Effectiveness Trial of a Dissonance-Based Obesity Prevention Program

Overview

Obesity is a major US public health problem. Few obesity prevention programs have reduced risk for weight gain over follow-up and those that have are very intensive, making dissemination difficult and costly. A brief 3-hr selective prevention program (Healthy Weight) targeting young adults with body dissatisfaction involving participant-driven healthy dietary and physical activity lifestyle changes significantly reduced increases in body mass index (BMI) and obesity onset relative to alternative interventions and assessment-only controls through 3-yr follow-up, though effects were small in magnitude. To enhance efficacy, the investigators added dissonance-inducing activities regarding unhealthy dietary and activity practices, drawing from a highly efficacious dissonance-based eating disorder prevention program. A pilot trial found that this new Project Health intervention significantly reduced increases in BMI relative to both the Healthy Weight intervention and an educational brochure condition from pre to post. The investigators propose to conduct a rigorous multisite effectiveness trial that will test whether adding the dissonance-induction elements to the originally Healthy Weight intervention improves weight gain prevention effects. 360 college students at risk for future weight by virtue of their age and weight concerns will be randomized one of three conditions: (1) a refined 6-hr group-based dissonance-based Project Health, (2) a 6-hr group-based Healthy Weight intervention, or (3) a psychoeducational video ("Weight of the World") condition. Participants will complete assessments of % body fat, mediators (including objectively measured physical activity), moderators, and other outcomes at pre, post, and 6, 12, and 24 month follow-ups.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Prevention
    • Masking: None (Open Label)
  • Study Primary Completion Date: June 30, 2016

Detailed Description

Aim 1 will test the hypothesis that Project Health significantly reduces increases in % body fat relative to the Healthy Weight intervention and video control condition during a 2-yr follow-up; secondary outcomes are BMI, depressive symptoms and eating disorder symptoms. The investigators will also compare Healthy Weight to video controls. Aim 2 will test the hypothesis that Project Health participants will experience increased cognitive dissonance (an uncomfortable psychological state) regarding eating unhealthy foods and engaging in sedentary behaviors, and that changes in dissonance mediate the program's weight gain prevention effects. The investigators will also test whether reduced calorie intake and increased physical activity mediate the effects of Project Health on change in % body fat. Aim 3 will test the hypothesis that intervention effects are amplified for participants with elevated body dissatisfaction (which should increase motivation change) and preference for consistency (which should maximize dissonance induction) and mitigated for participants who report emotional eating and substance use (because these factors increase risk for overeating).

Interventions

  • Behavioral: Healthy Weight
  • Behavioral: Project Health
  • Behavioral: Placebo Control
    • Participants will view a video on overweight and obesity

Arms, Groups and Cohorts

  • Active Comparator: Healthy Weight
    • The main goal of the Healthy Weight intervention is to make small, sustainable changes to input and output on a weekly basis to achieve a balance between caloric intake and output. All sessions begin with a brief review of what was covered in the previous session, presentation of educational handouts, careful review of previous behavior change goals, and the development of healthy behavior change plans for the next session. Home exercises for all sessions consist of following individualized diet and exercise goals, and keeping a food and exercise log to determine areas for future healthy changes.
  • Experimental: Project Health
    • Project Health adds dissonance-inducing activities, discussions, and homework activities to the Healthy Weight basic intervention. Each session begins with a verbal commitment to participate (to underscore the voluntary nature of participation), includes discussions of completed home practice assignments and in-session writing/sharing exercises (to create accountability), and concludes with home exercises (to increase level of effort). Completed home assignments are videotaped in subsequent sessions to increase accountability.
  • Placebo Comparator: Control
    • Some participants will be randomized to control condition whereby they will be given an psychoeducational video (“Weight of the World”)to view.

