in a 2009 review paper , puhl and heuer documented the incredible scope of discrimination faced by overweight individuals , including in health care settings , the workplace , and media . in addition , they discuss the relatively sparse data on interventions aiming to eradicate these conditions ( puhl and heuer , 2009 ) . indeed , the few effective studies that have been published describe approaches primarily delivered to university students . similarly , the broader literature on curbing rates of victimization and bullying indicate that school - based approaches are most successful ( rigby and slee , 2008 ; ttofi and farrington , 2011 ; vreeman and carroll , 2007 ) . overall , it appears that intervening in secondary schools or universities may be an opportune time to target body dissatisfaction and discrimination related to weight more globally . large - scale , school - based interventions have been promising in regard to decreasing victimization among pre - adolescents and adolescents ( busch et al . , 2012 ; , the utrecht healthy school ( uhs ) program aimed to comprehensively improve healthy behaviors including eating habits , physical activity , and substance abuse , as well as decreasing bullying ( busch et al . , 2012 ) . the uhs approach emphasizes involvement of students , teachers , parents , and administrators , as well as building external connections with an overall goal of health promotion for all members of the school community . with advisement from these stakeholders , uhs was rolled out from 2007 to 2010 , and outcome assessment consisted of comparisons from two cohorts of students reporting in 2007 and 2010 . results showed improvements in many of the target behaviors , including increased physical activity and lower rates of bullying and victimization ( busch et al . , 2012 ) . a social and emotional learning ( sel ) curriculum aiming to improve mental health and related outcomes like victimization was developed and tested in sweden ( kimber et al . , 2008 ) . sel , based on cognitive and behavioral methods , focuses on helping students to develop the following five skills : self - awareness , managing one s emotions , empathy , motivation , and social competence . using a quasi - experimental design , after 2  years of the program , results showed some important differences between outcomes for students in experimental and control schools including decreases in victimization ( kimber et al . , 2008 ) . importantly , puhl and colleagues ( puhl et al . , 2013 ) surveyed adolescent recipients of weight - related victimization for their perspectives on intervention for example , the importance of teaching student bystanders how to prevent rather than reinforce bullying behavior appears to be a desirable strategy that has also been shown to be effective ( rigby and slee , 2008 ; salmivalli et al . , 2011 ) . it may also be useful to consider strategies that have been employed directly to victims or those at risk . for example , vessey and oneill ( 2011 ) used materials from the us health services resources administration s stop bullying now campaign to develop a group intervention for children with disabilities , who are at high risk for experiencing victimization . results showed that group members were less bothered by teasing afterwards and also experienced improved self - concept . similarly , in hong kong , a 10-week cognitive behavioral program was delivered to 68 victims of bullying ( fung , 2012 ) . the program yielded mixed results with students reporting decreased victimization although parents and teacher reports did not echo these findings . overall , these programs offer some suggestions for strategies that psychologists can draw from when addressing victim - blaming in therapy . it may also be useful to consider strategies that have been employed directly to victims or those at risk . for example , vessey and oneill ( 2011 ) used materials from the us health services resources administration s stop bullying now campaign to develop a group intervention for children with disabilities , who are at high risk for experiencing victimization . results showed that group members were less bothered by teasing afterwards and also experienced improved self - concept . similarly , in hong kong , a 10-week cognitive behavioral program was delivered to 68 victims of bullying ( fung , 2012 ) . the program yielded mixed results with students reporting decreased victimization although parents and teacher reports did not echo these findings . overall , these programs offer some suggestions for strategies that psychologists can draw from when addressing victim - blaming in therapy . as marks ( 2015 ) states , the media promotes an unhealthy body image , in which most women seen in magazines and billboards are visibly underweight ( ahern and hetherington , 2006 ) . specifically , the media reinforces the perpetuation of the thin - ideal through the glorification of ultra - thin models , causing those who look to the media for information to internalize this ideal ( thompson and stice , 2001 ) . the perceived discrepancy between people s ideal and actual body image , as well as the unrealistic nature of the ideal , can lead to body image