Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 156: (i) New Book; (ii) Disordered Eating; (iii) Technology, Part 2 (n = 2); (iv) Weight Stigma, Part 3 (n = 3); and (v) Early Intervention, Part 1 (n = 2)
Colleagues (N now = 1378 in 49 countries),
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list.
EVERYTHING-IS-ADVOCACY, so
Spend Time with Bolder Models in
Dr. Kathy Pike’s Big Ideas in Eating Disorders Podcast Series
including our own
Drs. Anne Becker (USA), Carolyn Becker (USA), Kelly Klump (USA), and Phillipa Hay (Australia)
ML NOTE 1: As you listen to (or watch on YouTube) these podcasts, please keep in mind that the host, distinguished scientist-practitioner-advocate, and my friend, Dr. Kathy Pike, is herself a Bolder Model. In that regard, I strongly encourage you to check out https://www.columbiapsychiatry.org/profile/kathleen-pike-phd.
From the Podcast Website: In this series, “Big Ideas in Eating Disorders,” join host, Dr. Kathy Pike, clinical psychologist and professor at Columbia University, as she talks with leaders in the field of eating disorders. We hear from researchers, clinicians, and people who have personally experienced an eating disorder. In each episode, guests share one big idea that they believe is crucial to improving the lives of people at risk for developing or currently living with an eating disorder. Capturing today’s wisdom for a better future, “Big Ideas in Eating Disorders” is filled with stories as they have never been told before.
Kathleen M. Pike, Ph.D. | Professor of Psychology, Columbia University | Visit kathypikephd.com
LISTEN TO ALL THE Big Ideas PODCASTS at: https://bigideasineatingdisorders.com/
DR. ANNE BECKER (~44.7 minutes)
Today’s episode takes us on a global journey with Dr. Anne Becker, Maude and Lillian Presley Professor of Global Health and Social Medicine at Harvard Medical School. Although Anne never became the meteorologist she imagined in her youth, as a psychiatrist and anthropologist, she traveled far from home to launch pioneering work in Fiji focused on how culture contributes to shaping the meaning of body image and risk for eating disorders. In this episode, Anne shares how she got to Fiji, the surprising conversations, and the evolving meaning of weight in Fijian communities at different points in time. Anne shares the serendipitous circumstances that enabled her to map the impact of the arrival of American television on triggering eating disorder symptoms and rising body shape and weight concerns. Dr. Becker’s keen intellect and her delight in discovery is riveting and contagious as she shares her pioneering work, which is foundational for anyone who wants to understand culture and eating disorders.
Becker, A. E. (2004). Television, disordered eating, and young women in Fiji: Negotiating body image and identity during rapid social change. Culture, Medicine, and Psychiatry, 28, 533–559. https://doi.org/10.1007/s11013-004-1067-5 [Email address for correspondence: Abecker@mgh.harvard.edu]
Becker, A. E. (1995). Body, self, and society: The view from Fiji. University of Pennsylvania Press.
DR. CAROLYN BECKER (41 minutes)
In this episode, we delve into the insights of Trinity University Psychology Professor Carolyn Becker, whose insatiable curiosity and openness to explore diverse fields have been the driving forces behind her innovative and fruitful career. Recognized for her excellence in teaching and research, Professor Becker’s expertise lies in implementing scientifically backed interventions in both clinical and real-world contexts. She has led innovative work focused on body image and athletes and has spearheaded groundbreaking research on eating disorders among individuals facing food insecurity, a demographic often overlooked by conventional eating disorder studies. Her work underscores the imperative to dismantle stereotypes surrounding eating disorders.
DR. KELLY KLUMP (~42.5 min)
Today we have the good fortune to hear from Dr. Kelly Klump whose contributions to the field of eating disorders are indeed invaluable. Inspired by one of her early mentors, Professor Gloria Leon, Dr. Klump has embarked on a journey of groundbreaking research that reshapes our understanding of the complex interplay between genetics, hormones, and environmental factors in the development of eating disorders. Dr. Klump’s exploration of gonadal hormones, including estrogen, progesterone, and testosterone, is steadily uncovering the relationship of hormonal fluctuations, particularly during puberty, to the onset and expression of eating disorders. Translating these findings to clinical practice has the potential to inform more effective prevention strategies and personalized interventions for individuals at risk of developing eating disorders.