Clinical Trial Outcome Measures

Primary Measures

  • Body Fat Percentage
    • Time Frame: Changes in body fat from baseline to 2-year follow up
    • We will use air displacement plethysmography (ADP) via the Bod Pod S/T to assess % body fat. Two measures will be averaged. Body density, calculated as body mass divided by estimated body volume, is used to calculate age- and gender-adjusted body fat percentile scores, based on normative reference data (McCarthy et al., 2006). A pilot validity study (N = 30) revealed that direct DEXA measures of % body fat correlates much more strongly with ADP estimates of body fat (r = .88) than with BMI (r = .23). Change in age- and gender-adjusted body fat percentile over the 2-year follow-up will be the primary outcome. This assessment takes 3-5 minutes to complete.

Secondary Measures

  • Eating Pathology
    • Time Frame: Baseline and post intervention (6 weeks); 6/12/24 month follow-up
    • The Eating Disorder Diagnostic Interview, a brief semi-structured interview, will assess eating disorder symptoms. It provides diagnoses for anorexia nervosa, bulimia nervosa, and binge eating disorder, which will allow us to exclude participants with these disorders. It also provides a continuous measure of overall eating disorder symptoms.
  • Negative Affect
    • Time Frame: Baseline and post intervention (6 weeks); 6/12/24 month follow-ups
    • The 20-item Negative Affect subscale of the Positive and Negative Affect Schedule (PANAS: Watson et al., 1988) measures general negative affectivity and depressive symptoms. Using a Likert rating system, participants choose their degree of endorsement of negative affectivity items such as “disgusted with self” and “lonely” (response options: 1 = not at all; 5 = extremely).
  • Food Craving/Liking
    • Time Frame: Baseline, 6 weeks (post intervention), 6/12/24 month follow ups
    • The 28-item Food Craving Inventory (FCI; White et al., 2002) assesses subjective cravings for individual foods (pasta, ice cream), asking: “Over the past month, how often have you experienced a craving for the food?”

Participating in This Clinical Trial

Inclusion Criteria

  • University student – Presents with self-reported "weight concerns" Exclusion Criteria:

  • Diagnosis of Eating Disorder – Obese – Underweight – Non-english speaking

Gender Eligibility: All

Minimum Age: 17 Years

Maximum Age: 23 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Oregon Research Institute
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Eric Stice, PhD, Principal Investigator, Oregon Research Institute
    • Paul Rohde, PhD, Study Director, Oregon Research Institute
    • Heather Shaw, PhD, Study Director, Oregon Research Institute
    • Kyle Burger, PhD, Study Director, Oregon Research Institute
    • Nathan Marti, PhD, Study Director, Oregon Research Institute

References

Anderson DA, Shapiro JR, Lundgren JD. The freshman year of college as a critical period for weight gain: an initial evaluation. Eat Behav. 2003 Nov;4(4):363-7. doi: 10.1016/S1471-0153(03)00030-8.

Becker CB, Stice E, Shaw H, Woda S. Use of empirically supported interventions for psychopathology: can the participatory approach move us beyond the research-to-practice gap? Behav Res Ther. 2009 Apr;47(4):265-74. doi: 10.1016/j.brat.2009.02.007. Epub 2009 Feb 21.

van den Berg P, Neumark-Sztainer D. Fat 'n happy 5 years later: is it bad for overweight girls to like their bodies? J Adolesc Health. 2007 Oct;41(4):415-7. doi: 10.1016/j.jadohealth.2007.06.001.

Blair AJ, Lewis VJ, Booth DA. Does emotional eating interfere with success in attempts at weight control? Appetite. 1990 Oct;15(2):151-7. doi: 10.1016/0195-6663(90)90047-c.

Block G, Subar AF. Estimates of nutrient intake from a food frequency questionnaire: the 1987 National Health Interview Survey. J Am Diet Assoc. 1992 Aug;92(8):969-77.

Bohon C, Stice E, Spoor S. Female emotional eaters show abnormalities in consummatory and anticipatory food reward: a functional magnetic resonance imaging study. Int J Eat Disord. 2009 Apr;42(3):210-21. doi: 10.1002/eat.20615.