dissatisfaction ( bessenoff and snow , 2006 ; gluck and geliebter , 2002 ) . one particularly illuminating study demonstrated that after introducing prolonged television access in fijian adolescent girls , those with exposure to western television demonstrated significantly more disordered eating attitudes and behaviors than those without exposure ( becker et al . , 2002 ) . buys into  socially defined ideals of attractiveness and engages in behaviors designed to approximate those ideals ( ahern and hetherington , 2006 ) and is one of the most important risk factors for the development of eating pathology ( stice and shaw , 1994 ) . the body project , the most successful eating disorder prevention program , is a 4-session group - based intervention that utilizes the principle of cognitive dissonance . it requires participants to explore the costs of and to reject the thin - ideal , thereby reducing their thin - ideal internalization . extensive research on the body project has demonstrated a decrease in thin - ideal internalization that has led to significant and clinically meaningful reductions in body image dissatisfaction and negative affect ( two parts of the cod ) , as well as 60  percent reductions in diagnostic and statistical manual of mental disorders ( 4th ed . ; dsm - iv ) eating disorders at 3-year follow up compared to controls ( stice et al . , 2013a , 2013b ) . a large body of research has demonstrated the efficacy of the body project in reducing thin - ideal internalization , body image dissatisfaction , and negative affect in female college ( e.g. stice et al . , 2011 ) and high school students ( stice et al . , 2011 ) , although it has been less successful among middle school girls ( rohde et al . , 2014 ) . given its efficacy , efforts have been focused on improving the translatability of this intervention . recent research has demonstrated support for a train - the - trainer approach to body project dissemination . specifically , when master trainers trained novice trainers to train undergraduate peer leaders , participants showed significantly reduced levels of thin - ideal internalization , body dissatisfaction , and disordered eating at post - treatment and 5-month follow up ( grief et al . , 2015 ) . 2014 ) found that effects of the intervention were not related to facilitator s age , sex , education level , or body mass index ( bmi ) or the size of the group , which is encouraging for dissemination . other efforts to disseminate the intervention have included an internet - dissonance - based program , which demonstrated similar efficacy to an in - person group intervention at post - test , but improvements were not as well maintained at 1- and 2-year follow ups ( stice et al . , 2014 ) . although the majority of dissonance - based prevention programs have been geared toward the prevention of eating disorders , this recent study of the internet - based program ( ebody project ) also demonstrated large weight gain prevention effects , significantly more so than the body project , which were comparable to other obesity prevention programs ( stice et al . , 2014 ) . thus , at least for women and girls , these cognitive - dissonance - based programs can reduce body image dissatisfaction , and in some contexts , prevent weight gain . working toward eliminating obstacles to dissemination of this program may help to break the cod . the most obvious and likely effective way of devalorizing the thin - ideal is on a societal level , by diversifying representations of individuals of varying weights in the media and expanding access to larger sized clothing , for example . as these societal concerns are tackled , clinicians can also help to devalorize the thin - ideal on a more individual level . although not designed to target the thin - ideal directly , mirror exposure therapy is currently used to promote body image acceptance and reduce body image dissatisfaction . during exposure , patients are asked to look at themselves in a mirror while describing their physical appearance in a neutral manner . studies of mirror exposure have demonstrated significant reductions in body image dissatisfaction among adults with binge eating disorder ( hilbert et al . , 2002 ) , as well as overweight and obese adolescents ( jansen et al . , 2008 ) . in conclusion , it is important for psychologists to be aware of effective approaches available to intervene stemming from marks ( 2015 ) novel homeostatic theory . indeed , the literature has shown that there are both systemic and individual empirically supported interventions that can be employed by psychologists . in particular , such services can be feasibly and acceptably delivered to adolescents and young adults in school settings . it seems reasonable to suggest initiating large - scale programs in secondary schools and universities that perhaps can even be packaged together to most impactfully address circumstances intertwined with weight gain . overall , informed by theory , such  culture changes  may be an ideal way to focus prevention and intervention efforts . thin - ideal internalization is defined as the extent to which an individual  buys into  socially defined ideals of attractiveness and engages