Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 153: (i) Epidemiology (n = 3); (ii) Risk Factors; (iii) Media, Part 1 (n = 2); (iv) Disordered Eating, Part 5 (n = 3); and (v) Access to Treatment, Part 1 (n = 2)
Colleagues (N now = 1372 in 50 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 Request for
Researchers in the Field Exploring Physical Activity, Exercise, and Sport in the Context of Eating Disorder Prevention and/or Recovery
to Complete a Short Survey on a Proposed two-day International Conference on Eating Disorders and Physical Activity
planned to take place in Norway in 2026 (most probably 8th - 9th of June in the capital Oslo)
Received yesterday, 16 June 2025 (California time), via an email from Dr. Therese Fostervold Mathisen (Norway) and Solfrid Bratland-Sanda (Norway)
ML NOTE 1: Dr. Mathisen, Mx. Bratland-Sanda, and I would appreciate if you would pass this (see https://nettskjema.no/a/516986) along to (a) any and all researchers in the field exploring physical activity, exercise, and sport in the context of eating disorder prevention and/or recovery; and/or (b) any and all people you know who are working with researchers in this area.
ML NOTE 2: In regard to this request, please note that the work of Dr. Mathison and colleagues, including Solfrid Bratland-Sanda, has been presented in previous versions of this Newsletter, sent on 23 October 2023 (NOTE 4a - a.) and 24 January 2024 (#2 - b.), as well in the 30 January 2025 Substack Newsletter #104 (#7 - c.).
Distinguished scientist-practitioner-mentor Dr. Phillipa Hay (Australia) is a member of this Newsletter Group.
a. Mathisen, T. F., & Hay, P., & Bratland-Sanda, S. (2023). How to address physical activity and exercise during treatment from eating disorders: A scoping review. Current Opinion in Psychiatry, 36(6), 427-437. DOI: 10.1097/YCO.0000000000000892 [Email address for correspondence: Therese.F.Mathisen@hiof.no]
b. Sundgot-Borgen, C., Wisting, L., Sundgot-Borgen, J., Steenbuch, K., Skrede, J. V., Nilsen, K., Stice, E., & Fostervold Mathisen, T. (2024). The “Young Athlete Body Project”—A pilot study evaluating the acceptability of and results from an eating disorder prevention program for adolescent athletes. International Journal of Eating Disorders, 57(3), 568-580. https://doi.org/10.1002/eat.24140 [Full text available for download at: https://onlinelibrary.wiley.com/doi/full/10.1002/eat.24140]
c. Gjestvang, C., Mathisen, T. F., Bratland-Sanda, S., & Haakstad, L. A. H. (2024). The risk of disordered eating in fitness club members—A cross-sectional study. Sport, 12(12), 343. https://doi.org/10.3390/sports1212034 [Full text available for download at: https://www.mdpi.com/2075-4663/12/12/343]
[Dr. Mathisen writes:]
This is an invitation for you—and for your colleagues and associates who are clinically or scientifically involved in eating disorders and physical activity!
You have been identified as an internationally active researcher in the field exploring physical activity, exercise, and sport in the context of eating disorder prevention and/or recovery. We believe the time has come to join forces.
With this short survey, we aim to gauge the interest in attending a two-day international conference on eating disorders and physical activity, planned to take place in Norway in 2026 (most probably 8th - 9th of June in the capital Oslo).
The conference will bring together researchers and clinicians—like yourself—who have contributed to the understanding of how physical activity interacts with eating disorders. Our focus will be on exploring the role of professionally supervised physical activity in the treatment and recovery process of individuals with eating disorders.
We are reaching out via an open email recipient list, allowing you to identify any missing expertise that might benefit from being informed about this survey and initiative. You may either forward this email to them or add their name and contact information in the registration form.
