Discussion
eating disorders, cognitive dissonance, disordered eating, eating disorder, depression
SECONDARY, RECRUITMENT, RECRUITMENT
This study, called the HEIDI BP-HW project, evaluated the acceptability and preliminary effectiveness of two well-validated eating disorders prevention interventions, the BP and HW, in the French-speaking region of Switzerland. Overall, our three hypotheses were confirmed: both interventions proved to be acceptable; the primary outcome, which was body dissatisfaction, was reduced after both interventions and some secondary outcomes as well; and the post-intervention scores were stable at a one-month follow-up. However, these positive results have to be tempered by the difficulty of the feasibility of the recruitment. The results of this study should be interpreted with caution because of the small sample size.Recruitment was complicated by the lockdown and difficulty in reaching our population of interest. Therefore, we used social networks and internet announcements with modest success. The difficulty in reaching and engaging young persons at risk of eating disorders in prevention programs has already been pointed out [Acceptability, including satisfaction with the BP and the HW, has rarely been assessed and compared between these two interventions. However, a preference for the HW over the BP, both adapted for athletes, has been documented in this population [The BP, which promoted cognitive dissonance in participants, produced significant decreases between pre and post scores in comparison with the WLCG with large effect sizes for body dissatisfaction, shape concern, dietary restraint and eating disorder psychopathology. The post-intervention scores of the BP group were maintained at the one-month follow-up. These results are comparable to those reported by numerous studies evaluating this intervention, in the US and internationally [The HW, which promoted behavioral techniques to gradually implement new health habits, produced significant group comparisons with the WLCG of pre-post scores with large to moderate effect sizes for body dissatisfaction, shape concern, dietary restraint, and depression. The post-intervention scores of the HW group were maintained at the one-month follow-up. In the same way as previously observed [In summary, these study results suggest that the French versions of the BP and HW were successful adaptations of the original programs designed for US populations. The French manual of the BP was translated by a team of the University of Grenoble-Alpes in collaboration with the original authors of the BP. Moreover, we were trained by the person who led the translation to ensure that the spirit of the program was preserved. The HW was translated and adapted by us because, to our knowledge, no French version exists. Following the recommendations of Swami and Barron [The main strength of this study was that it was the first to evaluate the effectiveness of the BP and HW in a French-speaking region of Switzerland, where a prevalence of disordered eating similar to other Western countries has been reported. The study contained three randomized arms, and each intervention was compared with a waiting-list control group. However, this study had several limitations that need to be mentioned. Due to the unique circumstances at the time of this study, recruitment was slower and the number of participants in each arm was smaller than expected. This prompted us to adjust our previously reported inclusion and exclusion criteria. Due to limited funding, we had to close the participants’ inclusion in the study before reaching the sample size estimated as necessary to detect large effect sizes. The participants in the study may have been highly motivated by the social contact provided by the meetings, which may have increased the satisfaction scores for both interventions. The statistical analyses did not follow the announced plan and were conducted per protocol, which may have overestimated the effectiveness of the interventions in real-life settings, and the sample was self-selected. The internal consistency of the rating scales was satisfactory, except for the depression subscale, for which the results should be interpreted with caution. Finally, the stability of the pre-post effects after one month of follow-up could only be evaluated within groups without a comparison with the WLCG.This study showed preliminary encouraging results on eating disorder risk factors in at-risk young women. The preventive effect of these interventions on eating disorders should be confirmed in large-scale, long-term studies. However, both interventions have already provided numerous proof of their efficacy in primary research, systematic reviews, and meta-analyses [