Thomas Parling

Eating disorders (EDs) are common conditions that cause significant suffering, reduction in functioning and deterioration in quality of life. The need for efficient preventive interventions against EDs are huge, as the majority of the patients do not seek treatment, and only half of those who receive treatment recover fully. Consequently, EDs tend to have an enduring course. The target of efficient prevention programs has been to reduce risk specific factors for EDs (e.g., internalization of the thin ideal), but they have been difficult to implement on a broad basis to make a notable impact on public health. It has proven difficult to scale up these interventions due to the resources needed for adequate implementation. Recent research has shown that optimization of protective factors (e.g., intuitive eating, appreciation of what we can do with our bodies, or self-compassion) might be a viable option and easier to implement on a large scale. The aim of the current project is to evaluate the efficacy and cost-effectiveness of such an interactive prevention program in a randomized controlled trial, and to investigate the mechanisms of change in the intervention.The innovative aspects of this project are 1) notable focus on optimizing protective factors, instead of only reducing risk factors (e.g., body dissatisfaction), 2) targeting at-risk-groups instead of universal prevention, 3) interactive program instead of standard psychoeducation, 4) possibility of including individuals of all genders and the minority groups, 5) recruitment of participants through social media, and 6) delivery of the intervention through Internet to make it flexible, and to make later large-scale implementation possible.Focus on protective factors has also the benefit of lower potential stigma for participation in prevention, despite recruiting an at-risk-group.In a randomized controlled trial, we recruit 644 participant aged 15-20 years who will receive either the prevention program (one hour per week across four weeks), or a placebo condition (Expressive Writing). In addition to the outcome after the intervention, and at follow-ups (six-, and 12-months post intervention) and cost-effectiveness will be investigated. Mediators and moderators of outcome as well as the reach of the program, risk for stigma, and possibility of spreading the program on a large-scale though collaborative projects in social media channels will also be investigated.

Research area and aims Eating disorders (EDs) are common and cause significant morbidity and mortality. Due to stigma, only 25% seek help and only 50% fully recover after receiving treatments. Large-scale prevention is urgently needed to reduce the emergence and burden of EDs at a population level. However, current prevention programs do not meet requirements for efficient and economically attractive large-scale implementation. The main aim of this project is to investigate the efficacy and cost-effectiveness of a scalable, brief, and interactive prevention program based on reinforcement of protective factors against EDs using a randomized controlled design. A focus on protective factors disrupts the processes by which risk factors increase the probability for EDs to emerge and minimizes the risks for stigmatization. Research questions: How effective is an internet-based prevention program, that reinforces protective factors against EDs, in reducing the onset of EDs 6, 12, and 24 months post-intervention?Does the intervention reduce the incidence of EDs through enhancement of specifically targeted protective factors (mediators)?Is prevention of EDs based on reinforcement of protective factors cost-effective?How sustainable are virtual communities for maintenance of future recruitment and prevention on a large scale? Secondary questions concern gender differences in enrollment and compliance, potential moderators of outcome, participation in booster sessions, and potential risk for stigma. Data and MethodParticipants (15-20 years old, n=644, based on power analysis) will be recruited online and randomized to prevention or a credible placebo. The intervention will be selective (target those with significant body dissatisfaction), delivered in a scalable format (Internet-based), brief (45 minutes/week for four weeks), and with interactive components of the program moderated by artificial intelligence for future scalability. Assessments will be done using the gold standard within the field of EDs.  Plan for project realisationThe proposed project is an extension of our previous work, including the largest controlled trial of prevention of EDs in Sweden. Recruitment, intervention, and assessments will be done using established methods. The costs are necessary for running a large randomized controlled trial. RelevanceA brief, scalable and efficacious prevention program is the pre-requisite for reducing the emergence and burden of EDs on public health level.