Block G, Hartman AM, Naughton D. A reduced dietary questionnaire: development and validation. Epidemiology. 1990 Jan;1(1):58-64. doi: 10.1097/00001648-199001000-00013.

Boomsma. (2000). Reporting analyses of covariance structures. Structural Equation Modeling, 7, 461-483.

Boutelle KN, Hannan P, Fulkerson JA, Crow SJ, Stice E. Obesity as a prospective predictor of depression in adolescent females. Health Psychol. 2010 May;29(3):293-8. doi: 10.1037/a0018645.

Burton E, Stice E. Evaluation of a healthy-weight treatment program for bulimia nervosa: a preliminary randomized trial. Behav Res Ther. 2006 Dec;44(12):1727-38. doi: 10.1016/j.brat.2005.12.008. Epub 2006 Feb 3.

Butler SM, Black DR, Blue CL, Gretebeck RJ. Change in diet, physical activity, and body weight in female college freshman. Am J Health Behav. 2004 Jan-Feb;28(1):24-32. doi: 10.5993/ajhb.28.1.3.

Chambers WJ, Puig-Antich J, Tabrizi MA, Davies M. Psychotic symptoms in prepubertal major depressive disorder. Arch Gen Psychiatry. 1982 Aug;39(8):921-7. doi: 10.1001/archpsyc.1982.04290080037006.

Cialdini, R. B., Trost, M. R., & Newsom, J. T. (1995). Preference for consistency: The development of a valid measure and the discovery of surprising behavioral implications. J Pers Soc Psychol, 69, 318-328.

Coleman KJ, Tiller CL, Sanchez J, Heath EM, Sy O, Milliken G, Dzewaltowski DA. Prevention of the epidemic increase in child risk of overweight in low-income schools: the El Paso coordinated approach to child health. Arch Pediatr Adolesc Med. 2005 Mar;159(3):217-24. doi: 10.1001/archpedi.159.3.217.

Colley RC, Tremblay MS. Moderate and vigorous physical activity intensity cut-points for the Actical accelerometer. J Sports Sci. 2011 May;29(8):783-9. doi: 10.1080/02640414.2011.557744.

Cummins S, Macintyre S. Food environments and obesity–neighbourhood or nation? Int J Epidemiol. 2006 Feb;35(1):100-4. doi: 10.1093/ije/dyi276. Epub 2005 Dec 7. No abstract available.

Dietz WH, Robinson TN. Use of the body mass index (BMI) as a measure of overweight in children and adolescents. J Pediatr. 1998 Feb;132(2):191-3. doi: 10.1016/s0022-3476(98)70426-3. No abstract available.

Eisenberg, N., Cialdini, R. B., McCreath, H., Shell, R. (1989). Consistency-based compliance in children: when and why do consistency procedures have immediate effects? International Journal of Behavioral Development, 12, 351-367.

Ello-Martin, J. A., Roe, L., & Rolls, B. (2004). A diet reduced in energy density results in greater weight loss than a diet reduced in fat. Obes Res, 12, A23-A23.

Esliger DW, Probert A, Connor Gorber S, Bryan S, Laviolette M, Tremblay MS. Validity of the Actical accelerometer step-count function. Med Sci Sports Exerc. 2007 Jul;39(7):1200-4. doi: 10.1249/mss.0b013e3804ec4e9.

Esliger DW, Tremblay MS. Technical reliability assessment of three accelerometer models in a mechanical setup. Med Sci Sports Exerc. 2006 Dec;38(12):2173-81. doi: 10.1249/01.mss.0000239394.55461.08.

Everitt, B., & Pickles, A. (2004). Statistical aspects of the design and analysis of clinical trials. London: Imperial College Press.

Festinger, L. (1957). A theory of cognitive dissonance. Stanford University Press.

Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009 Sep-Oct;28(5):w822-31. doi: 10.1377/hlthaff.28.5.w822. Epub 2009 Jul 27.