DR. PHILLIPA HAY (42 minutes) - “Reconsidering Weight-Based Criteria for Eating Disorders”
Professor Phillipa Hay is a psychiatrist and the current Chair of Mental Health at Western Sydney University in Australia, the co editor-in-chief of the Journal of Eating Disorders, and past recipient of the Lifetime Leadership Award from the Australia New Zealand Academy for Eating Disorders. Drawing on her experience from decades of teaching, research, and clinical care in eating disorders, Dr. Hay discusses the limitations of weight-based criteria in eating disorder diagnostic criteria, both in terms of limiting treatment access and in restricting our understanding of recovery.
Research Publication Categories in This Newsletter
(i) New Book: Obesity & EDs; (ii) Disordered Eating; (iii) Technology, Part 2 (n = 2); (iv) Weight Stigma, Part 3 (n = 3); and (v) Early Intervention, Part 1 (n = 2)
CONGRATULATIONS to our own
Drs. Kathryn Smith (USA) and Tyler Mason (USA) and colleague for publication of the Disordered Eating research article in #2.
Dr. Marci Gluck (USA) and colleagues for publication of the Disordered Eating research article in #3.
Drs. Jake Linardon (Australia), Mariel Messer (Australia), and Hannah Jarman (Australia) and colleagues for publication of the Technology research article in #6.
Dr. J. Kevin Thompson (USA) and colleagues, including distinguished researcher Dr. Myles Faith (USA), for publication of the Weight Stigma research article in #7.
Drs. Jeff Hunger (USA) and A. Janet Tomiyama (USA) and colleagues for publication of the Weight Stigma research article in #9.
Dr. Adrea LaMarre (Canada) and colleagues for publication of the Early Intervention review article in #10.
Dr. Gemma Sharp (Australia) and colleagues for publication of the Early Intervention research article in #11.
And CONGRATULATIONS Are Also in Order for a
NEW BOOK entitled
The New Food Fight: How the Weight Management and Eating Disorder Fields Became So Divided and What We Can Do About It
by Drs. Marion Tanofsky-Kraff (USA), Natasha Schvey (USA), Robyn Pashby (USA), and [our own] Natasha Burke (USA)
Publication dates: 19 June 2025 online; 30 September 2025 in print
1. Tanofsky-Kraff, M., Schvey, N. A., Pashby, R. O., & Burke, N. A. (2025). The new food fight: How the weight management and eating disorder fields became divided and what we can do about it. Oxford University Press. https://doi.org/10.1093/oso/9780197752531.001.0001 (200 pp. + Index; Online ISBN: 9780197752562; Print ISBN: 9780197752531)
Publisher’s website: https://academic.oup.com/book/60471
Description at the publisher’s website: The New Food Fight guides readers through the complex and often contradictory landscape of body weight nutritional advice, body image, and health, offering both clarity and compassion. Integrating personal narratives, clinical examples, cutting-edge research, and expert insights, the book delves into the polarized fields of eating disorders and weight management. It debunks common myths, tackles misinformation, and reveals surprising similarities between these two seemingly opposing disciplines.
Written with both empathy and authority, the book offers clear, actionable recommendations to bridge the divide and promote a more unified understanding of health. It serves as an essential resource for anyone who has grappled with body image, struggled to decide what to eat, or found themselves torn between self-acceptance and the desire for change.
Table of Contents: 1. Author Perspectives Based on Lived Experiences || 2. A Fork in the Road: How the Eating Disorders and Obesity Fields Diverged || 3. Sticking Points About High Body Weight: Illness or Identity? || 4. Sticking Points About Food: Good, Bad, or All in Moderation? || 5. Sticking Points About Weight Loss: Healthy or Harmful? || 6. Sticking Points About Eating Disorders: Caused by Dieting, or More Complicated Than That? || 7. Getting Unstuck: Ending the New Food Fight
DISORDERED EATING/EATING PATHOLOGY
2. Khalil, Z., Mason, T. B., & Smith, K. (2025). Examining racial-ethnic and gender differences in the associations between resilience, psychological inflexibility, and eating disorders. Journal of American College Health.,Advance online publication. https://doi.org/10.1080/07448481.2025.2510687
Email address for correspondence: zk_454@usc.edu
Introduction: This study investigated independent and interactive associations of resilience and psychological flexibility and racial-ethnic and gender identity in relation to ED risk. Methods: Young adults in the 2022–2023 Healthy Minds Study (N = 24,431) completed the Brief Resilience Scale, Acceptance and Action Questionnaire (AAQ-II), and an ED screening tool.
