Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 211: (i) Body Image, Part 2 (n = 2); (ii) Appearance Concerns and Comparisons, Part 1 (n = 2); (iii) Media, Part 4 (n = 3); (iv) Technology, Part 3 (n = 2); and (v) Recovery, Part 1 (n = 2)
Colleagues (N now = 1425 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.
PERSONAL-PROFESSIONAL-POLITICAL EDUCATION
The New York Center for Eating Disorders presents a
Free Webinar:
The Ozempic Debate: Obesity, Shame, and Health At Every Size
with our own Mary Anne Cohen, LCSW, BCD (Director, NYCED) and Bracha Banayan, NP
Monday, November 17, 2025, at 7:30 Eastern Time | 4:30 p.m. Pacific | 11:30 p.m. UTC
Received yesterday (California time) via an everything-is-advocacy email from our own Mary Anne Cohen, LCSW, BCD (USA).
ML NOTE 1: For information about Mary Anne’s very recent book see the following, as presented in the Substack Newsletter of 30 October 2025, NO. 206 (#1).
Cohen, M. A. (2025). Ozempic for smarties: A psychotherapist tells the straight skinny. BookBaby. [eBook ISBN-13: 9798317814861, 64 pages] | Description at an informative website: https://www.bookpassage.com/book/9798317814854
[Mary Anne writes:]
Mary Anne Cohen, Director of The New York Center for Eating Disorders and author of Ozempic for Smarties: A Psychotherapist Tells the Straight Skinny, and Bracha Banayan, N.P. founder of HelloDose.com invite you to a free webinar:
The Ozempic Debate: Obesity, Shame, and Health At Every Size. This webinar will explore the controversy about these drugs, who can be helped by them, who cannot be helped by them, and - with case examples - we will explore the psychological impact that patients need to know.
Monday, November 17, 2025, at 7:30 p.m. Eastern Time | 4:30 p.m. Pacific | 11:30 p.m. UTC
To register: https://us06web.zoom.us/webinar/register/WN_BUex-2CxRtO2T_rpzB0SsA#/registration
Please indicate you heard about the webinar through Mary Anne!
Mary Anne Cohen, LCSW, BCD | Director- The New York Center for Eating Disorders |490 Third Street, Brooklyn, New York 11215 | macohen490@aol.com |web: EmotionalEating.Org | Facebook.com/NewYorkCenterforEatingDisorders
ADVOCACY-IN-ACTION
Australian National Taskforce for Social Media, Body Image and Eating Disorders
presents Government with
Urgent Recommendations to Make Social Media Safer for All Users
Received via a 4 November 2025 newsletter 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 — The following people are members of the Australian National Taskforce for Social Media, Body Image and Eating Disorders and members of this Substack Newsletter Group: Drs. Hannah Jarman (Chair), Jasmine Fardouly, and Siân McLean.
Australian National Taskforce for Social Media, Body Image and Eating Disorders presents Government with
Urgent Recommendations to Make Social Media Safer for All Users
Acknowledging the Government’s introduction of a ban on social media for young people under 16, experts say more needs to be done.
Exposure to appearance-based content on social media can lead to body dissatisfaction, disordered eating, eating disorders and poor mental health[i]
Time spent on social media has a direct correlation to body dissatisfaction, desire for thinness/leanness, life disengagement, and desire for muscularity. [ii]
Eating disorders in 10-19 year olds in Australia have risen by 86% since 2012[iii]. Butterfly National Helpline has seen a corresponding 275% surge in enquiries across all age groups in the same period.
New research finds that the public strongly supports the removal of cyberbullying content on social media, with views that this is likely to have the most significant impact on body image issues, and be feasible to implement[iv]
According to the report, 90% of people in Australia support the option to reset recommender algorithms; 86% support the removal of cyberbullying content, including appearance-based cyberbullying, and 85% support algorithm transparency and independent risk audits.
The National Taskforce for Social Media, Body Image and Eating Disorders is today presenting its key 5 recommendations to Government and policymakers to make social media safer for young people’s body image.
Canberra, Australia: Zali Steggall OAM MP today hosted the Parliamentary Friends of Eating Disorder Awareness Group, along with her co-Chairs, Susan Templeman MP, and Andrew Wallace MP.
