The Efficacy of a Universal School-Based Prevention Program for Eating Disorders among German Adolescents: Results from a Randomized-Controlled Trial
- 50 Downloads
Disordered eating is highly prevalent during adolescence and has a detrimental effect on further development. Effective prevention programs are needed to prevent unhealthy developmental trajectories. This study evaluated the efficacy of the POPS-program (POtsdam Prevention at Schools), a universal school-based eating disorder prevention program for adolescents. In a cluster-randomized design, we compared the intervention group receiving the prevention program to a waiting control group. Outcomes included indicators of disordered eating and relevant risk factors for eating disorders (body dissatisfaction, internalization of the thin ideal, perceived media pressure, perfectionism, emotional element of exercise, social comparison, and perceived teasing). Questionnaires were administered at the start of the intervention, 3 and 12 months post intervention. At baseline, 1112 adolescents aged 10 to 16 years participated (49% girls; 51% intervention group). Intention-to-treat analyses with the complete data set and per-protocol analyses as a completer analysis were performed. The intervention group showed a more favorable course compared to the control group regarding all observed risk factors for eating disorders except for perceived teasing. Effect sizes were small but comparable to other primary prevention programs. At 1-year follow-up, a small but significant effect on disordered eating was observed. Results of the per-protocol analyses were mostly confirmed by the intention-to-treat analyses. Results were promising for both genders although girls benefited more regarding disordered eating and internalization of the thin ideal. Further studies are warranted examining successful program elements and whether gender-specific programs are needed.
KeywordsEating disorders Evaluation Primary prevention Adolescents School-based RCT
We are grateful to the students, parents and teachers who agreed to participate in the study. Special thanks to Susanne Helfert and Eva-Maria Krentz, who were involved in the conceptualization of the POPS-program and the evaluation study. Thanks to Diana Peitz for her support in the statistical analyses. Thanks to the Federal Ministry of Education and Research for funding the project.
PW conceived and coordinated the study, developed the statistical data analysis plan, performed the statistical analysis, and participated in the interpretation of the data; JZ performed the statistical analysis, drafted the manuscript, and participated in the interpretation of the data. All authors read and approved the final manuscript.
This project was funded by the Federal Ministry of Education and Research (BMBF; Registr.nr: 01EL0607; Prof. Dr. P. Warschburger).
Data Sharing Declaration
The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.
Compliance with ethical standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Written informed consent was obtained from all individual participants included in the study as well as from their parents. The privacy rights of human subjects were observed. The study was approved by the University Ethics Board prior to survey administration. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards
Written informed consent was obtained from all individual participants included in the study as well as from their parents. The privacy rights of human subjects were observed
- Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research Review: What we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 56(11), 1141–1164.CrossRefPubMedGoogle Scholar
- Herpertz-Dahlmann, B., Wille, N., Hölling, H., Vloet, T. D., & Ravens-Sieberer, U. (2008). Disordered eating behaviour and attitudes, associated psychopathology and health-related quality of life: Results of the BELLA study. European Child & Adolescent Psychiatry, 17(1), 82–91.CrossRefGoogle Scholar
- Klauer, K. (1993). Denktraining für Jugendliche. Ein Programm zur intellektuellen Förderung. Handanweisung [Cognitive training for adolescents. A training program. Manual.]. Göttingen: Hogrefe.Google Scholar
- Kromeyer-Hauschild, K., Wabitsch, M., Kunze, K., Geller, F., Hesse, V., von Hippel, A., et al. (2001). Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben [Percentiles of body mass index in children and adolescents evaluated from different regional German studies]. Monatsschrift Kinderheilkunde, 149(8), 807–818.CrossRefGoogle Scholar
- Levine, M., & Smolak, L. (2013). Toward a model of the developmental psychopathology of eating disorders: The example of early adolescence. In L. Smolak, R. Striegel-Moore & M. Levine (Eds.), The developmental psychopathology of eating disorders: Implications for research, prevention, and treatment (pp. 59–80). London: Routledge.Google Scholar
- Meermann, R., & Vandereycken, W. (1987). Therapie der Magersucht und Bulimia nervosa: Ein klinischer Leitfaden für den Praktiker [Treatment of anorexia and bulimia nervosa: A clinical guide for the practitioner]. Berlin: De Gruyter.Google Scholar
- Micali, N., Solmi, F., Horton, N. J., Crosby, R. D., Eddy, K. T., Calzo, J. P., et al. (2015). Adolescent eating disorders predict psychiatric, high-risk behaviors and weight outcomes in young adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 54(8), 652–659.CrossRefPubMedPubMedCentralGoogle Scholar
- Neumark-Sztainer, D., Wall, M., Larson, N. I., Eisenberg, M. E., & Loth, K. (2011). Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study. Journal of the American Dietetic Association, 111(7), 1004–1011.CrossRefPubMedPubMedCentralGoogle Scholar
- Paul, T., & Thiel, A. (2005). EDI-2. Eating Disorder Inventory-2. Göttingen: Hogrefe.Google Scholar
- Rainer, G., & Rathner, B. (1997). EAT-Normen für deutschsprachige weibliche Jugendliche: Eine populationsgestützte Studie. Zeitschrift für Klinische Psychologie, Psychopathologie und Psychotherapie, 45(3), 16–35.Google Scholar
- Shisslak, C. M., & Crago, M. (2001). Risk and protective factors in the development of eating disorders. In J. Thompson & L. Smolak (Eds.), Body image, eating disorders, and obesity in youth. Assessment, prevention, and treatment (pp. 103–125). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
- Thompson, J. K., Heinberg, L., & Tantleff, S. (1991). The Physical Appearance Comparison Scale (PACS). The Behavior Therapist, 14, 174.Google Scholar
- Thompson, J. K., & Pasman, L. (1991). The Obligatory Exercise Questionnaire. The Behavior Therapist, 14, 137.Google Scholar
- Warschburger, P. (2009). Körperunzufriedenheit und gestörtes Essverhalten bei Jugendlichen. Praxis Klinische Verhaltensmedizin und Rehabilitation, 85(3), 152–158.Google Scholar