Please find more information, including the aim for this planned event, in the registration form AND the SURVEY: https://nettskjema.no/a/516986
Best wishes
Therese Fostervold Mathisen, PhD [for Solfrid Bratland-Sanda, Norway]
Førsteamanuensis | Associate Professor Fakultet for helse, velferd og organisering | Faculty of Health, Welfare and Organisation | Høyskolen i Østfold / Østfold University College (Norway)
EVERYTHING IS ADVOCACY | RECOVERY LITERACY | SPENDING TIME WITH A BOLDER MODEL
The Wise Body Podcast, created and moderated by Dr. Sarah Hewes
presents
Episode 2: One of the Greatest Pioneers and Thought Leaders in the Field - An Interview with the GOAT, Dr. Margo Maine
Received 16 June 2025 via an Instagram post.
ML NOTE 3: One of my best friends, and a colleague and collaborator, and one of my personal (Bolder) role models, I have known Dr. Margo Maine (USA) for nearly 40 years. She is one of the seven original members this Newsletter Group when it began in 1998, and she was one of the two inspirations for the following chapter by the late Lori Irving. The other inspiration, and another of the original seven, is our own Dr. Niva Piran (Canada; see/listen to, for example, https://teacherfanclub.com/?p=66).
Irving, L. (1999). A bolder model of prevention: Science, practice, and activism. In N. Piran, M. P. Levine, & C. Steiner-Adair (Eds.), Preventing eating disorders: A handbook of interventions and special challenges (pp. 63-83). Routledge/Taylor & Francis. [For a copy, email ML at levine@kenyon.edu]
Listen (40 min) at: https://tinyurl.com/yfhpwas8
Welcome to the second episode of the Wise Body Podcast! It is only fitting to have the GOAT, Dr. Margo Maine to be my very first guest. No amount of accolades would do her justice. She is one of the most prominent psychologists in the field of eating disorders, with 40 years of experience and author of 8 well-known books. She has received several honorary and lifetime achievement awards for her research and practice. I am lucky to practice alongside her and call her my friend.
In this episode, I ask Dr. Maine how she came to become an eating disorder psychologist and what keeps her in the field. Shockingly, during her internship years, she was told to find another niche and that eating disorders were just a fad! I am so glad she didn’t believe that, as she’s been a fierce advocate for her patients ever since, fighting for the much needed medical care and insurance coverage they deserve, which is what keeps her in the field.
She also shares her biggest accomplishments, why she wrote a book about hair, and the question people ask her the most, and gives us her answer. Listen in to hear from the GOAT herself, Dr. Margo Maine.
Follow her on: Instagram: @drmargomaine | Website: https://www.mwsg.org/
To purchase her latest book, click here.
My Website: https://www.drhewes.com | My Instagram: https://www.instagram.com/drsarahhewes | The Wise Body YouTube Channel: https://www.youtube.com/channel/UCvOKmICHyAdq22q5Q3usbyA
Research Publication Categories in This Newsletter
(i) Epidemiology (n = 3); (ii) Risk Factors; (iii) Media, Part 1 (n = 2); (iv) Disordered Eating, Part 5 (n = 3); and (v) Access to Treatment, Part 1 (n = 2)
CONGRATULATIONS to our own
Drs. Vivienne Hazzard (USA), Natasha Burke (USA), and Kendrin Sonneville (USA) and colleagues for publication of the Epidemiology research article in #2.
Dr. Hiba Jebeile (Australia) and colleagues for publication of the Epidemiology research article in #3.
Drs. Chelly Maes (USA), Jasmine Fardouly (Belgium/Australia), and Laura Vandenbosch (Belgium) and colleague for publication of the Social Media Research article in #5.
Dr. Rachel Rodgers (USA/France), Genevieve Nowicki (USA), Dr. Eleanor Wertheim (Australia), and Dr. Susan Paxton (Australia) for publication of the Media research article in #6.
Dr. Kara A. Christensen Pacella (USA) and colleague for publication of the Disordered Eating research article in #8.
Drs. Daniel Le Grange (USA) and Stephen Touyz (Australia) and colleagues for publication of the Access to Treatment research article in #10.
