Hunna J Watson1,2,3,4,5, Tara Joyce6, Elizabeth French7, Vivienne Willan7, Robert T Kane7, Emily E Tanner-Smith8, Julie McCormack6, Hayley Dawkins7, Kimberley J Hoiles6, Sarah J Egan7. 1. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. hunna_watson@med.unc.edu. 2. Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia. hunna_watson@med.unc.edu. 3. Department of Health in Western Australia, Centre for Clinical Interventions, Perth, Australia. hunna_watson@med.unc.edu. 4. Faculty of Medicine, Dentistry, and Health Sciences, School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia. hunna_watson@med.unc.edu. 5. Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia. hunna_watson@med.unc.edu. 6. Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia. 7. Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia. 8. Department of Human and Organizational Development, Peabody Research Institute, Vanderbilt University, Nashville.
Abstract
OBJECTIVE: This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention. METHOD: A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted. RESULTS: Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up. DISCUSSION: The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required.
OBJECTIVE: This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention. METHOD: A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted. RESULTS: Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up. DISCUSSION: The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required.
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