Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 222: (i) Sociocultural Factors; (ii) BDD/MDD, Part 2 (n = 3); (iii) Media, Part 2 (n = 2); (iv) Caregivers, Part 2 (n = 2); and (v) October-November Treatment Interlude, Part 4 (n = 3)
Colleagues (N now = 1432 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.
RECOVERY/PREVENTION PARENTING PODCAST
The Plateful Parent Podcast presents
Season 2, Episode 6 (NO. 41): Breaking Cycles — Recovery, Reflection, and Raising Resilient Children
with our Dawn Smith-Theodore, MA, MFT, CEDS (USA)
Rec’d 25 November 2025 via an everything-is-advocacy email from our own Dawn Smith-Theodore, MA, MFT, CEDS, developer, curator, and moderator of TuTu Thin: A Podcast for Dancers | Be a healthy dancer/athlete in mind, body and spirit.
ML NOTE 1: If you are interested in being an everything-is-advocacy guest on the Plateful Parenting Podcast, go to https://platefulparenting.com/.
Season 2, Episode 6 of The Plateful Parenting Podcast
With Christine Heller & Chanel Kenner, RD
Guest: Dawn Smith-Theodore, LMFT | Author of Mother, Men & Me and Tutu Thin
Episode Title: Breaking Cycles — Recovery, Reflection, and Raising Resilient Children
Listen (51.75 min) at:
Episode Description
In this powerful continuation of our conversation with therapist, author, and former professional dancer Dawn Smith-Theodore, we explore how generational patterns, perfectionism, and secrecy shape our children’s relationships with food, body, and identity.
Dawn opens up about her new memoir Mother, Men & Me: A Memoir of Anxiety, Anorexia, and Affairs—and the courage it took to revisit her past in order to break cycles of control and shame.
From the ballet studio to the therapy room, Dawn’s story offers a profound look at what recovery looks like across a lifetime—and what it means to parent with compassion even when you’re still healing yourself.
In this episode:
Family secrets, body image, and inherited anxiety
How Dawn’s lived experience as a dancer informs her therapy work today
The early cues parents can look for when perfectionism turns harmful
Body image pressures in dance, sports, and social media culture
Practical tools from Tutu Thin for raising confident, body-aware kids
How writing and storytelling can bring healing and closure
Whether you’re a parent navigating your child’s body image struggles—or confronting your own—this conversation is a reminder that it’s never too late to rewrite your family story.
Resources Mentioned:
Mother, Men & Me by Dawn Smith-Theodore
CULTURAL LITERACY
Lived Experience/Essay
Body Image Pressures and Eating Disorders in Asian Cultures
by Ashley
Received 2 December 2025 via a newsletter/email from Butterfly, “Australia’s leading not for profit supporting everyone affected by eating and body image issues. You can find out more about Butterfly and our prevention services for schools and communities at www.butterfly.org.au or contact our education team - education@butterfly.org.au.” Our own Dr. Janet Lowndes (Australia) is on Butterfly’s board of directors.
ML NOTE 2: Below is, roughly, the first half of this essay (bold-for-emphasis in the original). The entire essay can be read at https://tinyurl.com/mzeczwfv.
Body Image Pressures and Eating Disorders in Asian Cultures
In this blog, Ash shares her lived experience of an eating disorder, and how weight-focused comments are normalised in Asian cultures.
Growing Up Filipino in Australia
I was born in the Philippines, but grew up mostly in Australia, having moved here when I was two years old. My parents made sure my sister and I stayed connected to our culture, by celebrating Filipino traditions and keeping Filipino food on weekly rotation. They spoke to us, and continue to, in the main language of the Philippines – Tagalog. However, it was also important to them that we learned English.
At home, I lived with a different language, food and environment, and my family was loud and energetic. But outside that space, at school, English was the only language accepted. My peers’ lunches looked different to mine – they had sandwiches, while I brought meat and rice. Everyone would look at my food in disgust. I felt like an outsider, that I was different.
The high school I attended was not very diverse – most of my classmates were Caucasian and born in Australia, and I felt isolated and alone, coming from a minority group. No one had my skin colour or eye shape or body shape – the things I was most insecure about.
The girls I grew up with didn’t look like me and I felt like I had to change my whole personality to feel accepted. They seemed confident, popular and constantly surrounded by attention, and I often compared myself to them. I was shy, introverted, and fearful of being disliked, so I turned to food, as a way to feel some control over my life.