Results: Generalized linear models showed that lower resilience and psychological flexibility were associated with increased ED risk across gender and race-ethnicity categories. Asian American/Asians, American Indian/Alaskan Natives, cisgender women, and transgender women also showed elevated ED risk. An interaction between AAQ-II scores and gender identity revealed that transgender females demonstrated a stronger association between psychological inflexibility and ED risk compared to cisgender males. Resilience emerged as a protective factor regardless of racial-ethnic or gender identity.
Discussion: Results highlight the importance of addressing resilience in future ED prevention and treatment and considering variability across racial-ethnic identity and gender in studies of ED risk.
3. Willig, M., Cabeza de Baca, T., J. Stinson, E., Treviño-Alvarez, A. M., Rodzevik, T., Votruba, S. B., Lameman, C. C., Krakoff, J., & Gluck, M. E. (2025). The impact of COVID-19 fear during the later stages of the pandemic on maladaptive eating, psychological distress and body weight: A global cross-sectional study. BMC Public Health, 25, 1365. https://doi.org/10.1186/s12889-025-22444-6
Full text available for download at: https://tinyurl.com/2jdjzvnt
ABSTRACT. Background: The COVID-19 pandemic significantly impacted global mental health, leading to increased levels of fear, stress, and anxiety [1]. Previous research has suggested associations between functional fear of detrimental mental health outcomes and psychological stressors which may drive maladaptive eating behaviors. This study explored the associations between COVID-19 fear during later stages of the pandemic, psychological distress (anxiety, depression, and stress), maladaptive eating behaviors (emotional, uncontrolled, binge, and nighttime eating), and self-reported body weight.
Methods: This was a global cross-sectional survey conducted from February 2022 to February 2024, involving 4390 adults (70% female) from 25 countries. The survey collected information on demographics, psychosocial impact, eating behaviors, and COVID-19 related behaviors. General linear models, multinomial logistic regression modes, and structural equation modeling were used to analyze the data.
Results: Higher fear of COVID-19 was significantly associated with increased emotional and uncontrolled eating, even after adjusting for psychological distress and other covariates. Specifically, each unit increase in fear of COVID-19 scores was associated with a corresponding increase in emotional eating (β = 0.018) and uncontrolled eating (β = 0.029) behaviors (p-values < 0.0001). Furthermore, fear of COVID-19 was linked to higher odds of engaging in binge eating (OR = 1.05, 95% CI: 1.03, 1.07, p-value < 0.0001) and nighttime eating behaviors (OR = 1.04, 95% CI: 1.03, 1.06, p-value < 0.0001) in models adjusted for covariates; however, these associations were no longer significant when psychological distress variables were included.
Fear of COVID-19 was also associated with body weight (β = 0.18) and BMI (β = 0.08) even with adjustments of covariates and psychological distress variables (p-values < 0.01). Structural equation modeling showed that fear of COVID-19 was related to current body weight through its impact on psychological distress and maladaptive eating behaviors.
Conclusions: Maladaptive eating behaviors influenced by the psychological distress experienced during the COVID-19 pandemic have persisted into the later stages of the pandemic. These results underscore an interconnectedness between functional fear and its influence on maladaptive eating behaviors and body weight. Understanding this link is crucial and has the potential to inform the development of public health policies. Trial registration: Clinical Trials.gov NCT04896060 Date of Registration: May 21, 2021.
4. Lan, A., Harel, L., & Einat, H. & (2025). Light and food: Body image moderates the effects of chronotype on the risk to develop an eating disorder. Journal of Clinical Medicine, 14(12), 4328. https://doi.org/10.3390/jcm14124328
Full text available for download at: https://tinyurl.com/3ud2ppbv
ABSTRACT. Background: Evening chronotypes are increasingly recognized as being at elevated risk of psychological vulnerabilities, including sleep disturbances, mood disorders, and disordered eating. Body image, a central self-related construct, has been identified as a key factor influencing eating disorder (ED) risk. This study aimed to explore whether body image moderates the relationship between chronotype and the risk of developing an ED.
Methods: A total of 165 adults (139 women; mean age = 35.45) completed validated self-report questionnaires assessing chronotype (Morningness–Eveningness Questionnaire), body image (Body Shape Questionnaire), and ED risk (EAT-26). Pearson correlations and moderation analyses (PROCESS macro and Model 1) were conducted with body image as a moderator of the association between chronotype and ED risk.
