Participant Handouts for Six-Session Project Health Obesity Prevention Program

Chapter 13 includes all of the home and in-session exercises, and handouts used for Project Health. These are Food and Activity Change and tracking sheets, forms for: In-Session Writing Exercises, the presentation on How Society or the Food Industry Encourages Obesity, Letter about the Costs of Obesity, the Top-10 Costs of Unhealthy Foods and Sedentary Behaviors, the Refusing Unhealthy Food/Beverage Practice, Finding Healthy Food choices, Be a Healthy Body Activist, Make an Exercise Plan or Prepare a Healthy Meal, and the Exit Exercise, which involves writing a letter to one's future self about meeting goals for a healthy lifestyle. There are handouts on: calories in beverages, Tips for Eating Out, Exercise and Calorie Expenditure, Healthy Fruits and Vegetables by Color, and How to Deal with Slips.

Training, Supervision, and Quality Assurance

Various training models can be effective, and the optimal training approach depends on the availability of experienced group leaders and other resources (e.g., supervisors). Ongoing supervision can be very helpful and enhance the training experience, which can occur via email, telephone, or face-to-face meetings. Recording the intervention sessions is recommended for supervision and quality assurance monitoring, as well as to enhance dissonance induction. With appropriate screening procedures, excellent group leaders can be recruited, trained, and supervised to maximize the success of Body Project groups. We have found that most facilitators with whom we have worked have expressed an enthusiastic interest in continuing to deliver the intervention.

Significance of Body Image and Eating Disturbances

Eating disorders are one of the most prevalent classes of psychiatric disorders for adolescent and young-adult females, affecting approximately 10% of young women. Approximately 40-50% of women experience body dissatisfaction, which is a key risk factor for eating disorders. Unfortunately, less than 50% of those with eating disorders receive treatment and treatment can be very expensive. Thus, developing and disseminating effective prevention programs has become a public healthy priority. Of the many eating disorder prevention programs that have been created, very few have significantly reduced eating disorder risk factors and symptoms in controlled trials, and only two (Body Project, Project Health) have significantly reduced the risk for future onset of eating disorders.

Intervention Script for Six-Session Project Health Obesity Prevention Program

Chapter 12 provides the script for Project Health, which uses dissonance and persuasion principles to get people to make small, gradual changes toward a healthy lifestyle. Each session starts with a voluntary commitment to participate. Sessions include discussions of society's promotion of overeating through fast food and marketing, the costs of obesity, and the importance of a healthy diet. Each session includes a section where each participant is asked to commit to making or maintaining small healthy changes to their diet and activity level, which are gradually increased each week; progress in making these healthy changes are shared with the group. Role-plays and writing exercises are incorporated into each session to get participants to adopt a healthy lifestyle stance, and confront pressures from their peers and family that arise.

Participant Handouts for Four-Session Enhanced-Dissonance Body Project

Chapter 9 provides the handouts for the 4-session version of the Body Project script. There are roughly 2 home exercises for each session. These handouts are Letter to a Younger Girl, Self-Affirmation form (for the mirror exercise), the Verbal Challenge Form, the Top-10 List form, the Behavioral Exercise Form, the Body Activism Form, a Self-Affirmation Exercise Form. There are also exit exercises for the last session, which include a Letter to a Younger Girl, and the Group Body Activism exercise.

Intervention Script for Four-Session Enhanced-Dissonance Body Project

Chapter 8 provides the script for the refined enhanced-dissonance version of the 4-session Body Project. Each session begins with a voluntary commitment to participate—to increase accountability and dissonance. In the first session participant-led discussions introduce the thin-ideal and review costs associated with this ideal. In the second session, participants engage in role-plays to dissuade someone from pursuing the thin-ideal and debrief home exercises. In the third session, participants practice “Quick comebacks” to thin-ideal statements and debrief home exercises. Participants also discuss reasons for signing up for the class, and are asked to do a behavioral challenge. The fourth session focuses on future pressures to be thin and a discussion of the benefits of the group, as well as debriefing for home exercises. In each session, all participants are expected to talk and generate anti-thin-ideal statements in each session.Abstracts and keywords to be supplied.

Participant Handouts for Six-Session Enhanced-Dissonance Body Project

Chapter 11 provides the handouts for the 6-session version of the Body Project script. There are roughly 2 home exercises for each session. These handouts are Letter to a Younger Girl, Self-Affirmation form (for the mirror exercise), the Verbal Challenge Form, the Top-10 List form, the Behavioral Exercise Form, the Body Activism Form, a Self-Affirmation Exercise Form. There are also exit exercises for the last session, which include a Letter to a Younger Girl and the Group Body Activism exercise. In addition, the 6-session version includes a handout for the Media Misrepresentation News Flash exercise and a Consequences of Eating Disorders News Flash.

Implementation Issues

Thousands of young female students have participated in the Body Project. Different implementation issues can arise depending on the delivery setting. When securing administrative support to deliver the program it is important to present the empirical support received, and the number of eating disorder cases that can potentially be prevented. Challenges to delivery that can arise include engaging quiet participants, challenging scheduling issues, and dealing with a range of levels to which individuals have internalized the thin-ideal. This chapter provides tips on how to deal with these issues as they arise.

Recruitment Procedures

The Body Project targets toward young women with body image concerns because they are at elevated risk for eating pathology, and prevention effects tend to be larger for individuals at higher risk for eating disorders. The intervention is characterized as a body acceptance class, rather than an eating disorder prevention program, to facilitate recruitment and avoid stigmatization. We recommend a multi-pronged approach to recruitment, with at least one form of individual/direct contact. One question can screen for the presence of at least a moderate degree of body dissatisfaction. The Body Project is not intended as a stand-alone treatment, particularly for individuals with anorexia nervosa, whom should be referred to a clinic or therapist for treatment.

Evidence Base for the Body Project and Related Dissonance-Based Eating Disorder Prevention Programs

The Body Project has produced intervention effects for eating disorder risk factors and symptoms in eight independent research groups. It is the only eating disorder prevention program that has met the criteria necessary for an intervention to be considered efficacious by the APA. Positive effects of this intervention have resulted when delivered by research-trained staff, existing providers (e.g., health educators), and undergraduate students suggesting that it can be disseminated by a variety of providers. Perhaps most importantly, the Body Project has been shown to produce a 60% reduction in the incidence of eating disorders over a three-year follow-up period.