By Mandi Newton, RN, PhD
Edmonton, Alberta, Canada
Reprinted from Eating Disorders Review
January/February 2007 Volume 18, Number 1
©2007 Gürze Books
The increasing occurrence of disordered eating, as well as the personal and societal costs associated with having an eating disorder, has led to increased prevention efforts. These efforts have included delivering programs that use the Internet as their access point. Such an approach is hardly surprising given today’s trends in computer use. Computers have become a staple in everyday life, and Internet technology has broadened the ways in which we communicate and learn. But, how effective are Internet-based eating disorders prevention programs?
Little Research Has Been Done Thus Far
A recent review evaluated Internet-based eating disorders prevention programs published as research studies from 1985 to 2004.1 Only five studies had robust enough research designs to be included in the review. Each of the studies evaluated the same program, Student Bodies, indicating limited program options for individuals interested in delivering or being a part of this type of prevention initiative.
Student Bodies is a program based on social learning, cognitive behavioral, and psychoeducational theories (see page 2). It uses readings and reflection, an Internet-based body image journal, and Internet-based discussions to address many of the factors that lead to or allay eating pathology. This includes cognitive/affective factors (e.g., nutritional and exercise knowledge/attitudes, perceived social support), psychological factors (body image, drive for thinness, self-efficacy), sociocultural/peer norms (thinness ideal, dietary and exercise practices), and behavioral factors (coping/goal setting, food preparation, exercise patterns, for example).
The wide-ranging content of Student Bodies gives program participants the opportunity both to challenge negative influences and to develop skills that protect against the development of eating pathology. In theory, multi-session interventions like Student Bodies are ideal because they provide time for participants to reflect on new ideas and information and also to experiment with newly acquired skills.
In their review, Newton and Ciliska found no evidence, however, to suggest that the Student Bodies program used in the research studies was effective in reducing eating disordered attitudes and behaviors, body dissatisfaction (weight and shape concerns), or addressing factors known to contribute to the development of an eating disorder.1 The authors offered several explanations for these results. Three of the five reviewed studies had high program dropout rates, which potentially points to programmatic concerns. Also, content or specific ways that the content is delivered by Student Bodies may affect individuals’ investment in continuing with the program.
Two studies also reported results that suggest there may have been other factors that could have impacted eating-disordered attitudes and behaviors, body satisfaction, and contributing factors to eating disorders development. For example, other programs or media efforts, as well as the influence of negative and positive life events, may have impacted individuals’ experiences with Student Bodies.
Benefits and Drawbacks of Internet Programs
While the findings from this review are discouraging, the Internet as a delivery medium provides a novel approach to prevention, and this type of strategy may better reflect the future of program access. Internet-based prevention programs do come equipped with their own advantages and disadvantages compared to the traditional practitioner- or didactic-based programs.
Student Bodies Student Bodies™ is a self-contained high school and undergraduate level course on the topic of eating disorders, body image disorders, and the concepts of beauty. It uses new multimedia course delivery technologies. Students who participate in the full scope of the program have reported significant improvement in their body images.
Student Bodies was developed at Stanford University in response to repeated student requests for an academic course covering the topics of eating disorders and body image. In 1993, the Human Biology Department sponsored a course called “Body Traps” to respond to this interest. Simultaneously, Barr Taylor MD and Andrew Winzelberg PhD, in the School of Medicine at Stanford, were developing a computer-delivered eating disorder prevention program (Student Bodies) for undergraduate women. They wanted to develop a computer-delivered program because of the flexibility and privacy it offered to students, and the ability to offer the course to larger numbers of students. In 1997, the Body Traps course was integrated into the Student Bodies software and evaluated in a clinical trial.
Easier access in terms of where and when an individual participates can increase program availability to individuals who may not otherwise participate in traditional prevention efforts. It is important to keep in mind, however, that Internet-based programs do not necessarily mean easier access. Computer and Internet speed, geographical location, and financial means can also be barriers to participation.
Privacy and confidentiality can also be both an advantage and a disadvantage for individuals concerned with disclosure. For example, both privacy and confidentiality are dependent upon the protection the Internet-based program provides from ‘computer hackers’ and supports in terms of ‘firewalls’.
Some scholars purpose that the Internet leads to better social relationships by removing geographical barriers or isolation related to the stigma that often accompanies mental disorders. Others argue that the Internet alienates users from genuine social relationships and personal contact.2
It is possible that an Internet-based prevention strategy such as Student Bodies improves social support. Two of the five reviewed studies assessed this outcome and found that participants felt therapeutically supported by the program’s on-line discussion.1 However, while the Internet may point to the future of many services, including eating disorder prevention strategies, it is important to remember that these types of programs are unable to detect and address serious eating disorder symptoms that might otherwise be screened and discussed during in-person interventions. Therefore, as developments in this field continue, clear standards and guidelines to govern Internet-based interventions will be need to help protect professionals who deliver them and eating disorders patients who receive them.
1. Newton M, and Ciliska D. Internet-based interventions for the prevention of eating disorders: A systematic review. Eating Disorders: Journal of Treatment and Prevention (in press, November 2006).
2. Kraut M, Patterson M, Lundmark V, et al. Internet paradox. A social technology that reduces social involvement and psychological well-being? American Psychologist 1998; 53(9), 1017.