in behaviors designed to approximate those ideals ( ahern and hetherington , 2006 ) and is one of the most important risk factors for the development of eating pathology ( stice and shaw , 1994 ) . the body project , the most successful eating disorder prevention program , is a 4-session group - based intervention that utilizes the principle of cognitive dissonance . it requires participants to explore the costs of and to reject the thin - ideal , thereby reducing their thin - ideal internalization . extensive research on the body project has demonstrated a decrease in thin - ideal internalization that has led to significant and clinically meaningful reductions in body image dissatisfaction and negative affect ( two parts of the cod ) , as well as 60  percent reductions in diagnostic and statistical manual of mental disorders ( 4th ed . ; dsm - iv ) eating disorders at 3-year follow up compared to controls ( stice et al . a large body of research has demonstrated the efficacy of the body project in reducing thin - ideal internalization , body image dissatisfaction , and negative affect in female college ( e.g. stice et al . , 2011 ) and high school students ( stice et al . , 2011 ) , although it has been less successful among middle school girls ( rohde et al . , 2014 ) . given its efficacy , efforts have been focused on improving the translatability of this intervention . recent research has demonstrated support for a train - the - trainer approach to body project dissemination . specifically , when master trainers trained novice trainers to train undergraduate peer leaders , participants showed significantly reduced levels of thin - ideal internalization , body dissatisfaction , and disordered eating at post - treatment and 5-month follow up ( grief et al . , 2015 ) 2014 ) found that effects of the intervention were not related to facilitator s age , sex , education level , or body mass index ( bmi ) or the size of the group , which is encouraging for dissemination . other efforts to disseminate the intervention have included an internet - dissonance - based program , which demonstrated similar efficacy to an in - person group intervention at post - test , but improvements were not as well maintained at 1- and 2-year follow ups ( stice et al . , 2014 ) . although the majority of dissonance - based prevention programs have been geared toward the prevention of eating disorders , this recent study of the internet - based program ( ebody project ) also demonstrated large weight gain prevention effects , significantly more so than the body project , which were comparable to other obesity prevention programs ( stice et al . , 2014 ) . thus , at least for women and girls , these cognitive - dissonance - based programs can reduce body image dissatisfaction , and in some contexts , prevent weight gain . working toward eliminating obstacles to dissemination of this program may help to break the cod . the most obvious and likely effective way of devalorizing the thin - ideal is on a societal level , by diversifying representations of individuals of varying weights in the media and expanding access to larger sized clothing , for example . as these societal concerns are tackled , clinicians can also help to devalorize the thin - ideal on a more individual level . although not designed to target the thin - ideal directly , mirror exposure therapy is currently used to promote body image acceptance and reduce body image dissatisfaction . during exposure , patients are asked to look at themselves in a mirror while describing their physical appearance in a neutral manner . studies of mirror exposure have demonstrated significant reductions in body image dissatisfaction among adults with binge eating disorder ( hilbert et al . , 2002 ) , as well as overweight and obese adolescents ( jansen et al . , 2008 ) . in conclusion , it is important for psychologists to be aware of effective approaches available to intervene stemming from marks ( 2015 ) novel homeostatic theory . indeed , the literature has shown that there are both systemic and individual empirically supported interventions that can be employed by psychologists . in particular , such services can be feasibly and acceptably delivered to adolescents and young adults in school settings . it seems reasonable to suggest initiating large - scale programs in secondary schools and universities that perhaps can even be packaged together to most impactfully address circumstances intertwined with weight gain . overall , informed by theory , such  culture changes  may be an ideal way to focus prevention and intervention efforts .
marks presents  homeostatic theory  which proposes that weight gain is fostered by a  circle of discontent  consisting of body dissatisfaction , negative affect , and overconsumption . 
 this innovative framework offers potential intervention approaches , including victim - blaming , stigma , and discrimination , as well as devalorizing the thin - ideal . 
 our article discusses possible ways that clinical health psychologists based in university settings may be uniquely positioned to consider and implement large - scale programs that have shown great promise for addressing these core issues .