At the event, the National Taskforce for Social Media, Body Image and Eating Disorders presented urgent recommendations to tackle the effects of social media on the body image and mental health of young people in Australia. The Taskforce, comprised of eating disorder sector experts, national and state-based eating disorder organisations, and individuals with lived experience, delivered five key recommendations.
The recommendations included the removal of pro-eating disorder and cyberbullying content, algorithm transparency and risk audits, and user controls such as functions for users to reset their algorithm and/or shield their account from specific content. Dr Jasmine Fardouly, Sydney University also released new research showing the Australian public’s support for the recommendations
While there are many factors that contribute to the development of an eating disorder, body dissatisfaction is one of the highest modifiable risk factors. Research has established that the use of social media, particularly engaging with image-based content, can increase body dissatisfaction among young people.
Varsha Yajman, who has her own experience of living with an eating disorder and is a member of the Taskforce, said: “Social media had a huge impact in the development of my eating disorder. Even with the ban in place, the platforms, as well as content creators, still have a responsibility to make the digital world safer for all. You don’t suddenly become social media savvy the day you turn 16. These are some clear, actionable recommendations that might just prevent young people going through what I did.”
Dr. Hannah Jarman, Chair of the National Taskforce, said: “This is a hugely prevalent issue within today’s society. According to Butterfly’s recent report, almost 90% of young people in Australia worry about their body image, and it’s holding many back from learning, being active, and speaking up for themselves. The consequences can also extend to mental health, including the onset of eating disorders and depression. Social media is a big part of the problem—nearly half of young Australians aged 12-15 say it makes them feel dissatisfied with their bodies, and two-thirds of this age group report using social media ‘more than they would like’. Our Taskforce has brought together leading experts in social media, body image and eating disorders, and our recommendations are clear, easy to implement, and will have a significant impact in protecting the mental health of our young people.”
Ms Zali Steggall OAM, MP, one of the Co-Chairs of the Parliamentary Friends of Eating Disorders Awareness group said: “The Australian community is clear – we need reform and action beyond an age ban when it comes to social media and its impact on young people’s body image. We need to make social media platforms a safer place for all. I’m proud to be building on the critical work Zoe Daniel MP did in this space while in office, and am determined to keep the momentum going. I strongly urge the Government to listen to the voice of experts and lived experience to implement these recommendations.”
Ms Susan Templeman, MP, welcomed the work of the National Taskforce for Social Media, Body Image and Eating Disorders. “They bring academics, advocates and members with lived experience together to form a strong voice,” she said. “Parliamentary Friends of Eating Disorder Awareness is an important vehicle for continuing to raise awareness and discuss these issues and I’m proud to continue as co-Chair in the 48th Parliament.”
Mr Andrew Wallace, MP, also a Co-Chair for the Group, said: “According to the Butterfly Foundation, more than one million Australians are said to be affected by eating disorders, 63 per cent of whom are women and girls. Anorexia nervosa is the most commonly known eating disorder, and it is Australia’s deadliest and perhaps most misunderstood psychiatric illness.
“Eating disorders kill more Australians each year than those who are killed on our roads. Each year approximately 2000 Australians die due to medical complications arising from these insidious illnesses.
“The National Taskforce for Social Media, Body Image and Eating Disorders has delivered a clear warning, social media is taking a serious toll on the body image and mental health of young Australians. Their report serves as a salient message and warning to Big Tech that they must get their houses in order. The evidence is clear. Young people are being harmed by Big Tech and if they won’t clean up their act, Government must step in and do it for them,” he added.
For the full set of recommendations, please see here: https://butterfly.org.au/wp-content/uploads/2025/10/Taskforce-full-report_FINAL.pdf
National Taskforce members: Dr Hannah Jarman, Deakin University (Chair) | Associate Professor Dr M Bromberg, The University of Western Australia | Varsha Yajman, Lived experience representative | Dr Jasmine Fardouly, University of Sydney | Dr Sarah Trobe, National Eating Disorders Collaboration | Dr Siân McLean, La Trobe University | Dr Jim Hungerford, Butterfly Foundation | Melissa Wilton, Butterfly Foundation
Research Publication Categories in This Newsletter
(i) Body Image, Part 2 (n = 2); (ii) Appearance Concerns and Comparisons, Part 1 (n = 2); (iii) Media, Part 4 (n = 3); (iv) Technology, Part 3 (n = 2); and (v) Recovery, Part 1 (n = 2)
CONGRATULATIONS to our own
Drs. Matthew Fuller-Tyszkiewicz (Australia; see also #9 below) and Isabel Krug (Australia) and colleagues for publication of the Appearance Comparisons research article in #3.
