Empowering Body Acceptance and Eating Disorder Prevention in College Students

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