Appearance Comments in Asian Cultures
This feeling of not being good enough because I looked different from my peers, played a big role in fuelling my eating disorder, which was only intensified by the normalisation of weight focused and body image comments within my Asian community. In Asian cultures, specifically within the Philippines, there is a beauty standard that is so incredibly unrealistic: petite, light-framed and underweight. If you do not fit into this standard, you are immediately seen as unattractive.
When I was experiencing an eating disorder, I was afraid to go to family events because I knew there would be comments about the way that I looked – from my skin tone to my weight. Relatives asking me how much I weighed was a ‘normal’ question and aunties providing ‘nutrition weight loss tips’ was also ordinary conversation.
If your weight or appearance changes, it’s deeply engrained in Asian culture for relatives to point out these physical changes directly, without any filter or sensitivity. These appearance-focused comments were normalised – and you’d be subjected to them, regardless of if you’re living in a larger body, or were underweight. In my experience, there was always an opinion and a backhanded compliment about my weight or appearance.
Being underweight is so glorified within Asian culture that I felt like I had to change my body to fit the standard – even if my body composition wasn’t made for it.
When I would excessively exercise, it wasn’t a concern. It was praised and applauded because I had ‘discipline’ and ‘self-control’. However, if I had muscle, I was portrayed as ‘too masculine’ and undesirable. Being in a larger body was seen as unattractive and being underweight was linked to ‘beauty’’.
When it comes to appearance ideals, whatever your body looks like, it is never ‘good enough’. I was chasing perfection, and to be the smallest version of myself to be accepted, but these harmful beauty standards only led me deeper into my eating disorder.
Mental Illness, Eating Disorders and Asian Culture
In the Philippines, mental illness is seen as taboo. There’s a common belief that mental illness is made up and eating disorders do not exist. I was raised by two immigrant parents from third world countries that faced food insecurity and was grateful when food was brought to the dinner table. But when I was struggling with an eating disorder, I would feel guilty that I was privileged to have access to food and struggled a lot with this idea that no one would believe me if I said I had an eating disorder.
Research Publication Categories in This Newsletter
(i) Sociocultural Factors; (ii) BDD/MDD, Part 2 (n = 3); (iii) Media, Part 2 (n = 2); (iv) Caregivers, Part 2 (n = 2); and (v) October-November Treatment Interlude, Part 4 (n = 3)
CONGRATULATIONS to our own
Taryn Henning (USA), Taylor Vashro (USA), and Drs. Marisol Perez (USA) and Suzanne Mazzeo (USA) and colleagues for publication of the Sociocultural Factors research article in #1.
Drs. Jason Nagata (USA), Kyle Ganson (Canada), Jinbo He (China), Stuart Murray (USA), and Jason Lavender (USA), and colleagues for publication of the Muscle Dysmorphia review article in #2.
Dr. Renee Engeln (USA) and colleagues for publication of the Media research article in #6.
Dr. Renee Reinecke (USA), Dr. Catherine Drury (USA), Alan Duffy (USA), and Dr. Erin Reilly (USA) and colleague, distinguished scientist-practitioner-mentor Dr. Philip S. Mehler (USA), for publication of the Caregivers research article in #7
Drs. Mia Pellizzer (Australia), Madelaine de Valle (Australia), Jake Linardon (Australia), and Tracey Wade (Australia), and colleague for publication of the Treatment review article in #10.
SOCIOCULTURAL FACTORS
1. Henning, T., Vashro, T., Derrigo, K., Parton, D., Perez, M., & Mazzeo, S. E. (2026). Associations among acculturative stress, body ideal internalization, body dissatisfaction and eating pathology among Asian, Black, and Latino men. Eating Behaviors, 60. Advance online publication. https://doi.org/10.1016/j.eatbeh.2025.102062
Email address for correspondence: henningt@vcu.edu
ABSTRACT. Background: Empirical findings support the association between acculturative stress and eating pathology, however, relatively few studies have examined mechanisms of this link among racially and ethnically diverse men. The current study addressed these gaps by examining the potential roles of thin-, and muscular-ideal internalization and body dissatisfaction as mediators of the relation between acculturative stress and eating pathology among Asian, Black, and Latino men.
Methods: Adult men from across the United States (Asian N = 110; Black N = 117; Latino N = 85) completed measures of acculturative stress, body ideals, body dissatisfaction, and eating pathology. Analyses investigated the mediating roles of body image ideal internalization (thin-, muscular-) and body dissatisfaction as mediators of the relation between acculturative stress and eating pathology across each racial and ethnic group.
