The Healthy Body Image intervention: A school-based, cluster-randomized controlled trial in high school students

Abstract

Background: Researchers have been encouraged to design and evaluate health promotive interventions specifically tailored to promote positive embodiment in adolescents because it is associated with important mental and physical health outcomes. Furthermore, because positive embodiment and healthy lifestyle habits are related phenomena, stimulating positive embodiment should also promote healthy lifestyle habits. It has been indicated that school-based, interactive, multicomponent interventions could be effective. However, few studies have implemented all the necessary criteria for a sound methodology: a study with a clustered-randomization, a controlled design; a large sample size, including both genders; a long-term follow-up; and a measurement of the promotion of positive embodiment, not only the lack of dissatisfaction or symptoms of eating disorder pathology. Additionally, more studies that investigate which constructs that need to be influenced in order to improve positive embodiment are needed, to further tailor content for the best possible intervention effect on boys and girls. The Healthy Body Image (HBI) intervention was a response to the lack of evidence in this field and to the reported gaps related to methodological quality.

Objectives: The primary objective of the thesis is to evaluate the effects of the HBI intervention on high school boys and girls. The first paper outlines the rationale and the specific study protocol for the intervention. The second paper examines both the short- and long-term effects of the intervention on positive embodiment and health-related quality of life (HRQoL), as well as the moderating effect of workshop attendance on intervention effects in boys and girls. The third paper evaluates whether the intervention has an additional effect on lifestyle habits, such as physical activity, eating, and sleep, in the same sample. The fourth paper examines whether the intervention affected positive embodiment through specific constructs such as, internalization, social media usage, self-compassion, self-esteem, and body image flexibility that the intervention aimed to target.

Paper I: Sundgot-Borgen, C., Bratland-Sanda, S., Engen, K. M., Pettersen, G., Friborg, O., Torstveit, M. K., Kolle., E., Piran, N., Sundgot-Borgen, J. & Rosenvinge, J. H. (2018). The Norwegian healthy body image programme: study protocol for a randomized controlled school-based intervention to promote positive body image and prevent disordered eating among Norwegian high school students. BMC Psychology, 6(1), 8.

Paper II: Sundgot-Borgen, C., Friborg, O., Kolle, E., Engen, K. M., Sundgot-Borgen, J., Rosenvinge, J. H., Pettersen, G., Torstveit, M. K., Piran, N. & Bratland-Sanda, S. (2019). The healthy body image (HBI) intervention: Effects of a school-based cluster-randomized controlled trial with 12-months follow-up. Body Image, 29, 122-131.

Paper III: Sundgot-Borgen, C., Friborg, O., Kolle, E., Torstveit, M. K., Sundgot-Borgen, J., Engen, K. E., Rosenvinge, J. H., Pettersen, G. & Bratland-Sanda, S. (2019). Does the Healthy Body Image program improve lifestyle habits among high school students? A randomized controlled trial with 12-month follow-up. Journal of International Medical Research. 0(0), 1-17. doi:10.1177/0300060519889453

Paper IV: Sundgot-Borgen, C., Stenling, A., Rosenvinge, J. H., Pettersen, G., Friborg, O., Sundgot-Borgen, J., Kolle, E., Torstveit, M. K., Engen, K. M. & Bratland-Sanda, S. (Submitted). The Norwegian Healthy Body Image Intervention promotes Positive Embodiment Through Improved Self-Esteem. Body Image.