Flegal KM. Epidemiologic aspects of overweight and obesity in the United States. Physiol Behav. 2005 Dec 15;86(5):599-602. doi: 10.1016/j.physbeh.2005.08.050. Epub 2005 Oct 19.

Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010 Jan 20;303(3):235-41. doi: 10.1001/jama.2009.2014. Epub 2010 Jan 13.

Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003 Jan 8;289(2):187-93. doi: 10.1001/jama.289.2.187.

Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, Karpyn A, Kumanyika S, Shults J. A policy-based school intervention to prevent overweight and obesity. Pediatrics. 2008 Apr;121(4):e794-802. doi: 10.1542/peds.2007-1365.

Green M, Scott N, Diyankova I, Gasser C. Eating disorder prevention: an experimental comparison of high level dissonance, low level dissonance, and no-treatment control. Eat Disord. 2005 Mar-Apr;13(2):157-69. doi: 10.1080/10640260590918955.

Green, H. J., Frank, R. M., Butwell, A., & Beck, O. J. (2007). Implementation and evaluation of brief cognitivebehavioural therapy in a mental health acute assessment and treatment service. Behaviour Change, 24(2), 87-98.

Haines J, Neumark-Sztainer D, Wall M, Story M. Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity (Silver Spring). 2007 Nov;15(11):2748-60. doi: 10.1038/oby.2007.327.

Harris JK, French SA, Jeffery RW, McGovern PG, Wing RR. Dietary and physical activity correlates of long-term weight loss. Obes Res. 1994 Jul;2(4):307-13. doi: 10.1002/j.1550-8528.1994.tb00069.x.

Heil DP. Predicting activity energy expenditure using the Actical activity monitor. Res Q Exerc Sport. 2006 Mar;77(1):64-80. doi: 10.1080/02701367.2006.10599333.

Hill JO, Peters JC. Environmental contributions to the obesity epidemic. Science. 1998 May 29;280(5368):1371-4. doi: 10.1126/science.280.5368.1371.

Hoagwood K, Olin SS. The NIMH blueprint for change report: research priorities in child and adolescent mental health. J Am Acad Child Adolesc Psychiatry. 2002 Jul;41(7):760-7. doi: 10.1097/00004583-200207000-00006.

Hodgkins C, Frost-Pineda K, Gold MS. Weight gain during substance abuse treatment: the dual problem of addiction and overeating in an adolescent population. J Addict Dis. 2007;26 Suppl 1:41-50. doi: 10.1300/J069v26S01_05.

Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991 Feb;59(1):12-9. doi: 10.1037//0022-006x.59.1.12.

Jiang J, Xia X, Greiner T, Wu G, Lian G, Rosenqvist U. The effects of a 3-year obesity intervention in schoolchildren in Beijing. Child Care Health Dev. 2007 Sep;33(5):641-6. doi: 10.1111/j.1365-2214.2007.00738.x.

Klohe DM, Clarke KK, George GC, Milani TJ, Hanss-Nuss H, Freeland-Graves J. Relative validity and reliability of a food frequency questionnaire for a triethnic population of 1-year-old to 3-year-old children from low-income families. J Am Diet Assoc. 2005 May;105(5):727-34. doi: 10.1016/j.jada.2005.02.008.

Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage

Lowe MR, Annunziato RA, Markowitz JT, Didie E, Bellace DL, Riddell L, Maille C, McKinney S, Stice E. Multiple types of dieting prospectively predict weight gain during the freshman year of college. Appetite. 2006 Jul;47(1):83-90. doi: 10.1016/j.appet.2006.03.160. Epub 2006 May 2.

MacKinnon, D. P. (2008). Multivariate Applications: Introduction to Statistical Mediation Analysis. New York: Lawrence Erlbaum Associates.

Martin M, Beekley A, Kjorstad R, Sebesta J. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis. 2010 Jan-Feb;6(1):8-15. doi: 10.1016/j.soard.2009.07.003. Epub 2009 Jul 17.

