Eating disorder prevention research: a meta-analysis
The purpose of this study was to quantitatively evaluate the overall effectiveness of eating disorder prevention programs and to investigate potential moderating variables that may influence the magnitude of intervention effects. Meta-analysis was used to conduct a comprehensive and systematic analysis of data across 46 studies. Effect size estimates were grouped into outcome sets based on the following variables: knowledge, general eating pathology, dieting, thin-ideal internalization, body dissatisfaction, negative affect, and self-esteem. Q statistics were used to analyze the distribution of effect size estimates within each outcome set and to explore the systematic influence of moderating variables. Results revealed large effects on the acquisition of knowledge and small net effects on reducing maladaptive eating attitudes and behaviors at posttest and follow-up. These programs were not found to produce significant effects on negative affect, and there were inconsistent effects on self-esteem across studies. Population targeted was the sole moderator that could account for variability in effect size distributions. There was a tendency toward greater benefits for studies targeting participants considered to be at a relatively higher risk for developing an eating disorder. Previous assumptions regarding the insufficiency of "one-shot" interventions and concerns about the iatrogenic effects of including information about eating disorders in an intervention were not supported by the data. These findings challenge negative conclusions drawn in previous review articles regarding the inability of eating disorder prevention programs to demonstrate behavioral improvements. Although these findings have implications for the prevention of eating disorders, it was argued that a clear link between intervention efficacy and a decreased incidence of eating disorders was not demonstrated. Rather, only direct information was offered about the ability to influence eating disorder related knowledge, attitudes, and behaviors. Specific recommendations related to intervention content, reasonable goals/expectations, and outcome criteria were offered for improving research in this area.