Drs. Jennifer Wildes (USA) and Andrea Kass Graham (USA) and colleagues for publication of the Access to Treatment research article in #11
EPIDEMIOLOGY
1. Ge, Y., Zhang, S., Li, Z., Guo, H., Li, X., Li, Z., Dong, F., & Zhang, F. (2025). Global, regional and national level burden of bulimia nervosa from 1990 to 2021 and their projections to 2030: analysis of the global burden of disease study. Journal of Eating Disorders, 13, 110. https://doi.org/10.1186/s40337-025-01289-9
Full text available for download at: https://tinyurl.com/mskpc36w
ABSTRACT. Background: Bulimia nervosa (BN) is increasingly recognized as a significant public health issue worldwide. This study aims to explore the effects of BN on global, regional, and national scales by analyzing data from the Global Burden of Disease (GBD) Study 2021.
Methods: We obtained the age-standardized rates (ASRs) of prevalence, incidence, and disability-adjusted life years rates (DALYs), along with their 95% uncertainty intervals (UIs) for BN from the GBD 2021 dataset, covering the period from 1990 to 2021. And estimated annual percentage changes (EAPCs) was used to represent the changing trend of BN burden. The Long-term trends of the burden of BN were quantified by Age-period-cohort (APC) analysis. Furthermore, an evaluation of inequality and a prospective prediction concerning the worldwide impact of BN is performed.
Results: From 1990 to 2021, the global burden of BN showed a continuous increase. In 2021, the highest burden of BN was observed in regions with a high socio-demographic index (SDI), particularly in Australasia (ASPR was 811.9 per 100,000 individuals; 95% UI: 629.68 to 1041.59). The most substantial increase in the burden of BN was observed in Asia. In the national level, Equatorial Guinea experienced the most significant increase in the burden of BN from 1990 to 2021 (EAPC of ASPR was 3.48; 2.86 to 4.11).
In contrast, burden of BN in High-income North America recorded a substantial decrease from 1990 to 2021 (EAPC of ASPRs was − 0.26; -0.39 to -0.13). The growth rate of male BN burden was higher than that of female. The relative inequality of the BN burden decreased between 1990 and 2021. Further forecasts from the GBD indicated that the global burden of BN would continue to rise by 2030.
Conclusion: These results can help governments across the globe in developing suitable health and medical policies focused on the prevention and early intervention of BN. Moreover, the differences in BN burden should be analyzed based on region, nation, gender, and year when setting international health goals.
ML NOTE 4: The article described below in #2 came to my attention via the Obesity and Energetics Offerings online newsletter of 13 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.
ML NOTE 5: In regard to food in/security, see also the article described below in #11.
2. Efstate, A., Hazzard, V. M., Burke, N. L., Sonneville, K. R., & Hammond, D. (2025). Food security and eating disorder behaviors in the International Food Policy Study, 2018 to 2022. International Journal of Epidemiology, 54(3), dyaf060. https://doi.org/10.1093/ije/dyaf060
Full text available for download at: https://tinyurl.com/272nzwt2
ABSTRACT. Background: A link has been established between food insecurity and eating disorder (ED) pathology, but most research on this topic has occurred in the USA. This study examined associations and potential moderators of associations between food security (FS) levels and ED behaviors cross-nationally.
Method: Repeated cross-sectional data representing 104 881 adults 18–100 years of age in Australia, Canada, Mexico, the UK, and the USA came from five waves (2018–22) of the International Food Policy Study. Participants completed the Household Food Security Survey Module and reported on past-3-month binge eating and self-induced vomiting to control weight. Associations between past-year household FS level and ED behaviors were examined with adjusted modified Poisson regression models. Interactions with potential moderators were also tested.
Results: Marginal, low, and very low FS were associated with elevated prevalence of both ED behaviors. Compared with households with high FS, binge eating was 1.34, 1.54, and 1.73 times as prevalent in households with marginal, low, and very low FS, respectively. Associations were stronger for self-induced vomiting; compared with households with high FS, self-induced vomiting was 2.40, 7.10, and 11.98 times as prevalent in households with marginal, low, and very low FS, respectively. Moderation results revealed meaningful differences by some factors. For example, associations were weaker in Mexico and stronger among ethnic minorities and participants with children.