Results: Eveningness was significantly associated with greater ED risk (r = −0.53, p < 0.001) and a more negative body image (r = −0.48, p < 0.001). Body image was a strong predictor of ED risk (r = 0.85, p < 0.001). Moderation analysis revealed a significant interaction between chronotype and body image (b = −0.006, SE = 0.0009, p < 0.001), indicating that the relationship between chronotype and ED risk was stronger among individuals with a more negative body image. Conclusions: These findings highlight the role of body image as a moderating factor in the link between chronotype and eating disorder vulnerability. Interventions aimed at improving body image, especially among evening chronotypes, may help mitigate ED risk. These results underscore the importance of integrating circadian and psychosocial factors in ED prevention and early intervention strategies.
TECHNOLOGY, Part 2 of 4
5. Cruz, T., Duarte, C., Ferreira, T. B., Santos, C., & Martins, M. V. (2025). Smartphone applications for eating disorders: A systematic review and meta-analysis of randomized controlled trials. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24488
Email address for correspondence: telmandreiacruz@gmail.com
ABSTRACT. Objective: Given the rising prevalence of eating disorders (EDs), smartphone applications (apps) have received growing clinical attention, but their overall effectiveness remains undetermined. This study aimed to conduct a meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of app interventions for EDs and to identify the psychological approaches featured in these interventions. Method: The online databases SCOPUS, PubMed, and EBSCO were searched for trials published up to February 2025. This review followed PRISMA guidelines, and meta-analyses were conducted using post-intervention assessment data. Pooled effect sizes were calculated with 95% confidence intervals.
Results: Seventeen studies met the inclusion criteria, and 14 were included in the quantitative synthesis. Trials involving not formally diagnosed samples indicated that app-based interventions were more efficacious than controls in reducing global levels of ED symptomatology, shape and weight concerns, dietary restraint, binge eating, and compensatory behaviors. No significant effects were found for body dissatisfaction/disturbance or drive for thinness.
Self-help interventions showed generally comparable improvements. In formally diagnosed samples, only objective binge eating was analyzed, with a medium effect observed when the app was incorporated into guided self-help. The use of an adjunctive app was not shown to have benefit above and beyond traditional therapy. Most interventions were based on cognitive-behavioral therapy principles.
Discussion: This review supports the efficacy of app-based interventions in reducing key ED symptoms, particularly within the binge-eating spectrum and among at-risk individuals. Nonetheless, given the limited number of studies, further research with high-quality RCTs, larger samples, and proper follow-ups is needed.
6. Linardon, J., Messer, M., Anderson, C., Liu, C., McClure, Z., Jarman, H. K., Goldberg, S. B., & Torous, J. (2025). Role of large language models in mental health research: An international survey of researchers' practices and perspectives. BMJ Mental Health, 28(1), e301787. https://doi.org/10.1136/bmjment-2025-301787
Full text available for download at: https://tinyurl.com/42ymej2w
ABSTRACT. Background: Large language models (LLMs) offer significant potential to streamline research workflows and enhance productivity. However, limited data exist on the extent of their adoption within the mental health research community. Objective: We examined how LLMs are being used in mental health research, the types of tasks they support, barriers to their adoption and broader attitudes towards their integration. Methods: 714 mental health researchers from 42 countries and various career stages (from PhD student, to early career researcher, to Professor) completed a survey assessing LLM-related practices and perspectives
Findings: 496 (69.5%) reported using LLMs to assist with research, with 94% indicating use of ChatGPT. The most common applications were for proofreading written work (69%) and refining or generating code (49%). LLM use was more prevalent among early career researchers. Common challenges reported by users included inaccurate responses (78%), ethical concerns (48%) and biased outputs (27%). However, many users indicated that LLMs improved efficiency (73%) and output quality (44%). Reasons for non-use were concerns with ethical issues (53%) and accuracy of outputs (50%). Most agreed that they wanted more training on responsible use (77%), that researchers should be required to disclose use of LLMs in manuscripts (79%) and that they were concerned about LLMs affecting how their work is evaluated (60%).
Conclusion: While LLM use is widespread in mental health research, key barriers and implementation challenges remain. Clinical Implications: LLMs may streamline mental health research processes, but clear guidelines are needed to support their ethical and transparent use across the research lifecycle.
