Pragmatic Indicated Prevention and Early Intervention for Disordered Eating: A Randomized Controlled Trial of Media...

We evaluated 3 new features of Media Smart Targeted (MST), an 8-module internet, self-guided, indicated prevention and early intervention for disordered eating (DE): a broader audience, optimal rate of program delivery, and impact on social media (SM) behaviors.

Participants (N = 555, aged 13-25 years, of any gender, from Australia and New Zealand) were randomized to: MST-Flexible (MST-F: user accesses modules at own rate, n = 184); MST-Standard (MST-S: weekly module release, n = 187); and control (body image tips, n = 184). Primary (Eating Disorder Examination-Questionnaire [EDE-Q] Global and DE diagnostic status), secondary (DE risk factors) and tertiary (SM) outcome measures were completed at baseline and at post-program, 6-month, and 12-month follow-up.

A total of 52.2% of participants randomized to MST-F or MST-S accessed their intervention. Modified intent-to-treat analyses (n = 378) included these participants (MST-F = 109; MST-S = 84) and all controls (n = 184) showed MST-F participants were more likely to complete each module and full program than MST-S participants. More favorable outcomes for EDE-Q Global were reported in the MST-F condition than control. MST-F and MST-S participants with baseline DE were 94% and 92% respectively less likely than controls to meet DE criteria at any point from post program onward (n = 36). Compared to controls, participants in the MST-F condition experienced significant improvements regarding regular eating, clinical impairment, internalization, and SM behaviors, including reduced appearance comparisons, following of appearance-based influencers, use of TikTok, and fewer SM accounts.

Although self-guided internet interventions have lower completion rates and more modest effects than face-to-face indicated prevention programs, MST-F can be delivered at scale, with low cost and greater flexibility in target audience, to achieve meaningful reductions in DE risk, symptoms, and SM behaviors.

Media Smart Targeted (MST) is an 8-module internet, self-guided prevention and early intervention program for disordered eating that has previously demonstrated benefit in 18- to 25-year-old women. This study investigated program effectiveness in a broader population of 13- to 25-year-olds of any gender, compared standard and flexible formats of program delivery, and evaluated impact on social media behaviors. About half of the participants accessed their intervention. The flexible format of MST was associated with higher rates of program completion and a greater reduction in symptoms of disordered eating and clinical impairment, as well as certain related social media behaviors. MST represents an additional scalable, low-cost treatment option for eating disorders in youth.

A randomised controlled trial of an efficacious school-based eating disorder risk reduction program: A comparison of 2, 4 and 8 lessons; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377675 DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.