Drs. Rachel Flatt (USA) and Cynthia Bulik (USA/Sweden; see also #10 below) and colleagues for publication of the Technology research article in #8.
Dr. Matthew Fuller-Tyszkiewicz (Australia; see also #9 below) and colleagues for publication of the Technology research article in #9.
Drs. Anna Bardone-Cone (USA), Hunna Watson (USA/Australia), Nancy Zucker (USA), and Cynthia Bulik (USA/Sweden) and colleagues for publication of the Recovery research article in #10.
Ana Julia Ferreira (England) and Dr. Melissa Atkinson (England) and colleagues for publication of the Recovery research article in #11.
BODY IMAGE, Part 2 of 2
1. Bullard, N., Rupani, N., Renteria, J. A., Miller, J., & Kaliebe, K. E. (2025). Yoga as a therapeutic intervention for body image in the pediatric population: A systematic review. Journal of Eating Disorders, 13(1), 222. https://doi.org/10.1186/s40337-025-01386-9
Full text available for download at: https://tinyurl.com/mrxbht9y
ABSTRACT. Body image concerns significantly impact adolescents’ mental health and self-esteem, with increasing prevalence observed globally. This systematic review evaluates the impact of yoga interventions in promoting positive body image among children and adolescents. Following PRISMA guidelines, six electronic databases were searched up to August 6, 2024, yielding six studies that met the inclusion criteria. Eligible studies were peer-reviewed, published in English, included quantitative data, and enrolled pediatric participants with a mean age under 18 years.
Studies were included if they examined yoga as a stand-alone intervention with or without a comparison group and reported body image outcomes such as body satisfaction, body dissatisfaction, embodiment, body appreciation, or appearance concerns. The included studies varied in design, duration, and participant characteristics, with interventions ranging from 4 to 24 weeks and involving participants aged 8 to 21 years. Methodological quality was assessed using the GRADE criteria, evaluating risk of bias across dimensions such as allocation concealment, blinding, sample size, and reporting clarity. Due to heterogeneity in outcome measures and study design, meta-analysis was not feasible, and a structured narrative synthesis was conducted instead.
Results indicate that yoga may improve body esteem and body satisfaction, particularly among adolescents with disordered eating. However, findings were mixed for other outcomes including shape concern, weight concern, body surveillance, and body appreciation. Methodological limitations, including small sample sizes, variability in study quality, and lack of diversity in study populations, were common. The review highlights the potential of yoga as a supplementary approach to enhance body image but underscores the need for high-quality, diverse, and inclusive research to confirm its impact across different populations.
2. Ogawa, M., Nakazato, M., Yokota, J., & Koga, K. (2025). Knowledge of the risks associated with being underweight and body shape differences among young Japanese women: A cross-sectional study. Biopsychosocial Medicine, 19, 17. https://doi.org/10.1186/s13030-025-00338-8
Full text available for download at: https://tinyurl.com/275bphem
ABSTRACT. Background: In Japan, approximately 20% of young women are underweight, a rate higher than that of other developed countries. For women, being underweight at a young age has been associated with amenorrhea, eating disorders, osteoporosis, and adverse pregnancy outcomes. We investigated young women’s knowledge of these risks and associated factors.
Methods: A web-based survey was conducted among 984 Japanese women aged 18–29 years. The survey included questions about actual body weight, perceived healthy weight, body image, eating disorder tendency, knowledge of various risks and factors associated with being underweight, and sources of this knowledge. Participants were divided into underweight (< 18.5 kg/m2), normal weight (18.5–25 kg/m2), and obese (≥ 25 kg/m2) groups based on their body mass index (BMI). The body image and knowledge of health risks associated with being underweight were compared across the three groups and with women with and without an eating disorder tendency.