WEIGHT STIGMA, Part 3 of now 4
7. Zumaglini, S., Fredrick, S., Thompson J. K., & Faith, M. S. (2025). Confronting pediatric weight-based cybervictimization: Time for action. Obesity Science and Practice, 11(3), e70073. https://doi.org/10.1002/osp4.70073
Full text available for download at: https://tinyurl.com/exp977kd
ABSTRACT. Weight-based victimization represents a critical challenge for youth, particularly those with obesity, and has been linked to a range of negative psychological, academic, and behavioral outcomes. While research has extensively examined in-person victimization, the rise of digital platforms has given way to weight-based cybervictimization, which remains understudied. This paper highlights the urgent need for research, prevention, and intervention strategies focused on weight-based cybervictimization, emphasizing its harmful effects and its overlap with traditional forms of victimization.
It identifies gaps in the existing literature, particularly regarding the inconsistent use of assessment tools and terminology in research on weight-based victimization, and proposes the necessity for culturally relevant and validated measurement tools that accurately capture youth experiences. Finally, it aims to inform best practices for healthcare providers, educators, and parents by promoting strategies that effectively address and mitigate the impact of weight-based victimization among youth.
ML NOTE 2: The article described below in #8 came to my attention via the Obesity and Energetics Offerings online newsletters of 6 June 2025. For more information about free participation in this ongoing and valuable exercise in education, research methods, and critical thinking, see Obesity and Energetics Offerings.
8. Goldkorn, M., Schwartz, B., & Monterosso, J. (2025). Views among the general public on new anti-obesity medications and on the perception of obesity as a failure of willpower. Obesity Science and Practice, 11(2), e70041. https://doi.org/10.1002/osp4.70041
Full text available for download at: https://tinyurl.com/mpmympn4
ABSTRACT. Background: The experience of obesity stigma is associated with negative clinical outcomes that include increased mental health problems and additional weight gain. Researchers have treated the public view that obesity is caused by poor willpower as both an element of obesity stigma and as a cause of obesity stigma. Here we test the hypothesis that awareness of new and effective glucagon-like peptide receptor agonist anti-obesity medications (AOMs) will encourage the view that obesity is a biologically-determined medical condition rather than a personal willpower failure and thereby lessen obesity stigma.
Materials and Methods: Two questionnaire studies, in which participants were randomly assigned to either read about the success of AOMs or to read various alternative material (N = 640 in total), investigated the effect that AOM awareness has on views of obesity.
Results: Contrary to the study hypotheses, reading about AOMs did not increase the degree to which participants viewed obesity as a medical condition, nor did it reduce the role willpower failure was believed to play in obesity. Across conditions, participants reporting more personal success in weight loss without medication indicated greater belief that obesity was amenable to self-control, expressed greater obesity stigma, and held less positive attitudes toward the use of AOMs to manage weight.
Conclusion: Taken together, these two studies provide no evidence that the success of AOMs will, in the short-term, lead to changes in how people view the etiology of obesity or to a reduction in obesity stigma. Correlational data suggest the possibility that blame and stigma associated with obesity may be robustly informed by participants' understanding of their own experiences managing weight.
9. Figueroa, D., Murley, W., Parker, J. E., Hunger, J. M., & Tomiyama, A. J. (in press). Weight stigma and mental health symptoms: Mediation by perceived stress. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1587105
Email address for correspondence: tomiyama@psych.ucla.edu
ABSTRACT. Prior research has established that weight stigma, or social devaluation based on an individual's body size or weight, is directly related to greater depressive and anxiety symptoms. In this investigation, we apply the Cyclic Obesity/Weight-Based Stigma model to investigate if the association between weight stigma and poor mental health is mediated by greater perceived stress. We analyzed data from a census-matched sample (N = 1,993) of the U.S. on age, race/ethnicity, gender, income, and census-region. Issues with missing data and mediation models were addressed using a Bayesian multiple imputation approach.Analyses controlled for Body Mass Index and sociodemographic variables as covariates.
Weight stigma was directly associated with greater depressive and anxiety symptoms. Moreover, the relationship between weight stigma and greater depressive and anxiety symptoms was mediated by greater perceived stress. Perceived stress explained 37% of the relationship between weight stigma and mental health outcomes, even after accounting for Body Mass Index. These results provide evidence for weight stigma as an important psychosocial stressor that contributes to poor mental health outcomes.
