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Disordered Eating Prevention Programme

Policy category

Helping Vulnerable Children, Facilitating Positive Transitions to Adulthood

Recommendation Pillars

Put in place mechanisms that promote children’s participation in decision making that affect their lives

Countries that have implemented practice

Spain

Age Groups

Teenagers (age 13 to 19)

Target Groups

Children, Children/teenagers with behavioural problems

Years in Operation

2012  - 2014

Type of Organization Implementing Practice

City or Town Government

Practice Overview

This programme was implemented in 13 publicly funded schools in Terrassa, a city in the Barcelona metropolitan area of Spain for students aged 13.  The programme consisted of one 90 minute ML session discussing media literacy, critical thinking about the feminine Aesthetic-Beauty Model of extreme thinness, and awareness of historical, cross-cultural and media conceptions of beauty.  Some classes also participated in a 90 minute NUT session discussing nutrition and balanced eating.  Male and female students participated in their usual classroom setting as the programme was delivered in weekly sessions over the course of up to two weeks.

Sustainability

Transferability

This program was implemented in 13 schools in Terrassa, Spain, and programme materials were developed in Spanish.  The programme has not been implemented in any other locations.

Evidence of Effectiveness

Evaluation 1  

 

Raich, R., Sánchez-Carracedo, D., López-Guimerà, G., Portell, M., Moncada, A., & Fauquet, J. (2008).  A controlled assessment of school-based preventive programs for reducing eating disorder risk factors in adolescent Spanish girls. Eating Disorders, 16(3), 255-272.

 

This evaluation included two intervention groups, only one of which received the nutrition session.  Data was collected from boys and girls but only data from girls was analysed. 

 

Outcomes measured included outcomes on the Eating Attitudes Test (EAT), the CIMEC Questionnaire on Influences of Aesthetic Body Ideal-26, and a nutrition questionnaire (NUT-Q) designed by the study authors. 

Summary of Results for Evaluation 1

 

 

 

Outcome

ML Intervention Group

ML+NUT Intervention Group

Control Group

Outcomes improved (statistically significant)

 

 

 

Post-test mean change scores:

EAT-Diet (Scored out of 26)

CIMEC-Total (Scored out of 26)

CIMEC-Body Image Distress (Scored out of 5)

NUT-Q (Scored out of 10)

 

1.93

2.93

1.39

-0.22

 

2.01

3.18

1.30

1.25

 

0.80

1.34

0.34

0.07

Outcomes with no effect

 

 

 

Post-test mean change scores:

EAT-Total (Scored out of 120)

EAT-Bulimia (Scored out of 26)

EAT-Oral control (Scored out of 26)

CIMEC-Influence of Advertising (Scored out of 5)

CIMEC-Influence of Verbal Messages (Scored out of 5)

CIMEC-Influence of Social Models (Scored out of 5)

CIMEC-Influence of Social Situations (Scored out of 5)

6 month follow-up mean change scores:

EAT-Total (Scored out of 120)

EAT-Diet (Scored out of 26)

EAT-Bulimia (Scored out of 26)

EAT-Oral control (Scored out of 26)

CIMEC-Total (Scored out of 26)

CIMEC-Body Image Distress (Scored out of 5)

CIMEC-Influence of Advertising (Scored out of 5)

CIMEC-Influence of Verbal Messages (Scored out of 5)

CIMEC-Influence of Social Models (Scored out of 5)

CIMEC-Influence of Social Situations (Scored out of 5)

NUT-Q (Scored out of 10)

 

 

2.88

0.17

0.49

0.78

 

0.46

 

0.11

 

0.29

 

 

-0.09

-0.11

-0.37

-0.20

-0.70

0.16

-0.13

 

-0.05

 

-0.29

 

-0.28

 

0.20

 

3.10

0.32

0.39

0.94

 

0.44

 

0.32

 

0.27

 

 

2.03

0.32

-0.13

0.52

0.05

0.22

0.14

 

0.05

 

-0.30

 

-0.14

 

0.56

 

1.54

0.24

0.44

0.49

 

0.25

 

0.12

 

0.15

 

 

0.72

0.21

0.03

0.52

-0.12

-0.09

0.04

 

0.01

 

-0.03

 

-0.06

 

0.64

 

Evaluation 2  

Raich, R., Portell, M., and Pelaez-Fernandez, M., (2010).  Evaluation of a School-Based Programme of Universal Eating Disorders Prevention: Is it More Effective in Girls at Risk? Eur. Eat. Disorders Rev. 18, 49-57.

 

This evaluation re-analyses the data and outcome measures from Evaluation 1 (Raich et al., 2008) without the 6 month follow-up, focusing on risk groups identified at pre-test.  The groups examined were those considered to be at higher risk for eating disorders because they exhibited at least one of the following characteristics at pre-test:

• Early age of first menstruation

• Overweight

• Distorted attitudes towards food

• High influence of the thin aesthetic model

Summary of Results for Evaluation 2

Outcome

ML Intervention Group

ML+NUT Intervention Group

Control Group

Outcomes improved (statistically significant)

 

 

 

Change scores from pre-test to post-test

Early menarche risk group – CIMEC (Scored out of 26)

Early menarche risk group – Nut-Q (Scored out of 10)

Overweight risk group- EAT (Scored out of 120)

Overweight risk group- CIMEC (Scored out of 26)

High influence of thin aesthetic model risk group – NUT-Q (Scored out of 10)

 

 

 

 

4.63

 

5.48

 

 

 

4.50

 

1.22

 

 

 

 

 

1.04

 

1.65

 

0.08

 

0.64

 

2.19

 

-0.11

Outcomes with no effect

 