Conclusion: Results support cross-sectional associations between FS and ED behaviors, with a particularly strong link for self-induced vomiting. Some heterogeneity in these associations was observed across country and sociodemographic factors.
3. Melville, H., Lister, N. B., Libesman, S., Seidler, A. L., Cheng, H. Y., Kwan, Y. L., Garnett, S. P., Baur L. A., & Jebeile, H. (2025). The prevalence of eating disorders and disordered eating in adults seeking obesity treatment: A systematic review with meta-analyses. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24483.
Full text available for download at: https://tinyurl.com/4v8j3v7a
ABSTRACT. Objective: To estimate the prevalence of eating disorders and disordered eating in adults seeking obesity treatment. Method: Databases, MEDLINE, Embase, and PsycINFO, were searched to 20th March 2025. Studies reporting the prevalence of eating disorders or disordered eating at presentation to obesity treatment in adults (≥ 18 years) with overweight (BMI 25 to < 30 kg/m2) or obesity (BMI ≥ 30 kg/m2), with ≥ 325 participants to ensure a representative sample, were included. A random-effects model was used to pool prevalence estimates of eating disorders and disordered eating.
Results: 85 studies were included (N = 94,295, 75.9% female, median (IQR) age 44 (5) years, BMI 46 (10) kg/m2). When assessed by clinical interview, the pooled prevalence of binge-eating disorder (Diagnostic and Statistical Manual of Mental Disorders-5) was 14% (95% CI: 7 to 22, prediction interval [PI]%: 0 to 43, k = 10, n = 8534), and bulimia nervosa 1% (95% CI: 0 to 1, PI%: 0 to 2, k = 9, n = 9448, τ2 = 0). When assessed using the Binge Eating Scale, the prevalence of self-reported moderate severity binge eating was 26% (95% CI: 23 to 28, PI%: 18 to 33, k = 12, n = 8113, τ2 = 0.001) and severe binge eating was 12% (95% CI: 8 to 16, PI%: 0 to 31, k = 18, n = 12,136, τ2 = 0.01).
Discussion: Obesity and eating disorders or disordered eating do co-occur. There was variability between studies and between the prevalence of eating disorders and disordered eating in adults presenting for obesity treatment. It is critical that clinicians are well resourced to effectively identify individuals with eating disorders and disordered eating and provide appropriate treatment pathways.
RISK FACTORS
4. Dachew, B. Tusa, B. S., Damtie, Y. Calton, E., Ayano, G., Anderson, R., & Alati, R. (2025). Prenatal and perinatal risk factors for feeding and eating disorders in children: A population-based linked cohort study. Eating Behaviors. Advance online publication. https://doi.org/10.1016/j.eatbeh.2025.102006
Full text available for download at: https://tinyurl.com/34f33yux
ABSTRACT. Objective: This study aimed to investigate the longitudinal effects of prenatal and perinatal risk factors on the development of feeding and eating disorders (FEDs) in children. Methods: A population-based retrospective cohort study was conducted using data from 223,068 mother–child pairs born between 2003 and 2005 in New South Wales, Australia. Offspring were followed for up to 15 years, until 2018. FEDs in children were identified using the Australian version of the International Classification of Diseases, 10th Revision (ICD-10-AM) codes. Logistic regression models were employed to identify predictors of FEDs in children.
Results: A total of 435 children (0.2 %) were diagnosed with FEDs. The multivariable analysis identified both maternal and child-related factors significantly associated with FEDs in children. Maternal factors included advanced age (over 35 years) (adjusted odds ratio [AOR] = 1.36, 95 % CI = 1.03–1.79), high socio-economic status (AOR = 1.44, 95 % CI = 1.09–1.91), and perinatal anxiety disorder (AOR = 1.95, 95 % CI = 1.15–3.31). For children, being female (AOR = 3.35, 95 % CI = 2.69–4.17), having low birth weight (AOR = 1.60, 95 % CI = 1.10–2.52), and low Apgar scores were associated with a higher risk of FEDs (AOR = 2.55, 95 % CI = 1.46–4.53).
