Body Project

1. Body Project Body Acceptance Promotion Eating Disorder Prevention

3. Jo Wilcox, M.A.Myron Veenstra, Ph.D. University of North Dakota

4. Fall 2010 UCC: Academic Standing Freshmen 3033 (22%) 21% Sophomores 2636 (19%) 23% Juniors 1919 (14%) 20% Seniors 3551 (26%) 20% Graduate 2560 (19%) 10%

5. Fall 2010 UCC: Gender Males 7142 (52%) 45% Females 6557 (48%) 55%

6. The most potent risk factor for developing an eating disorder is being a woman1. For all eating disorders combined, the median age of onset was between ages 18 and 212.

7. Anorexia Nervosa • 5x more prevalent among13 -19 y.o. than other age groups. • 3x increase in incidence of AN in females ages 20 to 303,4. • 0.9% life-time prevalence of AN among women1. • AN interferes with educational, vocational, and independent functioning5. • AN increases mortality rate and rates of persistent psychological problems5.

8. Bulimia Nervosa Prevalence 1% for adult women and 1-3% among adolescent and young adult women3,1 Greatest incidence of BN between the ages 16 - 206

9. Eating Disorder NOS • 3% incidence in the general adult population3 • 35-50% of adolescent females seeking ED symptom treatment3 • Women ages 15-17 with EDNOS, 2-3x more likely to experience depression, anxiety, and substance abuse as young adults7 • Subclinical eating disturbances predict onset of obesity, depression, substance abuse, among other health problems8

10. Binge Eating Disorder • Prevalence 2-3% • 77% of those are women3,1 • At 12 year follow-up: • 1/3 of individuals with BN or BED diagnoses continued to meet ED criteria • 3.6% were classified as obese (BMI scores ≥ 30)1

11. ACHA/NCHA (2010): Within the last 12 months, have any of the following (ED symptoms)affected your academic performance?

13. Theory of Pathogenesis 1,10

14. Body Image , Dissatisfaction, and Thin Ideal Internalization 58-80% of college-aged women have negative body image 9,10 Body dissatisfaction increases during and after transition from high school to college 10

15. Current Treatments • ESTs: • Long-term outcomes for bulimia similar to no treatment: ~50% at 5 years12 • Prevention Programs: • Meta-analysis: 23% effectively reduced ED symptoms immediately and at follow-up13 • 5% produced effects that lasted 1+ year(s) 13

16. http://www.youtube.com/watch_popup?v=iYhCn0jf46U&vq=medium

17. UCC 2006-2007 Subclinical “I am concerned about my eating habits and my body image.” 190 (30%) reported concern about eating 45 (24%) had subclinical disorder

18. Marketing an Eating Disorder Treatment

19. Body Project • Developed by Eric Stice • “Programs that Work” • Small & large-scale effectiveness trials • Independently evaluated • Decreased eating disorder rates • Decreased depression rates • Improved body satisfaction • Lowered levels of obesity at follow-up

20. Our Population • Introductory Psychology or other Psychology Courses • Offer Extra Credit • Screeners • Online Extra Credit System (SONA Systems) • 6 Semesters, 649 female students

21. Body Image • 65.8% felt moderately to extremely fat • 61.3% moderate to extreme fear of fatness • 56.8% self-judgments based on weight moderate to severe • 54.4% self-judgments based on shape moderate to severe

23. Eating Disordered Behavior • 2.8% laxatives ≥ 1/mo • 5.3% self-induce vomiting ≥ 1/mo • 5.9% took diet pills ≥1/mo • 12.6% fasted for 24hr+ at a time ≥1/mo • 3.3% ≥1/wk • 15.3% take “dietary supplement” ≥1/mo • 9.5% ≥1/wk • 55.5% skipped meals ≥1/mo • 37.3% ≥1/wk

24. Intervention Format Four, one-hour meetings, once a week Groups of 8 to 15 members, all female students, ages 18-25 Two female facilitators Round-table seating with whiteboard Handouts provided Discussion-based content, homework between sessions (debrief and review)

26. Cognitive Dissonance • What you say and argue for/against in front of peers makes you • Disequilibrium or discomfort leads to change

27. Creating a Group Environment • Agree to attendance • Agree to confidentiality • Agree to participation • All say “yes” • Normalization of body image concern • Course introduction/overview

28. Discussion: Establish “Thin Ideal” • Magazine pictures – collect attributes of “perfect woman” • Traits in opposition • Is it really possible to attain this?