Results: Results identified a significant association between acculturative stress and eating pathology among Asian, Black, and Latino men. In addition, across all groups, thin-ideal internalization mediated the relation between acculturative stress and eating pathology. However, body dissatisfaction and muscular-ideal internalization did not mediate the relation between acculturative stress and eating pathology among any of the groups.
Conclusion: Findings highlight the importance of acculturative stress, thin-ideal internalization, and their associations with eating pathology among racially and ethnically diverse men. Future research should examine within-group differences across racial and ethnic subgroups to further enhance understanding of culturally specific risk factors.
MUSCLE DYSMOPRHIA/BODY DYSMORPHIC DISORDER, Part 2 of 2
2. Nagata, J. M., Hur, J. O., Murakami, K., Ganson, K. T., He, J., Murray, S. B., & Lavender, J. M. (2025). Muscle dysmorphia in adolescents and young adults. The Lancet: Child & Adolescent Health. Advance online publication. https://doi.org/10.1016/S2352-4642(25)00283-4
Email address for correspondence: jason.nagata@ucsf.edu
SUMMARY. Body image concerns among adolescent boys and young men are increasingly recognised as societal ideals shift towards a lean, muscular physique. In severe cases, these pressures can lead to muscle dysmorphia, a specifier of body dysmorphic disorder marked by preoccupation with being too small or insufficiently muscular. Adolescents and young adults are developmentally vulnerable and might be at higher risk for a variety of eating-related and body image-related concerns, including muscle dysmorphia.
This narrative Review synthesises current evidence on the epidemiology, assessment, and treatment of muscle dysmorphia in adolescents and young adults to guide clinicians. Although some treatment approaches show promise, outcome data in large, diverse, clinical adolescent samples remain scarce. Muscle dysmorphia-specific preventive strategies are few, although eating disorder prevention programmes show potential for reducing muscle dysmorphia symptoms.
Future research should investigate pharmacotherapy and prevention programmes, validate assessment tools across populations, and examine cultural influences internationally. Advancing understanding of muscle dysmorphia will better equip clinicians to identify and address symptoms in adolescents and young adults.
3. Abrante, D., Cano, A., Clemente, G., & Díaz, M. (2025). Muscle dysmorphia symptomatology in male exercisers: Associations with cognitive flexibility and appearance motivation. Eating Behaviors. Advance online publication. https://doi.org/10.1016/j.eatbeh.2025.102050
Email address for correspondence: desire.abrante@universidadeuropea.es
ABSTRACT. The association between sociocultural pressure and muscle dysmorphia (MD) is well-documented, yet the psychological variables involved require further investigation. This cross-sectional study examined a statistical model in 95 male exercisers in Spain (M age = 34.40) to explore the roles of appearance motivation and cognitive flexibility. Specifically, it tested the indirect association between the perceived influence of appearance ideals and MD symptoms through appearance motivation, and whether cognitive flexibility moderated this relationship.
The overall model accounted for 48 % of the variance in MD symptoms (R2 = 0.48), controlling for age. Results indicated a significant indirect association through appearance motivation (b = 0.16, 95 % CI [0.03, 0.36]). Additionally, a significant moderation was found (p = .043); the positive association between the influence of appearance ideals and MD symptoms was weaker for individuals with higher levels of cognitive flexibility.
These findings are consistent with a model where MD symptom endorsement is linked to appearance motivation, while higher cognitive flexibility is related to a less pronounced association between sociocultural pressures and MD symptoms. Cognitive flexibility is highlighted as a potential protective correlate, suggesting that interventions could target motivational patterns and cognitive skills.
4. Noda, S., Kasch, C., Lindsay, C. E., & Hofmann, S. G. (2025). Cross-cultural network structures of social anxiety, body dysmorphic, and major depressive disorder symptoms in individualistic vs. collectivistic societies: A comparison between American, German, and Japanese populations. Journal of Anxiety Disorders, 116. Advance online publication. https://doi.org/10.1016/j.janxdis.2025.103090
Full text available for download at: https://tinyurl.com/k34rxaud
ABSTRACT. Social anxiety disorder (SAD), body dysmorphic disorder (BDD), and major depressive disorder (MDD) are highly comorbid, which may be influenced by cultural variables associated with individualism vs. collectivism with particular emphasis on shame. This study investigated the network structures comprising symptoms of SAD, BDD, MDD, and shame across three countries typically associated with either a high tendency of collectivism (Japan), a high tendency of individualism (USA), or in between (Germany).