Conclusion: Our findings highlight the association between several prenatal and perinatal factors and an increased risk of FEDs in children. These results underscore the critical need for monitoring and addressing modifiable risk factors during the prenatal and perinatal periods to mitigate their potential adverse effects on children's health.
MEDIA, Part 1 of 3
5. Maes, C., Vanherle, R., Fardouly, J., & Vandenbosch, L. (2025). #BoPo, #Ideal, or #Mixed? Exploring adolescents’ daily exposure to appearance content on social media and its relations with body image components. Communication Research. Advance online publication. https://doi.org/10.1177/00936502251338901
Full text available for download at: https://tinyurl.com/yc556554
ABSTRACT. When using social media, adolescents encounter various types of appearance-related content. Yet, no research has explored how daily exposure to such types of content, including idealized content, body positivity (BoPo) content, and a mixture of both, links to adolescents’ body image states. With the present 14-day daily diary study among French adolescents (N = 108, 1,434 daily assessments, Mage = 15.99, 64.8% girls), we examined how exposure to idealized appearance content and BoPo content predicts adolescents’ state body satisfaction and surveillance on the same day and the next day. More so, we explored how the relationships may vary depending on a co-occurrence of exposure to both content types (i.e., mixed exposure).
At a between-person level, exposure to idealized appearance and BoPo content was linked to higher body surveillance. At the within-level, BoPo content was associated with higher body satisfaction, meaning that on days that adolescents saw more BoPo content than usual (compared to their own means), they were also more satisfied with their bodies. However, these relations did not last until the following day. No other within-person level relations emerged. Also, when exploring the impact of the interaction between exposure to BoPo and idealized content, non-significant results emerged.
The findings highlight the complexity of adolescents’ interactions with social media and emphasize the importance of future research adopting an ecological approach. This should involve considering both intra-individual and inter-individual factors, as well as the diverse types of social media exposure.
6. Rodgers, R. F., Nowicki, G. P., Wertheim, E. H., & Paxton, S. (2025). Perceived effects of body positive social media content and correlations with trait body image. Eating Behaviors, 57, 101987. https://doi.org/10.1016/j.eatbeh.2025.101987
Full text available for download at: https://tinyurl.com/3a6me8v4
ABSTRACT. Body positive social media content has been described as less detrimental for body image as compared to idealized body-focused social media content. However, little work has explored who finds these posts helpful. This is an important gap, as individuals who are positive towards such content are more likely to engage with it and thus find more of it in their recommended content.
The aims of the study were to examine (1) reactions to body positive social media content and (2) their associations with dimensions of body image among young women. A sample of 135 undergraduate women completed an online survey. Participants viewed two different body positive social media posts and for each indicated their reactions on visual analog scales before completing measures of trait body image. One post included only text while the other featured a group of diverse women.
Findings revealed that, across dimensions and posts, favorable and positive reactions were more common than negative ones. However, the group image elicited higher ratings of feeling happy, good about one's body, and ok with one's looks, and lower feelings of anxiety and embarrassment. Correlational analyses revealed trait indices of positive body image were associated with higher positive reactions to posts (happy, good about body, OK with looks) and lower negative reactions (embarrassed, anxious, bad about body, motivated to change looks), while indices of poor body image were associated with lower positive and higher negative reactions. Findings suggest body positive social media might be most useful for maintaining positive body image.
DISORDERED EATING, Part 5 of 5
7. Jo, D., Garey, L., Redmond, B. Y., Shepherd , J. M., & Zvolensky, M. J. (2025). Latent profiles of processes in acceptance and commitment therapy and their associations with eating disorder symptoms among adult women. Journal of Contextual Behavioral Science, 36. Advance online publication. https://doi.org/10.1016/j.jcbs.2025.100899
Email address for correspondence: Duckhyun.Jo@uth.tmc.edu
ABSTRACT. The present study examined the latent profiles of processes in Acceptance and Commitment Therapy (ACT) to enhance the sensitivity of acceptance- and mindfulness-based interventions, particularly in the prevention of eating disorder symptoms among non-clinical female adults.