Matusek JA, Wendt SJ, Wiseman CV. Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: results from a controlled trial. Int J Eat Disord. 2004 Dec;36(4):376-88. doi: 10.1002/eat.20059.

McCarthy HD, Cole TJ, Fry T, Jebb SA, Prentice AM. Body fat reference curves for children. Int J Obes (Lond). 2006 Apr;30(4):598-602. doi: 10.1038/sj.ijo.0803232.

McMillan W, Stice E, Rohde P. High- and low-level dissonance-based eating disorder prevention programs with young women with body image concerns: an experimental trial. J Consult Clin Psychol. 2011 Feb;79(1):129-34. doi: 10.1037/a0022143.

Mitchell KS, Mazzeo SE, Rausch SM, Cooke KL. Innovative interventions for disordered eating: evaluating dissonance-based and yoga interventions. Int J Eat Disord. 2007 Mar;40(2):120-8. doi: 10.1002/eat.20282.

Muthén, L. K., & Muthén, B. O. (1998-2010). Mplus User's Guide (6th ed.). Los Angeles: Muthén & Muthén.

Muthén, L. K., & Muthén, B. O. (2002). How to use a Monte Carlo study to decide on sample size and determine power. Structural Equation Modeling, 9, 599-620.

Neumark-Sztainer D, Story M, Hannan PJ, Perry CL, Irving LM. Weight-related concerns and behaviors among overweight and nonoverweight adolescents: implications for preventing weight-related disorders. Arch Pediatr Adolesc Med. 2002 Feb;156(2):171-8. doi: 10.1001/archpedi.156.2.171.

Perez M, Becker CB, Ramirez A. Transportability of an empirically supported dissonance-based prevention program for eating disorders. Body Image. 2010 Jun;7(3):179-86. doi: 10.1016/j.bodyim.2010.02.006. Epub 2010 Mar 23.

Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008 Aug;40(3):879-91. doi: 10.3758/brm.40.3.879.

Reilly JJ, Penpraze V, Hislop J, Davies G, Grant S, Paton JY. Objective measurement of physical activity and sedentary behaviour: review with new data. Arch Dis Child. 2008 Jul;93(7):614-9. doi: 10.1136/adc.2007.133272. Epub 2008 Feb 27.

Ricciardelli LA, McCabe MP. Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys. Behav Res Ther. 2001 Nov;39(11):1317-28. doi: 10.1016/s0005-7967(00)00097-8.

Richardson LP, Davis R, Poulton R, McCauley E, Moffitt TE, Caspi A, Connell F. A longitudinal evaluation of adolescent depression and adult obesity. Arch Pediatr Adolesc Med. 2003 Aug;157(8):739-45. doi: 10.1001/archpedi.157.8.739.

Roehrig M, Thompson JK, Brannick M, van den Berg P. Dissonance-based eating disorder prevention program: a preliminary dismantling investigation. Int J Eat Disord. 2006 Jan;39(1):1-10. doi: 10.1002/eat.20217.

Rolls, B., & Barnett, R. (2000). Volumetrics: Feel full on fewer calories. New York, NY: Harper Collins

Rolls, B., & Barnett, R. (2000). Volumetrics: Feel full on fewer calories. New York, NY: Harper Collins.

Roy-Byrne PP, Sherbourne CD, Craske MG, Stein MB, Katon W, Sullivan G, Means-Christensen A, Bystritsky A. Moving treatment research from clinical trials to the real world. Psychiatr Serv. 2003 Mar;54(3):327-32. doi: 10.1176/appi.ps.54.3.327.

Schoeller DA, Ravussin E, Schutz Y, Acheson KJ, Baertschi P, Jequier E. Energy expenditure by doubly labeled water: validation in humans and proposed calculation. Am J Physiol. 1986 May;250(5 Pt 2):R823-30. doi: 10.1152/ajpregu.1986.250.5.R823.