Participants included 319 Japanese, 440 US Americans, and 308 Germans from the general populations of their respective countries, who completed questionnaires assessing the aforementioned symptoms as well as individualistic and collectivistic tendencies. Psychometric network analyses were conducted using Gaussian Graphical Models to separately examine the network structures of (a) individualistic and collectivistic tendencies and (b) symptoms of SAD, BDD, MDD, and shame. A Network Comparison Test (NCT) was used to assess the overall consistency of these networks across countries.
The NCT revealed significant cross-cultural differences in the network structures of individualistic and collectivistic tendencies across countries, as well as in the networks of symptoms of SAD, BDD, MDD, and shame between Japan and Germany and between Japan and the USA. Although certain central symptoms were shared across all countries, others differed. These findings underscore the coexistence of cultural homogeneity and heterogeneity in the manifestation and organization of SAD, BDD, and MDD symptoms, emphasizing the importance of culturally sensitive, targeted interventions.
MEDIA, Part 2 of now 5
5. Bloxham, I., Taumoepeau, M., & Treharne, G. J. (2025). ”Actually, let’s not give sick people any more ideas”: Eating disorder recovery content on TikTok. Eating Disorders: The Journal of Treatment & Prevention. Advance online publication. https://doi.org/10.1080/10640266.2025.2589521
Full text available for download at: https://tinyurl.com/hux2dkam
ABSTRACT. Research into the factors that drive the development, maintenance, and recovery from eating disorders (EDs) has established that social processes play an integral part in helping or hindering one’s recovery from an ED. In a world where social processes have increasingly moved online, this research aimed to better understand themes within ED recovery content on TikTok. A thematic analysis of n = 312 of the most popular TikTok videos about ED recovery was conducted using a snowball sampling method to find common hashtags related to ED recovery and a codebook to compile deductive and inductive codes.
Content related to suicide/self-harm or pro-anorexia beliefs was uncommon across the videos, but four themes were generated from the inductive thematic analysis: recovery milestones, the social nature of ED recovery, bodies as evidence of recovery, and the all-powerful ED. The findings from this research contribute to understandings about the shifting online landscape for ED recovery, where platforms like TikTok are increasingly becoming a source of support and community. The findings of this research will assist individuals in ED recovery and those supporting them when deciding whether engaging with recovery content on TikTok is right for their recovery journey.
6. Zola, A., Pike, H. K., & Engeln, R. (2025). Women’s reactions to body positivity posts Vary by posters’ race and body size. Computers in Human Behavior Reports. Advance online publication. https://doi.org/10.1016/j.chbr.2025.100870
Full text available for download at: https://tinyurl.com/ykfvuddy
ABSTRACT. The online body positivity movement focuses on representing and supporting those with marginalized bodies, particularly fat women and women of color. Despite the popularity of body-positive posts on Instagram, no research has examined how the race and body size of women featured in the posts affects users’ reactions.
Across four experiments (total N = 2113), young women (aged 18-30) in the U.S. were randomly assigned to rate a body positivity Instagram post featuring either a Black or White model who was either fat or thin. Study 1 indicated participants preferred body positivity posts featuring women with marginalized bodies (i.e., Black and/or fat). We replicated these findings with a new sample (Study 2), a new set of images (Study 3), and with a sample of Black and White women to examine the effects of participant race on reactions to the posts (Study 4).
Results suggested that in the context of body positivity posts, women preferred posts featuring women with marginalized bodies over posts featuring thin, White women. Despite the proliferation of anti-Black and anti-fat attitudes in online spaces, these studies suggest women prefer to see body positivity posts that center women with marginalized bodies.
CAREGIVERS, Part 2 of 2
7. Rienecke, R. D., Drury, C. R., Duffy, A., Mehler, P. S., & Reilly, E. E. (2025). Higher and lower endorsement of eating disorder symptoms among adolescents and their caregivers. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.70047.
Email address for correspondence: renee.rienecke@ercpathlight.com
ABSTRACT. Objective: Low symptom endorsement among adolescents with eating disorders (EDs) may pose challenges for the accurate assessment of symptoms. To better understand low symptom endorsement, the current study examined demographic and clinical characteristics associated with lower symptom endorsement among adolescents with EDs, and compared patterns of endorsement between adolescents and their caregivers.