A sample of 1347 female adults was recruited from a large public university in Hawaii, and latent profile analysis was employed to identify distinct groups based on ACT processes measured by the Multidimensional Psychological Flexibility Inventory (MPFI). The study also explored the influence of participants' racial backgrounds and sexual orientations on the formation of these profiles, as well as the association between the identified profiles and eating disorder symptoms.
The analysis revealed a five-profile solution, indicating that racial background and sexual orientation statistically significantly influenced profile categorization. Profiles characterized by high psychological flexibility and low psychological inflexibility were generally linked to lower levels of eating disorder symptoms. Notably, some profiles, such as the Moderately Flexible and Inflexible groups, necessitated a nuanced interpretation regarding their relationship with eating disorder symptoms. These findings emphasize the variability in individuals’ experiences of ACT processes and a person-centered approach in examining the associations between ACT processes and eating disorder symptoms.
8. Sagert, S. J., Christensen Pacella, K. A. (2025). Higher imposter syndrome symptoms associated with greater odds of eating disorders in college and university students. Journal of American College Health. Advance online publication. https://doi.org/10.1080/07448481.2025.2501013
Email address for correspondence: kara.christensen@unlv.edu
ABSTRACT. Objectives: This study evaluated the relationship between imposter syndrome symptoms (IS) and screening positive for eating disorders (EDs) in college and university students. Participants: The sample consisted of 4257 students from the 2021-2022 Healthy Minds Study. Methods: Measures assessed IS (five questions from the Clance Imposter Syndrome Scale), ED symptoms (SCOFF), and demographics. A binary logistic regression tested the association between IS total score and screening positive for an ED, adjusting for BMI, gender, race/ethnicity and age.
Results: Higher IS total scores were associated with greater odds of screening positive for EDs (OR = 1.10, 95% CI [1.09, 1.12]), after adjusting for covariates. Conclusion: IS symptoms may be a risk factor for ED pathology; however, more research is needed to understand potential causal or correlational relationships.
9. Gercek, H. G., İpek Bas, S., Kara, A., & Bukulmez, A. (2025). Examination of eating attitudes and symptoms of orthorexia nervosa in adolescents with and without celiac disease. Journal of Eating Disorders, 13, 102. https://doi.org/10.1186/s40337-025-01294-y
Full text available for download at: https://tinyurl.com/yx8kpjuh
ABSTRACT. Introduction: Celiac disease (CD) is an autoimmune disorder triggered by gluten, leading to digestive issues, malabsorption, nutritional deficiencies, mental health effects, and long-term health risks. Previous studies have indicated that increased attention directed to food in CD treated with a gluten-free diet may increase the risk of eating disorders (ED). Although Orthorexia Nervosa (ON), defined as an obsession with healthy eating, is not yet considered an ED in an official diagnostic system, it is similar to ED in some of its features. ON in adolescents with CD has not been explored in the existing literature. We aimed to compare ON symptoms, eating attitudes, anxiety, depression, and obsessive-compulsive disorder (OCD) symptoms between adolescents with and without CD in this study.
Method: The study involved 30 adolescents with CD and 30 healthy controls. Participants were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) in a semi-structured clinical interview. The risk of ON was evaluated with the ORTO-11 questionnaire while eating attitudes were measured using the Eating Attitudes Test (EAT-40). Anxiety, depression, and OCD symptoms were compared between the adolescents with and without CD using the parent and child forms of the Revised Child Anxiety and Depression Scale (RCADS).
Results: ON symptoms and impaired eating attitudes were higher in adolescents with CD than in the healthy control group. No significant differences were found between the groups in terms of anxiety, depression, and OCD symptoms. In the correlation analysis of the RCADS-child form with other scales, there was a positive correlation between ON symptoms, impaired eating attitudes, and OCD symptoms. When the correlation analysis of the RCADS-parent form with other scales was examined, no significant correlation was found.