Results: Among the participants, 31.5% were underweight (BMI < 18.5 kg/m2). Of these, 87.4% considered their subjective ideal weight to be underweight, and 66.1% viewed their subjective healthy weight similarly. Underweight women reported greater body satisfaction than did those in other body shape groups. While 73.2% recognized amenorrhea as a risk of being underweight, only approximately half identified infertility, eating disorders, and osteoporosis as risks and associated factors, and few were aware of adverse pregnancy outcomes.
Knowledge levels did not differ between underweight and normal-weight women. Conversely, women with a tendency toward an eating disorder were more aware of the risks of osteoporosis (58.6% vs. 49.0%) and eating disorders (66.8% vs. 55.2%) than were women without a tendency toward an eating disorder.
Conclusions: Young Japanese women had insufficient knowledge about the adverse pregnancy outcomes associated with being underweight. Underweight women are not less aware of the health risks and associated factors associated with underweight than normal-weight women. The body shape of young women may not be influenced by their knowledge of health issues associated with being underweight.
APPEARANCE CONCERNS AND COMPARISONS, Part 1 of 2
3. Ooi, W. L., Fuller-Tyszkiewicz, M., Simmons, J., & Krug, I. (2025). Body comparisons are bidirectionally linked with body dissatisfaction but not disordered eating urges. Body Image, 55. Advance online publication. https://doi.org/10.1016/j.bodyim.2025.101992
Full text available for download at: https://tinyurl.com/mrxtwe2x
ABSTRACT. We assessed the bidirectional relationship between body comparisons (BC) with body dissatisfaction (BD) and disordered eating (DE) urges in daily life. A secondary aim was to assess whether these effects were moderated by BC context (e.g., in person, social media, traditional media) and gender. Undergraduate men and women (n = 521, 76.0 % female-identifying) completed baseline measures and a 7-day ecological momentary assessment (EMA) reporting BC (frequency, direction and context), BD levels, and DE urges including food restriction, exercising and overeating. Data (collected 2020 – 2022) were statistically controlled for potential COVID lockdown effects.
Multilevel analyses revealed a bidirectional relationship between upward BC and BD, suggesting a reinforcing cycle. Downward BC predicted a decrease in BD, but during moments of heightened state BD, individuals were less likely to engage in downward BC. Urge to engage in compensatory exercise significantly predicted subsequent engagement in upward BC, but none of the remaining relationships between BC and DE urges were significant, suggesting other factors may play a more central role in these relationships. The effect of upward BC on BD were more pronounced in person and via other contexts than on social media, potentially due to increased awareness of digital image manipulation. Gender did not moderate these relationships, highlighting shared psychological processes across men and women.
These findings underscore the context-dependent nature of BC in body image concerns. Future research could investigate whether strategies developed to promote media literacy on social media can be adapted to help individuals manage in-person or other real-world comparisons.
4. Patel, T. A., Sala, M. C., & Cougle, J. R. (2025). Loneliness predicts symptom outcomes following a digital intervention for appearance concerns. Behavior Therapy. Advance online publication. https://doi.org/10.1016/j.beth.2025.06.005
Email address for correspondence: tapan.patel236@gmail.com
ABSTRACT. Digital mental health interventions have proliferated in the past decade, though it is not clear whether social isolation or loneliness influences their efficacy. The present study sought to determine whether loneliness predicted symptom outcomes following a digital treatment for appearance concerns. Women elevated in appearance concerns (N = 203) were randomized to one of two interventions where participants were either instructed to reduce appearance-related safety behaviors (ARSB; i.e., actions people take to reduce appearance anxiety) or general unhealthy behaviors.
Both treatments led to similar reductions in loneliness. However, we found that baseline loneliness moderated the effect of condition on social anxiety such that, at low levels of loneliness, ARSB reduction led to lower social anxiety than control, though these effects were absent at high levels of loneliness. We also found that, in the ARSB treatment condition (but not the control condition), pretreatment loneliness predicted symptoms of social anxiety at posttreatment and predicted social anxiety, eating disorder symptoms, and depression at follow-up. Taken together, loneliness appears to play an important role in the efficacy of this digital intervention, findings which may have implications for the broader digital treatment literature.
MEDIA, Part 4 of 4
ML NOTE 3: The article described below in #5 to my attention via the Obesity and Energetics Offerings (OEO) online newsletter of 17 October 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.