Schwitzer, A., & Choate, L., (2007). College student needs and counseling responses. Journal of College Counseling, 10, 3-5.

Seeley JR, Stice E, Rohde P. Screening for depression prevention: identifying adolescent girls at high risk for future depression. J Abnorm Psychol. 2009 Feb;118(1):161-170. doi: 10.1037/a0014741.

Seidel A, Presnell K, Rosenfield D. Mediators in the dissonance eating disorder prevention program. Behav Res Ther. 2009 Aug;47(8):645-53. doi: 10.1016/j.brat.2009.04.007. Epub 2009 May 3.

Singer, J. D., & Willett, J. B. (2003). Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence. New York: Oxford University Press.

Sirard JR, Kubik MY, Fulkerson JA, Arcan C. Objectively measured physical activity in urban alternative high school students. Med Sci Sports Exerc. 2008 Dec;40(12):2088-95. doi: 10.1249/MSS.0b013e318182092b.

Steele CM, Southwick LL, Critchlow B. Dissonance and alcohol: drinking your troubles away. J Pers Soc Psychol. 1981 Nov;41(5):831-46. doi: 10.1037//0022-3514.41.5.831.

Stice E, Whitenton K. Risk factors for body dissatisfaction in adolescent girls: a longitudinal investigation. Dev Psychol. 2002 Sep;38(5):669-78. doi: 10.1037//0012-1649.38.5.669.

Stice E, Cooper JA, Schoeller DA, Tappe K, Lowe MR. Are dietary restraint scales valid measures of moderate- to long-term dietary restriction? Objective biological and behavioral data suggest not. Psychol Assess. 2007 Dec;19(4):449-58. doi: 10.1037/1040-3590.19.4.449.

Stice E, Fisher M, Lowe MR. Are dietary restraint scales valid measures of acute dietary restriction? Unobtrusive observational data suggest not. Psychol Assess. 2004 Mar;16(1):51-9. doi: 10.1037/1040-3590.16.1.51.

Stice E, Marti CN, Rohde P, Shaw H. Testing mediators hypothesized to account for the effects of a dissonance-based eating disorder prevention program over longer term follow-up. J Consult Clin Psychol. 2011 Jun;79(3):398-405. doi: 10.1037/a0023321.

Stice E, Marti CN, Shaw H, Jaconis M. An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol. 2009 Aug;118(3):587-97. doi: 10.1037/a0016481.

Stice E, Marti CN, Spoor S, Presnell K, Shaw H. Dissonance and healthy weight eating disorder prevention programs: long-term effects from a randomized efficacy trial. J Consult Clin Psychol. 2008 Apr;76(2):329-40. doi: 10.1037/0022-006X.76.2.329.

Stice E, Mazotti L, Weibel D, Agras WS. Dissonance prevention program decreases thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment. Int J Eat Disord. 2000 Mar;27(2):206-17. doi: 10.1002/(sici)1098-108x(200003)27:23.0.co;2-d.

Stice E, Presnell K, Shaw H, Rohde P. Psychological and behavioral risk factors for obesity onset in adolescent girls: a prospective study. J Consult Clin Psychol. 2005 Apr;73(2):195-202. doi: 10.1037/0022-006X.73.2.195.

Stice E, Rohde P, Gau J, Shaw H. An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. J Consult Clin Psychol. 2009 Oct;77(5):825-34. doi: 10.1037/a0016132.

Stice E, Rohde P, Seeley JR, Gau JM. Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: a randomized efficacy trial. J Consult Clin Psychol. 2008 Aug;76(4):595-606. doi: 10.1037/a0012645.

Stice E, Rohde P, Shaw H, Gau J. An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects. J Consult Clin Psychol. 2011 Aug;79(4):500-8. doi: 10.1037/a0024351.

Stice E, Rohde P, Shaw H, Marti CN. Efficacy trial of a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain among female college students. J Consult Clin Psychol. 2012 Feb;80(1):164-170. doi: 10.1037/a0026484. Epub 2011 Nov 28.

