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Key overview details
- Targeted
- Promoting Emotional Wellbeing
- Self Esteem / Resilience
- Eating Disorders
- Adolescents: 13 to 18 years
The Body project
Summary
The Body project is a targeted, group based intervention designed to prevent eating disorders in young women (aged 14-25 years) who are dissatisfied with their bodies. The programme provides opportunities for these young women to critique the thin ideal, which is expected to reduce their pursuit of this unrealistic ideal. The reduction in pursuit of the thin ideal theoretically decreases body dissatisfaction, unhealthy dieting, negative affect and eating disordered behaviours. The Body project is a cognitive-dissonance based intervention that is typically delivered in schools (i.e. high schools and universities/ colleges) over four consecutive one-hour weekly sessions. Programme activities include role-play, mirror exercises, challenging thin ideal statements, body activism, letter to younger self, self-affirmation exercises, motivation enhancement exercises and homework exercises. Programme delivery is associated with significant reductions in thin-ideal internalisation, body dissatisfaction, dieting, negative affect, psychosocial impairment, eating disorder symptoms, and future onset of eating disorder symptoms.
The Body Project has been delivered in the United Kingdom.
Website: www.bodyprojectsupport.org
Core Components
The Body project is a targeted, group based intervention, designed to prevent eating disorders in young women (aged 14-25 years) who are dissatisfied with their bodies. This cognitive-dissonance based intervention recognises the societal and cultural pressures on young women to conform to the thin ideal. The Body Project therefore helps them to reject this thin-idealism, with the aim of enhancing body acceptance, boosting mood, reducing unhealthy weight control behaviours, and protecting against eating disorders.
The Body project is typically delivered in schools (i.e. high schools and universities/ colleges) by group leaders in group format (about 6 to 10 participants per group). It is usually delivered over four consecutive one-hour weekly sessions, but can also be delivered in two 2-hour sessions or in six 50-minute sessions. Sessions focus on critiquing of the thin ideal, and include a number of verbal challenges, written challenges, and behavioural exercises. Programme activities include role-play, mirror exercises, challenging thin ideal statements, body activism, letter to younger self, self-affirmation exercises, and motivation enhancement exercises. Homework exercises are also handed to programme participants to reinforce the taught skills, and promote use of these skills in their everyday lives. Individual make-up sessions (lasting about 15 minutes) are offered to students who miss previous sessions. Make-up sessions are delivered before the next group session either via phone or video call. These individual sessions help communicate the importance of each programme participant, and enhance intervention effects.
Fidelity
The Body project programme fidelity is evaluated using the following measures/ tools;
- Completion of group leader competence assessment form for programme sessions (recommended). This includes review of videotaped sessions, audiotaped sessions, or live observations. Assessment is carried out by programme developer or team member trained in rating
- Completion of session adherence forms (recommended). Adherence forms are unique to each session. Assessment is carried out by programme developer or team member trained in rating
Modifiable Components
The Body project is typically delivered in four consecutive one-hour weekly sessions, but can also be delivered in six consecutive 50-minutes weekly sessions, or two 2-hour sessions. It is usually delivered in high schools and universities/colleges, but can also be delivered in community centres or virtually. Programme materials are available in English, German, Italian, French, Spanish, Portuguese, Chinese, and Japanese. An orthodox Jewish adaptation of the programme is also available. Although originally developed to be a selective eating disorder prevention programme for young women with body image concerns, the Body Project can also be delivered universally, or to young men with body image concerns.
The Body Project programme has been modified into a more intensive programme called the Body Project Treatment programme for the treatment of eating disorders. The treatment programme is delivered in the clinic setting, in eight consecutive one-hour weekly sessions.
Implementation support is provided by the programme developer and the Body Project Collaborative team at Stanford University and Oregon Research Institute, USA.
Support for Organisation/Practice
Implementation Support
The programme developer and the Body Project team provide practitioner training and post-training supervision when requested by practitioners/ organisations. They provide free access to resources needed for programme delivery, including facilitator guide, scripted programme manual, and home practice exercises for participants. They also provide free access to recruitment materials (including recruitment posters, sample recruitment letter/ email invitation); fidelity monitoring tools; and assessment materials to evaluate programme impact (including pre/post intervention surveys, data entry instructions and effect size calculator).
Licence Requirements
There are no licence requirements for programme delivery
Start-up Costs
Training for a cohort of eight practitioners is charged at $200/hour (4-8 hours of training is recommended). Training costs do not include travel. Post-training supervision is charged at $125 per hour. All programme materials are freely available on the Body Project programme website.