5. Khan, R., Tanweer, A., & Suggs, L. S. (2025). Analysing celebrity and influencer marketing of food and beverages to adolescents on Instagram. Public Health Nutrition, 28(1), e144. https://doi.org/10.1017/S1368980025101006
Full text available for download at: https://tinyurl.com/ycjut4fc
ABSTRACT. Objective: To assess the nutritional quality of foods and beverages (F&B) advertised to adolescents and analyse marketing techniques and persuasive appeals used by celebrities and influencers on Instagram. Design: A content analysis study was conducted using the WHO’s CLICK Monitoring Framework and Nutrient Profile Model.
Setting: Instagram, a popular social media platform among adolescents with frequent F&B advertisements by celebrities and influencers. Participants: The top forty-eight Instagram accounts of celebrities and influencers posting F&B advertisements were selected based on follower count and engagement metrics. Nutrient profiling of advertised F&B (n 344) and content analysis of posts featuring F&B (n 326) between January 2021 and May 2023 were performed. Data collected included characteristics of celebrities and influencers, marketing techniques, online engagement and persuasive appeals in the posts.
Results: Carbonated beverages and flavored waters (28·5 %), energy drinks (20·6 %) and ready-made foods (15·4 %) were most frequently advertised, with the majority (89·2 %) of products not permitted for advertisement to adolescents, according to WHO. Common marketing techniques included tagging brand (96·9 %) and using brand logo (94·2 %). The most frequently used persuasive appeals were taste (20·9 %), energy (10·7 %), link to sports events (10·7 %), new product (9·5 %) and fun (7·4 %).
Conclusion: Most F&B advertised on Instagram by celebrities and influencers are prohibited from being advertised to adolescents by the WHO. This highlights the need for stricter regulation of user-generated content and for users and parents to be better educated about persuasive techniques used on social media to make them less vulnerable to the influence of marketing.
6. Gibson, G., Liddelow, C., Burke, K. J., & Lee, M. F. (2025). Exploring the influence of social media ‘Mumfluencers’ on postpartum body image. Journal of Health Psychology. Advance online publication. https://doi.org/10.1177/13591053251381895
Full text available for download at: https://tinyurl.com/ypus8y7m
ABSTRACT. Social media is an external influence thought to notably impact body image. There is limited research to date exploring whether the rise of social media ‘Mumfluencers’ – women who gain large social media followings by sharing their experiences of motherhood – positively or negatively influence postpartum body image and wellbeing. The current study explored the lived experience of 208 women up to 4 years postpartum through open-ended survey responses.
Through reflexive thematic analysis, we identified three main themes: (i) Protecting Body Image and Mental Health through Authentic Discourse, (ii) Conflicts of Interest and Appearance Ideals Shape Body Image Outcomes, and (iii) Postpartum Agency in Social Media Consumption. Our findings indicate that postpartum women are adaptable in navigating the complexities of Mumfluencer content for their body image. By implementing protective strategies and limiting harmful exposure, participants controlled their online experiences, curating environments that best supported positive body image.
7. Dimitrakopoulos, I. (2025). Direct harms of microaggressions and discipline among Grindr users: An analysis of the social harm of femmephobia and sizeism. Sexuality & Culture. Advance online publication. https://doi.org/10.1007/s12119-025-10470-w
Email address for correspondence: jondimitrakopoulos97@gmail.com
ABSTRACT. Microaggressions are subtle yet pervasive forms of prejudice that reinforce exclusion and marginalisation within social spheres. The theory of microaggressions has been widely applied to concepts of racial discrimination, while a few have applied such theory to other characteristics, like sexual orientation, and even fewer have examined concepts of within-group microaggressions, such as femmephobia or sizeism. This study examines within-group microaggressions among Grindr users, particularly focusing on femmephobia and sizeism as two of the most significant issues in relevant literature, by using a harm-oriented framework informed by theories of oppression and microaggressions.
Drawing on survey responses and qualitative narratives (N = 100), three interconnected themes emerged: degradation, exclusion, and monitoring and conformity. Findings indicate that microaggressions on Grindr operate as mechanisms of discipline and punishment, while they can have significant effects on users. By shifting the focus from individual actions to collective harm, this research contributes to a harm-oriented understanding of microaggressions, arguing that they function as tools of control that sustain exclusionary norms and social hierarchies within online dating platforms.
