Efficacy of Virtual Delivery of a Dissonance-Based Eating Disorder Prevention Program and Evaluation of a Donation Model to Support Sustained Implementation

Objective: Evaluate whether the Body Project prevention program reduces eating disorder risk factors and symptoms when implemented via synchronous video telepsychiatry, which could markedly increase the reach of this intervention and test whether a pay-it-forward donation model could support sustained implementation of this intervention. Method: Young women at high risk for eating disorders because of body image concerns (N = 75; age range 16-27) were randomized to Body Project groups delivered virtually by peer educators or a waitlist control condition; participants who completed the Body Project for free because of past donations were encouraged to donate money so that this intervention could be provided for free to others. Results: Participants randomized to virtually delivered Body Project groups showed significantly or marginally greater pretest-to-posttest reductions in pursuit of the thin ideal, body dissatisfaction, dieting, negative affect, and eating disorder symptoms than controls. The average effect was large (d = .79), which was 49% larger than the average effect observed previously for in-person peer-educator-delivered Body Project groups (d = .53; [.76−.53 = .23/.53 = 49%]). However, only 3.6% of participants donated money to support future implementation of this intervention. Conclusions: The evidence that the Body Project produced large reductions in eating disorder risk factors and symptoms when implemented virtually and that the effects were larger than for in-person Body Project groups suggests it would be useful to implement this prevention program virtually, which could expand the reach of this intervention. Future studies should evaluate alternative methods for supporting sustained implementation of this prevention program. What is the public health significance of this article? The Body Project, a dissonance-based eating disorder prevention program, produced large reductions in eating disorder risk factors and symptoms when implemented virtually via synchronous video telepsychiatry compared to waitlist controls in this randomized trial. The average pretest-to-posttest effect for virtually delivered Body Project groups was 49% larger than the parallel effect for groups that were delivered in-person, providing encouraging evidence that virtual delivery may increase the efficacy of this prevention program. Results suggest that a pay-it-forward donation model is not an effective approach to support sustained implementation of this preve