EARLY INTERVENTION, Part 1 of 2
10. LaMarre, A., Porter, J., Silva-Roy, P., & Obeid, N (2025). Identifying programme-led and focused interventions for early intervention for eating disorders in youth: A rapid review. Early Intervention in Psychiatry, 19(6). Advance online publication. https://doi.org/10.1111/eip.70053
Email address for correspondence: alamarre@cheo.on.ca
ABSTRACT. Background: Early intervention (EI) for eating disorders (EDs) has been recognised as important for interrupting the onset of ED symptoms and improving outcomes. Despite growing evidence for EI models of service delivery in community-based settings, there is limited clarity on which specific interventions might best suit young people in these contexts. In this rapid review, we aimed to identify and explore the evidence for programme-led and focused interventions applicable to an EI service delivery model for youth with EDs in community-based settings.
Methods: A systematic search was conducted in MEDLINE, Web of Science, and PsycINFO databases, focusing on interventions that maximise the use of resources, namely guided self-help and group approaches, for individuals under age 30. Studies were screened for eligibility based on intervention brevity (12 sessions or fewer) and relevance to EI models.
Results: Findings indicated that while many interventions reduced ED symptoms, few were explicitly designed for EI. Notably, interventions are skewed towards young adult populations, with fewer interventions addressing paediatric needs. Further, the strength of evidence for interventions varied, with many articles reporting on studies with small sample sizes or results illustrating non-superiority to comparison or control. Conclusion: This review highlights the need for further research on programme-led and focused interventions tailored to EI, particularly for younger populations, to build an evidence base and improve early-stage ED treatment options in resource-limited community-based settings.
11. Sharp, G., Dwyer, B., Randhawa, A., McGrath, I., & Hu, H. (2025). The effectiveness of a chatbot single-session intervention for people on waitlists for eating disorder treatment: Randomized controlled trial. Journal of Medical Internet Research, 27, e70874. https://doi.org/10.2196/70874
Full text available for download at: https://www.jmir.org/2025/1/e70874
Abstract. Background: Early treatment is critical for improving eating disorder prognosis. Single-session interventions (SSIs) can provide short-term support to people on waitlists for eating disorder treatment; however, it is not always possible to access SSIs. We co-designed and developed a rule-based chatbot called ED ESSI (Eating Disorder Electronic Single-Session Intervention), which delivered an SSI and demonstrated its acceptability and feasibility. However, the effectiveness of ED ESSI is yet to be investigated.
Objective: This study aimed to investigate the effectiveness of an SSI delivered by ED ESSI. We examined the chatbot’s impact on eating disorder pathology, psychosocial impairment, depression, anxiety, stress, and motivation for change or treatment in individuals aged ≥16 years on waitlists for treatment for all types of eating disorders.
Methods: This multicenter 2-armed randomized controlled trial included 60 people on waitlists for eating disorder treatment in the chatbot intervention group (n=30, 50%) or the control group (n=30, 50%). The ED ESSI chatbot guided participants through a 30-minute SSI of assessment and psychoeducation, while the control group received web-based information on the same core topics covered in the SSI. There were 4 time points: before intervention or baseline (time point 1 [T1]), after intervention within 72 hours of baseline (T2), 1 month after baseline (T3), and 3 months after baseline (T4).
Eating disorder pathology (primary outcome) and psychosocial impairment, depression, anxiety, and stress (secondary outcomes) were measured at T1, T3, and T4, and motivation for change or treatment (secondary outcome) was measured at all 4 time points. Furthermore, the System Usability Scale was implemented at T2 for the chatbot intervention group only.
Results: ED ESSI induced significantly greater reductions compared to the control group in the primary outcome of eating disorder pathology ( p = .003) and secondary outcomes of psychosocial impairment ( p = .008), depression ( p = .002), and anxiety ( p = .040) over the 1- and 3-month time points, with small to moderate effects (Cohen d = 0.15-0.53). Chatbot use also induced an increase in participants’ confidence in their ability to change (secondary outcome) immediately after use (T2), with a moderate effect (p < .001; Cohen d = 0.74). The chatbot was rated as “excellent” in terms of usability. A significantly higher proportion of participants in the chatbot group (28/30, 93%) entered treatment by 3 months upon the opportunity being offered to them, compared to the control group, with a moderate effect (21/30, 70%; p = .042; ϕ = 0.30).
Conclusions: ED ESSI promptly induced improvements in eating disorder pathology, psychosocial impairment, depression, and anxiety, which were detectable at 1 month and maintained to 3 months. ED ESSI potentially represents an effective, accessible, and scalable form of early intervention for people aged ≥16 years waiting for eating disorder treatment. Further research is needed to determine the longer-term effectiveness of ED ESSI. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12623000680662; https://tinyurl.com/2h9v7hh7