Stice E, Shaw H, Marti CN. A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work. Psychol Bull. 2006 Sep;132(5):667-91. doi: 10.1037/0033-2909.132.5.667.

Stice E, Shaw H, Marti CN. A meta-analytic review of eating disorder prevention programs: encouraging findings. Annu Rev Clin Psychol. 2007;3:207-31. doi: 10.1146/annurev.clinpsy.3.022806.091447.

Stice E, Shaw H, Burton E, Wade E. Dissonance and healthy weight eating disorder prevention programs: a randomized efficacy trial. J Consult Clin Psychol. 2006 Apr;74(2):263-75. doi: 10.1037/0022-006X.74.2.263.

Subar AF, Thompson FE, Kipnis V, Midthune D, Hurwitz P, McNutt S, McIntosh A, Rosenfeld S. Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires : the Eating at America's Table Study. Am J Epidemiol. 2001 Dec 15;154(12):1089-99. doi: 10.1093/aje/154.12.1089.

Surrao J, Sawaya AL, Dallal GE, Tsay R, Roberts SB. Use of food quotients in human doubly labeled water studies: comparable results obtained with 4 widely used food intake methods. J Am Diet Assoc. 1998 Sep;98(9):1015-20. doi: 10.1016/S0002-8223(98)00232-6.

Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc. 2005 Nov;37(11 Suppl):S531-43. doi: 10.1249/01.mss.0000185657.86065.98.

Trost SG, Pate RR, Freedson PS, Sallis JF, Taylor WC. Using objective physical activity measures with youth: how many days of monitoring are needed? Med Sci Sports Exerc. 2000 Feb;32(2):426-31. doi: 10.1097/00005768-200002000-00025.

Turk MW, Yang K, Hravnak M, Sereika SM, Ewing LJ, Burke LE. Randomized clinical trials of weight loss maintenance: a review. J Cardiovasc Nurs. 2009 Jan-Feb;24(1):58-80. doi: 10.1097/01.JCN.0000317471.58048.32.

van Strien, T., Frijters, J. E., Van Staveren, W. A., Defares, P. B., & Deurenberg, P. (1986). The predictive validity of the Dutch Restrained Eating Scale. Int J Eat Disord, 5, 747-755

Ward DS, Evenson KR, Vaughn A, Rodgers AB, Troiano RP. Accelerometer use in physical activity: best practices and research recommendations. Med Sci Sports Exerc. 2005 Nov;37(11 Suppl):S582-8. doi: 10.1249/01.mss.0000185292.71933.91.

Weisz JR, Donenberg GR, Han SS, Kauneckis D. Child and adolescent psychotherapy outcomes in experiments versus clinics: why the disparity? J Abnorm Child Psychol. 1995 Feb;23(1):83-106. doi: 10.1007/BF01447046.

Weyers AM, Mazzetti SA, Love DM, Gomez AL, Kraemer WJ, Volek JS. Comparison of methods for assessing body composition changes during weight loss. Med Sci Sports Exerc. 2002 Mar;34(3):497-502. doi: 10.1097/00005768-200203000-00017.

Wichstrom L. Psychological and behavioral factors unpredictive of disordered eating: a prospective study of the general adolescent population in Norway. Int J Eat Disord. 2000 Jul;28(1):33-42. doi: 10.1002/(sici)1098-108x(200007)28:13.0.co;2-h.

Wong SL, Colley R, Connor Gorber S, Tremblay M. Actical accelerometer sedentary activity thresholds for adults. J Phys Act Health. 2011 May;8(4):587-91. doi: 10.1123/jpah.8.4.587.

Yancey AK, Ortega AN, Kumanyika SK. Effective recruitment and retention of minority research participants. Annu Rev Public Health. 2006;27:1-28. doi: 10.1146/annurev.publhealth.27.021405.102113.

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