29. What is the Ideal Woman Like? • Rich • Thin, angular features • Pale • Pure • Shy • Powerful • Reserved www.ralphlauren.com

30. Thin • Tan • Perfect skin • Large breasts • Long, wavy hair • Outgoing • Adventurous/Free Spirit www.victoriassecret.com

31. Discussion: Establish “Thin Ideal” • Were there other times in history when perfect woman different? • Where did the thin ideal come from? • How promoted to us? • How do such messages make you feel? • What happens if you achieve the ideal? • Really?

33. Discussion: Establish “Thin Ideal” • Differentiate healthy ideal from thin ideal • Costs of pursuing the thin ideal • Effect on health, relationships, society? • Who does benefit? • Are you one of those people? • Given the costs, does it make sense to pursue it?

35. Discussion • Challenging “Fat Talk” • “she really let herself go,” “your so thin how do you do it?” • How can you stop this talk? • Can talk impact how you think about your body? • Future pressure to be thin • Anticipate how to deal with pressure

37. Role Plays • Role play obsession with thin ideal: • “I just saw an ad for a new diet pill. I’m going to order it so I can finally be as thin as I want” • “She doesn’t have the body to be wearing that outfit.” • Give counter-statements • Debrief

38. Arguing Against the Thin Ideal “I am thinking of going on a diet, want to join me?” “Swimsuit season is just around the corner, and so I think I will start skipping breakfasts to take off some extra weight.”

39. Homework Exercises • Write letter to an adolescent girl struggling with body image • Costs • Self-Affirmation • Write down 10 positive qualities • Was it difficult to come up with things? Why? • Midwest modesty

40. Homework Exercises • Verbal Challenge • Real-life thin ideal statements • Actual vs. ideal response? • 10 things to resist the thin ideal • Example: Do not buy fashion magazines • Take one from list and do it • Was it difficult? Barriers? • Could this make a difference?

41. Social Activism Come up with 5 things in your small group that you could do to resist the thin ideal.

42. Homework Exercises • Behavioral Challenge • Do something not done currently due to body image concerns • Why do this? • Debrief: • Was it as bad as you thought it would be? • Did others react? • What learned?

44. Personal Activism What could you do in your own life to reduce the impact of the thin ideal?

45. Homework Exercises • Redo: Letter to an adolescent girl • Additional costs? • Redo: Self-Affirmation exercise • Positive Body Talk: • With a friend/family member, talk about your positives • Keep a journal of the things your body allows you to do • Make a pact with another to avoid negative body talk • No complaints about your body – replace them with positive statements • Next time you get a compliment, accept it.

46. Anecdotal Feedback • What has the class done for you • Others struggling with same problems • Feel more comfortable with self • Change in how talk about own and others’ bodies

47. Active Control: Wellness Program • Change from active control in manual • Same four-week group set up • Same size and facilitation • Addresses healthy activity levels and stress management at each meeting. • Addresses special topics each week.

48. Wellness/Healthy Lifestyle • Healthy Lifestyle – focusing mostly in this course on emotional and physical dimensions • Weekly Physical Activity Principles • Weekly Stress Management Principles • Goals set are individually tailored, monitored by facilitators, re-evaluated

49. Special Activities/Topics Eating Healthy Equipment/Exercise training at Wellness Center Access to dietician and physical training staff Progressive Muscle Relaxation

50. Waitlist Group • No group contact • Chosen by • Random selection • No availability • Late sign-up • Did not attend assigned groups • Given option to participate in later semesters in active groups