TECHNOLOGY, Part 4 of 7
8. Flatt, R. E., Thornton, L. M., Tregarthen, J., Argue, S., & Bulik, C. M. (2025). How engagement changes over time in a digital eating disorder app: Observational study. JMIR Mhealth Uhealth, 13, e68824. https://doi.org/doi: 10.2196/68824
Full text available for download at: https://tinyurl.com/3kap35ms
ABSTRACT. Background: Engagement with digital mental health interventions is often measured as a summary-level variable and remains underresearched despite its importance for meaningful symptom change. This study deepens understanding of engagement in a digital eating disorder intervention, recovery record, by measuring engagement with unique components of the app, on 2 different devices (phone and watch), and at a summary level. Objective: This study described and modeled how individuals engaged with the app across a variety of measures of engagement and identified baseline predictors of engagement.
Methods: Participants with current binge-eating behavior were recruited as part of the Binge Eating Genetics Initiative study to use a digital eating disorder intervention for 4 weeks. Demographic and severity of illness variables were captured in the baseline survey at enrollment, and engagement data were captured through both an iPhone and Apple Watch version of the intervention. Engagement was characterized by log type (urge, behavior, mood, or meal), device type (logs on phone or watch), and overall usage (total logs) and averaged each week for 4 weeks. Descriptives were tabulated for demographic and engagement variables, and multilevel growth models were conducted for each measure of engagement with baseline characteristics and time as predictors.
Results: Participants (N = 893) self-reported as primarily White (743/871, 85%), non-Hispanic (801/893, 90%), females (772/893, 87%) with a mean age of 29.6 (SD 7.4) years and mean current BMI of 32.5 (SD 9.8) kg/m2 and used the app for a mean of 24 days. Most logs were captured on phones (217,143/225,927; 96%), and mood logs were the most used app component (174,818/282,136; 62% of logs). All measures of engagement declined over time, as illustrated by the visualizations, but each measure of engagement illustrated unique participant trajectories over time. Time was a significant negative predictor in every multilevel model.
Sex and ethnicity were also significant predictors across several measures of engagement, with female and Hispanic participants demonstrating greater engagement than male and non-Hispanic counterparts. Other baseline characteristics (age, current BMI, and binge episodes in the past 28 days) were significant predictors of 1 measure of engagement each.
Conclusions: This study highlighted that engagement is far more complex and nuanced than is typically described in research, and that specific components and mode of delivery may have unique engagement profiles and predictors. Future work would benefit from developing early engagement models informed by baseline characteristics to predict intervention outcomes, thereby tailoring digital eating disorder interventions at the individual level. Trial Registration: ClinicalTrials.gov NCT04162574; https://tinyurl.com/4jjfhemf
9. Bufton, K., Bates, M., Fuller-Tyszkiewicz, M., Hamid, J., & Westrupp, E. (2025). Design mapping: A conceptual framework for co-designing evidence-based digital mental health programs. Health Expectations, 28(5), e70385. https://doi.org/10.1111/hex.70385
Full text available for download at: https://tinyurl.com/yc26nr6z
ABSTRACT. Introduction: There is currently limited guidance on how to codesign digital mental health programs in collaboration with end-users. As a result, common barriers often prevent codesign initiatives from achieving their full potential in enhancing the effectiveness of digital mental health supports. These barriers include the exclusion of end-users from the early stages of design, a lack of attention to diversity in user experiences and needs, failure to use tools that facilitate creative and egalitarian collaboration, and prioritisation of usability over robust research methods. To address this gap, this article aims to present a novel conceptual framework, called ‘Design Mapping’, for developing digital mental health programs.
Methods: The Design Mapping framework was developed through a three-stage process. First, industry experts were consulted, and a review of relevant literature was conducted to identify current best practices for user collaboration in product/service development. Second, the initial conceptual development framework was created, drawing on the strengths of different approaches. Third, the framework was applied to develop a novel early childhood parenting program (called ‘Active Play’), enabling the approach to be tested and refined.