Method: Treatment-seeking adolescents (N = 629) completed measures of ED psychopathology (Eating Disorder Examination-Questionnaire; EDE-Q), depression, and anxiety at admission, and caregivers completed the Parent EDE-Q. Patients were categorised as ‘higher endorsers’ or ‘lower endorsers’ based on their EDE-Q Global score.
Results: Patients with anorexia nervosa-restricting subtype (AN-R) were more likely to be low symptom endorsers than those with AN-binge/purge subtype (AN-BP). Lower endorsers had a shorter length of stay, lower anxiety and depression symptoms at admission, and lower percent of expected body weight at admission and discharge than higher endorsers. Adolescents with AN-R exhibited more discrepancy between their report of ED symptoms and their caregivers’ report than adolescents with AN-BP.
Conclusion: The current study supports the importance of including multiple informants when assessing adolescents with EDs.
8. Pettitt, L., Satherley, R. M. & Hale, L. (2025). “No one was coming to save us”: an interpretative phenomenological analysis exploring the experience of parents supporting their autistic daughter through anorexia nervosa. Journal of Eating Disorders, 13, 264 https://doi.org/10.1186/s40337-025-01420-w
Full text available for download at: https://tinyurl.com/yc76tdv6
ABSTRACT. Background: Caring for someone with anorexia nervosa is associated with high levels of carer burden and burnout, however, there is a lack of research into caring for individuals who have anorexia nervosa and are also autistic, despite high levels of co-occurrence. This study aimed to offer an in-depth exploration of experiences for this group of caregivers.
Methods: Semi-structured interviews were conducted with six parents with an autistic daughter who had experienced anorexia nervosa. Data was analysed using Interpretative Phenomenological Analysis which enabled in-depth exploration of carers’ lived experience.
Results: Three themes and seven sub-themes were identified. These explored the experience of eating disorders services as largely unprepared to work with dual diagnosis; the impact of their daughter being autistic on carers’ experience of anorexia nervosa treatment and recovery, with variation depending on several factors; the journey of parenting through anorexia nervosa, and changes to parenting as a result.
Conclusions: This adds to our understanding of the lived experience of this group of carers, highlighting a need for early detection of autism spectrum conditions, enhanced staff understanding of autism spectrum conditions, tailored treatment, and specific carer support for this group.
OCTOBER - NOVEMBER TREATMENT INTERLUDE, Part 4 of 8
9. Guerrini Usubini, A., Ducale, S., Bondesan, A., Caroli, D., Frigerio, F., Savino, S., Abbruzzese, L., Castelnuovo, G., & Sartorio, A. (2025). Psychological adjustment in patients with anorexia nervosa and binge eating disorder following a 3-week Inpatient multidisciplinary rehabilitation program. Journal of Clinical Medicine, 14(19), 7127. https://doi.org/10.3390/jcm14197127
Full text available for download at: https://tinyurl.com/2rs2ujpb
ABSTRACT. Background: This study examined changes in psychological adjustment among patients with Anorexia Nervosa (AN) and Binge Eating Disorder (BED) following a 3-week inpatient multidisciplinary (disease-tailored) rehabilitation program.
Methods: twenty consecutive Italian female adults with a diagnosis of AN (mean age ± SD: 25.9 ± 9.4 years; mean Body Mass Index: BMI: kg/m2: 15.8 ± 1.61) and fifteen consecutive Italian female adults with diagnosis of BED (mean age ± SD: 43.5 ± 15.3 years; mean Body Mass Index: BMI: kg/m2: 41.1 ± 7.82) were admitted to the study. Psychological functioning and well-being were assessed pre- and post-intervention using the Strengths and Difficulties Questionnaire and the Psychological General Well-Being Index.
Results: Significant improvements in emotional symptoms [F(1, 31) = 21.1973, p < 0.001, ƞ2p = 0.406] and overall psychological functioning [F(1, 31) = 10.0062, p = 0.373, ƞ2p = 0.026] were observed in both groups, with the most pronounced changes in internalizing symptoms, such as anxiety and depression. Changes in BMI were significantly associated with emotional symptoms, vitality [F(1, 31) = 4.89, p = 0.035, ƞ2p = 0.136], and total well-being scores [F(1, 31) = 6.341, p = 0.017, ƞ2p = 0.170].