 

 

Change scores from pre-test to post-test

Early menarche risk group – EAT (Scored out of 120)

Early menarche risk group – CIMEC (Scored out of 26)

Early menarche risk group – Nut-Q (Scored out of 10)

Overweight risk group- EAT (Scored out of 120)

Overweight risk group- CIMEC (Scored out of 26)

Overweight risk group- NUT-Q (Scored out of 10)

Restrictive dieting risk group- EAT (Scored out of 120)

Restrictive dieting risk group- CIMEC (Scored out of 26)

Restrictive dieting risk group- NUT-Q (Scored out of 10)

Distorted attitudes toward food risk group- CIMEC (Scored our of 26)

Distorted attitudes toward food risk group- NUT-Q (Scored our of 10)

High influence of thin aesthetic model risk group – EAT (Scored out of 120)

High influence of thin aesthetic model risk group – NUT-Q (Scored out of 10)

 

3.38

 

2.84

 

-0.02

 

 

 

 

 

0.03

 

6.57

 

5.00

 

0.36

 

5.46

 

2.23

 

7.80

 

2.06

 

2.56

 

 

 

 

 

4.78

 

4.39

 

1.22

 

10.33

 

3.17

 

1.17

 

5.00

 

0.96

 

10.38

 

1.67

 

1.65

 

0.08

 

0.64

 

2.19

 

0.17

 

5.81

 

3.44

 

-0.25

 

3.30

 

0.25

 

1.60

 

-0.11

 

 

Issue to consider

Both studies of the Disordered Eating programme described here were conducted by the programme developers.  Additionally, very few demographic characteristics of the participants were reported.  It is also important to highlight that, per Raich et al. (2008), no measured outcomes remained statistically significant at the six-month follow-up.  This may be partially related to the brief nature of the intervention in this implementation scheme.  An additional issue to consider is that both intervention and control conditions were implemented at the same schools, allowing potentially for spill-over of intervention effects between groups.

Two additional studies were published in 2011 (Gonzalez et al., 2011 and Lopez-Guimera et al., 2011).  These studies examined the programme with a second 90 minute session discussing media literacy, critical thinking about the feminine Aesthetic-Beauty Model, and awareness of historical, cross-cultural and media conceptions of beauty, and with or without two 60-minute media literacy activity sessions.  They are not reported here because they do not meet EPIC criteria for evidence of effectiveness.  In particular, both studies lacked sufficient effective sample size because the total sample size, clustering and treatment assignment procedure was different for the second implementation of the intervention.

Contact Information

Name

 Prof. Dr Rosa M Raich 

Title

 

Organization

 

Dep. de Psicologia Clinica I de la Salut, Facultat de Psicologia, Edifici B, Campus UAB (Campus d’Excellència Internacional), Universitat Autònoma de Barcelona

Address

 

Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain

Phone

 935813170

Email

 

rosa.raich@uab.cat

Website

Available Resources

Evaluation Details

Evaluation 1

In this evaluation in Terrassa, Spain in 2002, 13 public and publicly funded private secondary schools were recruited to the study based on a previously implemented randomization scheme.  Students aged 12-14 at each school were already separated into two groups, one of which the study authors split further into two groups by alphabetical order.  The control and the two respective treatment conditions were delivered both to boys and girls but only data from girls was analysed as part of the study.  One 90 minute coaching session about media literacy and critical analysis of the feminine Aesthetic-Beauty Model and one 90 minute coaching session about nutrition and balanced eating were delivered to 84 girls, just the media literacy and critical analysis session was delivered to 98 girls, and 167 girls received no coaching sessions.  Difference in age across the groups is not reported, although on the study measures only BMI found a weakly significant difference across the groups at pre-test.  Participants completed BMI measurements, the Eating Attitudes Test, the CIMEC Questionnaire on Influences of Aesthetic Body Ideal-26 one week before the intervention, on the same day after the intervention, and again six months after the intervention.

Evaluation 2

This evaluation used the same sample and data as Evaluation 1, excluding the previously published six month follow-up results.  It focused on effects of the intervention for groups at risk of eating disorders based on pre-test measurement scores and self-reported characteristics.

Bibliography

Gonzalez, M., Penelo, E., Gutierrez, T., and Raich, R., (2011).  Disordered Eating Prevention Programme in Schools: A 30-Month Follow-up, Eur. Eat. Disorders Rev. 19, 349-356.
Lopez-Guimera, G., Sanchez-Carracedo, D., Fauquet, J., Portell, M., and Raich, R., (2011). Impact of a School-Based Disordered Eating Prevention Program in Adolescent Girls: General and Specific Effects Depending on Adherence to the Interactive Activities, The Spanish Journal of Psychology, 14(1), 293-303.
Raich, R., Portell, M., and Pelaez-Fernandez, M., (2010).  Evaluation of a School-Based Programme of Universal Eating Disorders Prevention: Is it More Effective in Girls at Risk? Eur. Eat. Disorders Rev. 18, 49-57.
Raich, R., Sánchez-Carracedo, D., López-Guimerà, G., Portell, M., Moncada, A., & Fauquet, J. (2008).  A controlled assessment of school-based preventive programs for reducing eating disorder risk factors in adolescent Spanish girls. Eating Disorders, 16(3), 255-272.

Date

Cost information

Scale of Implementation

Enduring Impact

One study has assessed the effects of the Disordered Eating programme over a period of 30 months after programme implementation in 7 schools in Terrassa, Spain.  It found statistically significant effects on tests measuring self-reported behaviours related to eating disorders and vulnerability to social influences related to eating disorders, but did not have sufficient effective sample size to be considered in this review.