Building Staff Competency
Qualifications Required
One or two group leaders deliver the Body Project sessions to participant groups (about 6 to 10 participants per group). Practitioners can have the equivalent of a master’s degree in a mental health field, but the programme can be also be delivered by those with a bachelor’s degree and training in the programme. Practitioners that typically deliver the programme include clinicians, university staff and high school staff. Peer educators (similar in age to group participants) have also effectively delivered the programme.
Training Requirements
Practitioner training prior to programme delivery is recommended. This includes four-hour training for clinicians and university/high school staff, and six to eight hour training for peer educators. An eight hour trainer training workshop is also available to practitioners who want to become trainers. In-person trainings can be delivered at the implementing site, and a virtual training option is also available. Practitioners have free access to scripted programme manuals and home exercises. The free resources can be accessed without training.
Supervision Requirements
Practitioner supervision is recommended during delivery of the first group. As part of supervision, practitioners submit recorded video or audio sessions for review and feedback. Practitioner supervision is not required for programme delivery
Theory of Change
The Body project is a cognitive-dissonance based intervention. The core idea of the programme is that by giving youth the opportunity to discuss the negative effects of pursuing the thin ideal, they will reduce their subscription to this appearance ideal. This is as people are motivated to align their attitudes with their publicly displayed behaviour. The programme is therefore expected to reduce the internalisation of, and subscription to the thin ideal.
Adolescents: 13 to 18 years - Rating: 4
Research Design & Number of Studies
The best evidence for The Body Project for persons aged 13-18 years comes from two internally conducted randomised controlled trials (RCTs) (Stice et al, 2006/ Stice et al, 2008; Stice et al 2009), and one RCT conducted in collaboration with the programme developer (Ghaderi et al, 2020). The first study included 481 high school and university girls aged 14-19 years (mean age of 17 years) (Stice et al, 2006/ Stice et al, 2008). The second RCT included 306 high school adolescent girls aged 14-19 years (mean age 15.7 years) (Stice et al, 2009). The third study included 443 young women aged 15-20 years. All three RCTs included participants with body image concerns, and two of the three studies included ethnically diverse participants, including African American, Caucasian, Asian/Pacific Islander, Hispanic, and other mixed racial heritage (Stice et al, 2009; Stice et al, 2006/Stice et al 2008)
Outcomes Achieved
Compared to assessment only control groups who did not receive the intervention, the following outcomes were observed:
Child Outcomes
- Significantly greater reduction in thin-ideal internalisation at post-test (Ghaderi et al, 2020; Stice et al, 2009), sustained at 6 months follow-up and at 1-year (Ghaderi et al, 2020; Stice et al, 2006), at 18 months follow-up (Ghaderi et al, 2020), and 2-year follow-up (Ghaderi et al, 2020; Stice et al, 2008)
- Significantly greater reduction in body dissatisfaction at post-test (Ghaderi et al, 2020; Stice et al, 2006; Stice et al, 2009), sustained at 6 months (Ghaderi et al, 2020; Stice et al, 2006; Stice et al 2009), at 1-year follow-up (Ghaderi et al, 2020; Stice et al, 2009), at 18 months follow-up (Ghaderi et al, 2020), at 2-year follow-up (Ghaderi et al, 2020; Stice et al, 2008), and 3-year follow-up (Stice et al, 2008)
- Significantly greater reduction in dieting at post-test (Stice et al, 2006; Stice et al, 2009), sustained at 6 months and 1-year follow-up (Stice et al, 2006)
- Significantly greater reduction in negative affect at post-test (Stice et al, 2006), sustained at 6 months follow-up (Stice et al, 2006), and at 2-year and 3 year follow-up (Stice et al, 2008)
- Significantly lower bulimic symptoms/ eating disorder symptoms at post-intervention, sustained at 6 months and 1-year follow-up (Ghaderi et al, 2020; Stice et al, 2006; Stice et al, 2009), at 2-year follow-up (Ghaderi et al, 2020; Stice et al, 2008), and at 3-year follow-up (Stice et al, 2008)
- Significantly lower psychosocial impairment at 2-year follow-up, sustained at 3-year follow-up (Stice et al, 2008)
- Significantly greater reduction in clinical impairment at post-intervention, sustained at 6-month follow-up (Ghaderi et al, 2020)
Parent Outcomes
None
Key References
Ghaderi, A., Stice, E., Andersson, G., Enö Persson, J., & Allzén, E. (2020). A randomised controlled trial of the effectiveness of virtually delivered body project (vBP) groups to prevent eating disorders. Journal of Consulting and Clinical Psychology, 88, 643-656.
Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77(5), 825–834
Stice, E., Marti, C. N., Spoor, S., Presnell, K., & Shaw, H. (2008). Dissonance and healthy weight eating disorder prevention programs: long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76(2), 329–340
Stice, E., Shaw, H., Burton, E., & Wade, E. (2006). Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 74(2), 263–275
Values
The Body project is a targeted, group based intervention, designed to reduce body dissatisfaction, and prevent eating disorders in young women who are dissatisfied with their bodies. The cognitive-dissonance based intervention helps these young women enhance body acceptance by rejecting societal and cultural pressures to achieve thinness.
- Does this approach align with the key values of your organisation?
Priorities
The Body project targets young women with body image concerns, but can also be delivered to young men with body image concerns, or delivered universally. The group based programme helps them critique the thin ideal, with the aim of reducing body dissatisfaction, a known risk factor for eating disorders.
- Is a programme that is designed to prevent eating disorders a priority for your service, or would an intervention that aims to treat persons with eating disorder symptoms be a better fit?
Existing Initiatives
- Does your organisation have existing programmes that aim to reduce body dissatisfaction and prevent eating disorders in young women?
- Are there components addressed by The Body project that are not met by existing programmes?
- Are the existing initiatives effective? Do they fit your current and anticipated future requirements?
Workforce
Two group leaders deliver the Body Project programme sessions to participant groups (about 6 per group). Practitioners can be clinicians, university staff, high school staff, or peer educators. Four to eight hour practitioner training is recommended prior to programme delivery. The programme is typically delivered to participant groups over four consecutive one-hour weekly sessions.
- Do you have practitioners with the recommended qualifications available to deliver this intervention?
- Do you have practitioners who are interested in learning and delivering this programme?
- Can your organisation support the time commitment required for practitioner /trainer training and delivery?
Technology Support
The Body project resources are freely available on the programme website. Programme sessions can be delivered face-to-face, or virtually. As part of fidelity monitoring, group leader competence assessment is conducted by programme developer. Videotaped sessions, audiotaped sessions, or live observations can be used for the assessment.
- Does your organisation have technology to access online resources, and to record and send video/audio recordings for fidelity assessment?
- Will sessions be held virtually? Does your organisation have technology to support virtual delivery?
Administrative Support
The Body project is typically delivered in high schools, universities/colleges, and community centres. Programme developers provide free access to recruitment materials (including recruitment posters, sample recruitment letter/ email invitation); fidelity monitoring tools; and assessment materials to evaluate programme impact (including pre/post intervention surveys, data entry instructions and effect size calculator).
- Does your organisation have a venue to run programme group sessions?
- How will programme participants be recruited?
- Does your organisation have administrative capacity and systems to support participant recruitment, retrieve online resources, collate data, and evaluate programme impact?
Financial Support
Training prior to delivering The Body project is recommended. Training for a cohort of 8 practitioners is charged at $200/hour (4-8 hours of training is recommended). Training costs do not include travel. Post-training supervision is charged at $125 per hour
- How many practitioners will be trained?
- Can the training costs for this number of practitioners be financially supported?
- Will post-training supervision be requested for your practitioners?
Comparable Population
The Body project is a targeted, group based intervention, designed to reduce body dissatisfaction, and prevent eating disorders in young women who are dissatisfied with their bodies. Evidence of effectiveness in persons aged 13-18 years comes from ethnically diverse young women aged 14-20 years, with body image concerns.
- Is this comparable to the population your organisation would like to serve?
Desired Outcome
The Body Project helps young women reject thin-idealism, with the aim of enhancing body acceptance, boosting mood, reducing unhealthy weight control behaviours, and protecting against eating disorders. Programme delivery is associated with significant reductions in thin-ideal internalisation, body dissatisfaction, dieting, negative affect, psychosocial impairment, eating disorder symptoms, and future onset of eating disorder symptoms.
- Is delivering a programme designed to help young women reject thin-idealism and protecting against eating disorders a priority for your organisation?
- Does your organisation have other initiatives in place that effectively and efficiency address the above outcomes?
Dr. Eric Stice (Co-Director, Body Project Collaborative)
estice@stanford.edu
+1 (541) 222-0615