By contrast, no significant changes were observed in domains such as behavioral problems, hyperactivity/inattention, and peer relationships, probably indicating the need for more prolonged and targeted, domain-specific interventions.
Conclusions: A 3-week inpatient multidisciplinary program was associated with improvements in internalizing symptoms and psychological well-being in women with AN and BED. Domains such as behavioral regulation and social functioning showed limited change, indicating the need for longer and targeted psychosocial components.
10. Pellizzer, M. L., Zhou, Y., de Valle, M. K., Linardon, J., & Wade, T. D. (2025). A timely update: An umbrella review and meta-meta-analysis of psychotherapy for non-underweight eating disorders. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24567
Email address for correspondence: mia.pellizzer@flinders.edu.au
ABSTRACT. Objective: This umbrella review and meta-analysis synthesized recent evidence on the efficacy of psychotherapy for adults with non-underweight eating disorders (EDs).
Method: PsycINFO, Scopus, PubMed, and ProQuest Dissertations and Theses Global were searched for meta-analyses of randomized controlled trials comparing psychotherapy to treatment as usual (TAU) or control conditions in non-underweight adults with EDs (published January 2020-September 2025). Standardized mean differences (SMDs) for ED psychopathology and objective binge episode (OBE) frequency were pooled using second-order random-effects models. Subgroup analyses examined specific diagnoses and delivery format. Quality was assessed with the A MeaSurement Tool to Assess systematic Review (AMSTAR 2). Data were synthesized with Covidence and analyzed using R.
Results: Ten meta-analyses (71 RCTs) were included. Most participants were female, White, and diagnosed with bulimia nervosa or binge eating disorder. Psychotherapy yielded significant medium-to-large improvements in ED psychopathology (SMD = 0.74, 95% CI: 0.67-0.82, Qp = 0.79, I2 = 0.0% [95% CI: 0.0%- 56.6%]) and OBE frequency (SMD = 0.64, 95% CI: 0.52-0.77, Qp = 0.40, I2 = 4.5% [95% CI: 0.0%- 66.4%]) relative to TAU/control, with low heterogeneity. Effects were comparable across sub-group analyses. Nine of 10 meta-analyses were rated as critically low regarding confidence in results, as per the AMSTAR 2.
Discussion: Psychotherapy is efficacious for non-underweight adults with eating disorders, including when delivered using program-led focused interventions. The use of the AMSTAR-2 tool is encouraged to guide high-quality, transparent reporting of future meta-analyses in our field.
11. Bluff, J. L. L., Daly, E. K., Bird, I. R., Bryce, H., Brook, S., & Beard, J. (2025). Brief group cognitive-behavioral therapy for non-underweight eating disorders: Feasibility and preliminary effectiveness. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24572
Full text available for download at: https://tinyurl.com/ymvar4ac
ABSTRACT. Objective: Individually delivered 10-session cognitive-behavioral therapy for nonunderweight eating disorders (CBT-T) has demonstrated comparable levels of effectiveness to longer CBT-ED. Group CBT-T has demonstrated feasibility and potential effectiveness in a pilot study. This study assessed the effectiveness and feasibility of group CBT-T in a larger sample of adults, and evaluated the predictive value of early change on treatment outcomes.
Method: The data analysis was pre-registered and received ethical clearance, and sample size analysis requirements were met. Using intention to treat analyses (ITT), generalized linear mixed models were used to examine change in eating disorder psychopathology, depression, anxiety, and objective binge eating. Recovery, reliable improvement, and clinically significant change were also examined. Early response as a predictor of treatment outcome was assessed with a paired samples t-test and Pearson’s product-moment correlation.
Results: Fifty-nine patients started group CBT-T and were entered into the ITT analyses. Twenty-two (37.3%) patients did not complete therapy. Eating disorder psychopathology, depression, anxiety, and objective binge eating significantly reduced from pre- to post-therapy (sustained at 3-month follow-up) with medium to very large effect sizes. Of the treatment completers (n = 37, 62.7%), over 70% recovered on the EDE-Q, and over half showed reliable improvement and clinically significant change. Patients who showed early change in EDE-Q scores by session 4 had significantly greater mean changes in EDE-Q scores from session 1 to session 10.
Discussion: The present study shows that group CBT-T can be effective in reducing eating disorder psychopathology and objective binge eating frequency, and improves mood in a transdiagnostic sample of patients with non-underweight eating disorders. Group CBT-T has the potential to increase accessibility to evidence-based treatment for nonunderweight eating disorders.