) active
      control condition used in previous Eating Disorder prevention programs. The present study
      will also explore the impact of MTM on additional risk factors for Eating Disorders and
      muscle dysmorphia in men not explicitly included in the previous RCT including unhealthy
      exercise, self- and other-objectification, appearance- and performance-enhancing drug (APED)
      use, and overall levels of depression, stress, and anxiety.

      Results from the present study will provide critical support to help translate research on
      Eating Disorders and muscle dysmorphia in men into evidence-based prevention of these
      problems. MTM represents a novel approach to eating disorder prevention in this underserved
      population. This intervention has potential for wide dissemination, as peer-led interventions
      in women have demonstrated comparable impact to professional-led interventions. Further, if
      effects for MTM replicate, future research could adapt online or web-based versions of the
      program to help disseminate this program to a wider audience of men across the country. Thus,
      if results support the intervention's efficacy, this could lead to the expanded delivery of
      the intervention into university-based or online effectiveness trials to help prevent Eating
      Disorders and reduce body dissatisfaction for men at a national level.
    

Intervention name(s): More than Muscles (MTM); Media Advocacy (MA)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): In session 1, the primary activities are: 1) define the "ideal" body type for men in our culture, 2) discuss the origin and perpetration of the "ideal," 3) brainstorm the costs of pursuing the "ideal," 4) participate in a verbal challenge during which participants counter the "ideal" message, and (5) are asked to complete three "homework" assignments (i.e., a letter to an adolescent boy, a behavioral challenge, and a mirror exposure assignment). In session 2, the primary activities are: 1) reviewing homework, 2) engage in role-plays to counter/discourage pursuit of the "ideal," 3) discuss ways to challenge and avoid "negative body talk" statements, 4) list ways to resist the pressure to pursue this "ideal" both individually and as a group within the larger community (i.e., body activism), 5) discuss barriers to body activism and strategies to overcome those barriers, and 6) individually select an exit exercise to continue to actively challenge the appearance ideal.; MA content generally centers on acknowledging and discussing the role the media has on shaping body image ideals. Session 1: In session 1, similar to MTM, the primary activities will include: (1) describing the ideal body for men in our culture, (2) discussing how the media impacts this ideal, with a particular focus on advertising. Following this, participants will (3) watch a video on how the media influences body image among men, and the consequences of internalizing these messages. Session 2: In session 2, content will continue by further discussion of the video showed in session 1, with participants sharing their reactions. Next, the group discusses the attainability of the ideal as well as discusses other forms of media (e.g., social media) and how it impacts body image.
Other intervention name(s): Body Project
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will briefly be screened for eligibility criteria by phone. Eligible participants will be assessed using two structured clinical interviews (SCID-5 & EPSI-CRV) and complete a set of self-report measures at baseline. Following assessment participants will be randomized into one of two groups. One group will receive a dissonance-based intervention known as the More than Muscles (MTM), while other participants will engage in a Media Advocacy (MA) active control. Participants will complete the same set of self-report measures from baseline, after their final group, at 1-month follow-up and at 6-month follow-up. During the 6-month follow-up participants will also be reassessed using the same structured clinical interviews at baseline.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Male; Muscularity Oriented Eating; Exercise; Eating Disorder; Body Image