Results: Design Mapping is a three-phase framework that integrates tools from Design Thinking that emphasise meaningful and creative user collaboration, within a robust and systematic methodology inspired by Intervention Mapping. The framework also considers factors pertinent when developing both mental health and digital support programs. Preliminary findings from pilot testing of the Active Play program suggest that Design Thinking may support the development of programs that are feasible, effective and engaging.
Conclusion: Design Mapping offers a novel conceptual codesign methodology for developing robust, evidence-based support programs that are responsive to diverse user needs and preferences. The next step is to evaluate its effectiveness in comparison to existing methodologies.
RECOVERY, Part 1 of 2
10. Bardone-Cone, A. M., Watson, H. J., Walsh, E. C., Wash, L. K., Wallace, L. R., Zucker, N., & Bulik, C. M. (2025). Comparing operationalizations of eating disorder recovery using a comprehensive lens: Physical, behavioral, and cognitive domains. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24559
Email address for correspondence: bardonecone@unc.edu
ABSTRACT. Objective: A standardized definition of recovery would advance treatment outcome research. This study examined combinations of different physical, behavioral, and cognitive recovery criteria to identify the operationalization of eating disorder (ED) recovery with the most empirical support based on concurrent and predictive validity.
Method: Participants included 223 females with a history of an ED and 105 age-matched female controls who completed questionnaires, interviews, and weight/height measurements at baseline and ~1-year follow-up. To examine different comprehensive operationalizations of recovery, we considered two approaches to assessing each of the following domains of recovery: physical (BMI ≥ 18.5 kg/m2; BMI ≥ 19 kg/m2), behavioral (no binge eating, purging, or fasting in the past 3 months; none of these ED behaviors in the past 6 months), and cognitive (all four EDE-Q subscale scores within 1 SD of age- and gender-matched norms; Global EDE-Q scores within 1 SD of norms). Allowing for all possible combinations across these domains yielded eight operationalizations of comprehensive ED recovery to test.
Results: Results showed that operationalizations were more similar than different, with high rates of stability in recovery (77%-86%) and low relapse rates (7%-15%) over time. Discussion: Based on the holistic consideration of the patterns of findings, we propose using BMI ≥ 18.5 or 19 kg/m2 (physical recovery), no binge eating, purging, or fasting over the past 3 months (behavioral recovery), and all four EDE-Q subscale scores within 1 SD of age- and gender-matched norms (cognitive recovery) as a standardized operationalization of recovery for research purposes.
11. Ferreira, A. J., Blackwood, L., Martinez-Barona Soyer, M., Fairchild, G., & Atkinson, M. (2025). How do people with lived experience of Anorexia Nervosa and mental health professionals working with people with eating disorders conceptualise recovery? Journal of Eating Disorders, 13, 247. https://doi.org/10.1186/s40337-025-01432-6
Full text available for download at: https://tinyurl.com/3er5jp4n
ABSTRACT. Background: Understanding the reasons for recovery or relapse in individuals with Anorexia Nervosa (AN) is vital to improving post-treatment care. However, progress has been limited by a lack of consensus on defining recovery, with calls for including patient and clinician perspectives. This qualitative study explored how individuals with lived experience of AN and mental health professionals conceptualise recovery from AN, and the factors they perceived as contributing to or preventing recovery or relapse.
Methods: We conducted three focus groups with people with lived experience of AN (n = 15 in total) and three focus groups and one individual interview with mental health professionals (n = 7). Data were analysed using reflexive thematic analysis.
Results: We identified three themes. Theme 1 “Recovered, Yet Still Recovering” highlighted the ambiguity around what constitutes full recovery or whether it is possible and how people with lived experience and professionals’ views differed. Theme 2 “Disentangling Recovery and Weight Gain” highlighted different views between the groups on whether weight markers should be included in recovery definitions. Theme 3 “The Role of Others in Recovery: A Motivator or a Hinderance?” showed that people in one’s life can be the primary source of motivation to recover, but this is not sufficient for sustaining recovery and intrinsic motivators are needed.
Discussion: Our study highlights that discrepancies between professional and lived experience definitions of recovery may be hindering therapeutic alliances, and that social support is crucial to promoting long term recovery. Additionally, we emphasise the importance of differentiating between cognitive, behavioural, and physical recovery in definitions.