Pilot Evaluation of the EVERYbody Project

A Pilot Evaluation of the EVERYbody Project: Professionally-delivered Inclusive Eating Disorder Risk Factor Reduction for College Students

A pilot randomized-controlled trial explored the feasibility, acceptability, and efficacy of an inclusive dissonance-based body image intervention called the EVERYbody Project. The professionally delivered EVERYbody Project was evaluated in a universal college student population compared to a waitlist control group through one-month follow-up.

An existing dissonance-based body image program (the Body Project; Stice, Shaw, Burton, & Wade, 2006) was adapted to directly discuss diversity within cultural appearance ideals (including race, gender identity, sexuality, ability, and age) and the individual and collective impact of pursuing exclusive appearance norms. The feasibility, acceptability, and efficacy of the EVERYbody Project was assessed in an initial randomized-controlled trial. College students within a university in the Pacific Northwest United States were invited to participate in programming (universal intervention target). Professional delivery of the two-session EVERYbody Project was compared to a waitlist control condition. Intervention groups were facilitated by one "expert" (faculty or staff with body image expertise) and two college student co-facilitators. Mixed methods assessment included a comparison of changes in quantitative eating disorder risk factor outcomes across randomization conditions and among students with marginalized identities at pre-intervention, post-intervention, and one-month follow-up. Qualitative interviews assessed the impact of the program on participants with marginalized identities. Feasibility and acceptability of the program was assessed to evaluate the appropriateness of the EVERYbody Project within universal college student audiences.

Participants were randomized on a 1-1 basis to receive either the EVERYbody Project or be on the waitlist control list (assessment-only control).

The EVERYbody Project is a dissonance body image intervention created from focus group feedback (Ciao, Ohls, & Pringle, 2017) and through an iterative process of student-driven feedback. The Body Project manual (Stice et al., 2006) was adapted to retain key dissonance activities while expanding the gender focus, adding an exploration of the diversity characteristics within appearance ideals, and adjusting activities to be inclusive of diversity characteristics. Several adapted versions of the intervention were piloted with groups of college students and further adapted based on feedback. Facilitators received 16 hours of training on the EVERYbody Project manual and facilitation guidelines.

Participants allocated to the waitlist completed assessments at time points parallel to those in the EVERYbody Project condition and were offered the EVERYbody Project upon completing the one-month follow-up assessment.

Eating disorder symptoms were assessed with the Eating Disorders Examination Questionnaire (EDEQ; Fairburn & Beglin, 1994). The Global score of the EDEQ was used in this study (average across all 28 items with a 0-6 range; higher scores equal greater eating disorder symptoms).

Assessed change from baseline (Survey 1) through post-intervention (Survey 2; immediately after intervention) and one-month follow-up (Survey 3; one month after intervention). Waitlist was assessed at parallel time points.

The Satisfaction and Dissatisfaction with Body Parts Scale (SDBPS; Berscheid, Walster, & Bohrnstedt, 1973) assessed satisfaction and dissatisfaction with nine parts of the body that are commonly endorsed as concerning (e.g., stomach, thighs, hips). The average score was used in this study (average across all 9 items with 1-5 range; higher scores equal greater body dissatisfaction).

Assessed change from baseline (Survey 1) through post-intervention (Survey 2; immediately after intervention) and one-month follow-up (Survey 3; one month after intervention). Waitlist was assessed at parallel time points.

The two Internalization subscales of the Sociocultural Attitudes Toward Appearance Questionnaire-4 (SATAQ-4; Schaefer et al., 2015) assess internalized cultural messages surrounding appearance and attractiveness. The two internalization subscales were combined for this study (average across all 10 items with 1-5 range; higher scores equal greater internalization), following prior research by Kilpela et al. (2016).

Assessed change from baseline (Survey 1) through post-intervention (Survey 2; immediately after intervention) and one-month follow-up (Survey 3; one month after intervention). Waitlist was assessed at parallel time points.

Negative affect was assessed with 20 items from the fear, guilt, and sadness subscales of the Positive and Negative Affect Schedule-Revised (PANAS-X; Watson & Clark, 1992). The average of all 20 items was used in this study with 1-5 range; higher scores equal greater negative affect.

Assessed change from baseline (Survey 1) through post-intervention (Survey 2; immediately after intervention) and one-month follow-up (Survey 3; one month after intervention). Waitlist was assessed at parallel time points.

Students with marginalized identities who participated in EVERYbody Project groups were invited to complete semi-structured interviews. Specific question asked were: How was your experience with the EVERYbody Project? Was anything in the program (any activity or part of the experience) particularly interesting or helpful to you? Why? Was anything in the program (any activity or part of the experience) particularly unhelpful or upsetting to you? Why? (3) The goal of this research was to have conversations about body image that are more inclusive, that is, with diverse individuals who have many different experiences. Do you think this occurred within your EVERYbody Project group? (4) Is there anything you would suggest for improving EVERYbody Project groups to meet the goal stated above? (5) Is there anything else you would like to share with us about the EVERYbody Project? Additional follow-up prompts were used at the interviewer's discretion.

Students are invited to participate after completing their follow-up survey (Survey 3) or one month after their participation in the EVERYbody Project.

Satisfaction with the EVERYbody Project (based on Ciao et al., 2015) included four Likert scale items (e.g., "I enjoyed the EVERYbody Project") rated from 1 (strongly disagree) to 5 (strongly agree). Questions were averaged to create a total "satisfaction" score; higher scores equaled greater satisfaction. Open-ended questions also assessed satisfaction (e.g., "Was any part of the EVERYbody Project particularly helpful/useful? If so, which part and why?"). Satisfaction questions were administered immediately following participation in the intervention (Survey 2). At post-intervention (Survey 2) and one-month follow-up (Survey 3), three questions gauged application of information learned in the program (e.g., "How often do think about the things you learned in the EVERYbody Project?" rated on a scale from 1 (not at all) to 5 (all the time). Items were averaged to created a total "application" score with higher scores equaling greater application of intervention content.

Assessed at post-intervention (Survey 2; immediately following the intervention) and one-month follow-up (Survey 3; four weeks post intervention).

Inclusion Criteria: Current college student enrolled at institution where research was taking place Exclusion Criteria: None

Data and other materials will be made available following reasonable request to study Principal Investigator. All outcome data will be included in data sharing. Socio-demographic characteristics will be collapsed into broader categories to protect participant identity. Other study materials, including intervention manuals, will be housed on the Principal Investigator's Open Science Framework page, where URLs will be made publicly available.

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