Conclusion: To the best of our knowledge, our study is the first to evaluate ON in adolescents diagnosed with CD, and our results show that there is an increase in the frequency of ON and impaired eating attitudes in CD. Additionally, we found that the increase in OCD symptoms in adolescents with CD was associated with ON and impaired eating attitudes.
ACCESS TO TREATMENT, Part 1 of 2
10. Hambleton, A., Kandar, V., Miskovic-Wheatley, J., Vatter, S., Le Grange, D., Touyz, S., & Maguire, S. (2025). The double-edged sword of translational research: Stakeholder perspectives of the enablers and challenges implementing anorexia nervosa treatment in rural health settings. Australian Journal of Rural Health, 33(3), e70043. https://doi.org/10.1111/ajr.70043
Full text available for download: https://tinyurl.com/2ue5vvx3
ABSTRACT. Objective: To explore the translational research processes that emerged at the early phase of the implementation of telehealth-delivered family-based therapy (FBT) for young people with anorexia nervosa (AN) attending Australian rural health services. Setting: Commencing mid-2019, five rural health districts across New South Wales (NSW) participated in the study.
Participants: Nine stakeholders, including study coordinators, clinicians and eating disorder coordinators, participated in a semi-structured interview during the early implementation of telehealth-delivered FBT. Design: Inductive thematic analysis methodology was used to identify key research factors that enabled and challenged the implementation.
Results: The translational research improved patient access to evidence-based care, afforded health services access to clinical expertise, workforce training and supervision and assisted with meeting government directives of improving care pathways. However, the study and intervention implementation were challenged by research-related factors, including ethical and clinical dilemmas, the burden of stakeholders holding multiple roles and general challenges associated with integrating research into non-academic health services.
Conclusion: To optimise implementation and to bridge the access gaps particularly felt by rural families and health settings, translational studies ought to consider the enablers and challenges identified by the stakeholders. Trial registration: ACTRN12620001107910.
11.Rooper, I. R., Azubuike, C., Ortega, A., Miller, G. C., Parsons, L. M., Lipman, L. D., Kruger, M., Flynn, R. L., Silverberg, B., Wildes, J. E., & Graham, A. K. (2025) ‘Harder to reach’ versus reaching harder: Exploring preferred dissemination pathways to a digital binge-eating intervention for adults with or at risk of food insecurity. Eating Behaviors, 57. Advance online publication. https://doi.org/10.1016/j.eatbeh.2025.101970
Email address for correspondence: isabel.rooper@northwestern.edu
ABSTRACT. Objective: Individuals from minoritized and under-resourced subpopulations, such as individuals with food insecurity, are sometimes considered “harder to reach.” Instead, tailored dissemination pathways may be required to reach them. We sought to learn how best to reach individuals with food insecurity seeking digital intervention for binge eating.
Method: As part of continued design work in two ongoing trials testing a digital intervention for binge eating, we conducted a secondary exploratory analysis of individuals' preferred dissemination channels, modes, and materials. We assessed individuals' preferences at baseline via a pre-intervention questionnaire. Adults (n = 90) with binge eating and food insecurity or at risk of food insecurity completed the questionnaire. We also compared their preferences to adults (n = 106) with binge eating and without food insecurity, and highlighted differences of p < 0.10.
Result: Individuals with or at risk of food insecurity preferred dissemination via community organizations and events, healthcare centers, fitness centers, and online sources, more than trusted sources (e.g., clinicians). They preferred websites over other dissemination modes (e.g., videos). They were most interested in useful promotional materials (e.g., grocery bags). Compared to those without food insecurity, individuals with or at risk of food insecurity were more interested in dissemination via community organizations and events, and less interested in dissemination through doctors.
Discussion: Findings indicate tailored dissemination strategies could improve reach to individuals with or at risk of food insecurity. This study is a first step toward better engaging this subpopulation. Future work should disseminate through the preferred channels, assess their reach, and iterate as needed.