Body Project

About This Program

Target Population: Adolescent girls 14-18 years

For children/adolescents ages: 14 – 18

Program Overview

The Body Project is delivered to groups of 6-10 participants in 4 1-hour sessions by 1 or 2 facilitators. Participants complete a series of verbal, behavioral, and written activities in which they collectively explore the negative effects of pursuing the unrealistic appearance ideal espoused for women in U.S. culture. These activities reduce pursuit of the beauty ideal, which in turn reduces body dissatisfaction, unhealthy dieting, negative affect, eating disorder symptoms, and risk for future onset of eating disorders.

Program Goals

The goals of the Body Project are:

  • Reduce pursuit of the thin beauty ideal
  • Promote body acceptance
  • Reduce current eating disorder symptoms
  • Prevent eating disorders

Essential Components

The essential components of the Body Project include:

  • Groups of 6-10 participants
  • 4 one-hour sessions
  • 1 or 2 facilitators who are clinicians or trained school staff
  • Participants:
    • Verbally agree to actively participate in the sessions on a voluntary basis
    • Critique the thin beauty ideal
    • Engage in role-plays in which they argue facilitators out of pursuing the thin beauty ideal
    • Write a letter to a younger girl about the costs of pursuing the thin ideal
    • Record positive personal features while looking in a mirror
    • Write a letter to someone who has pressured the participant to conform to the thin beauty ideal
    • Engage in activities that challenge the thin beauty ideal outside the group
    • Generate quick verbal comebacks that derail discussions about the beauty ideal and body image concerns
    • Engage in behaviors that participants avoid because of body image concerns
    • Write a letter to one’s younger self about how to develop a positive body image
    • Discuss the benefits of completing this body acceptance intervention
    • Commit to a self-affirmation exercise to complete after the group ends

Program Delivery

Child/Adolescent Services

Body Project directly provides services to children/adolescents and addresses the following:

  • Body dissatisfaction, eating disorder symptoms, potential future onset of eating disorders

Recommended Intensity:

1-hour weekly sessions (4 sessions total); other versions are 2-hour (2 sessions) or 50-minute weekly sessions (6 sessions total)

Recommended Duration:

4 weeks; other versions are 2 or 6 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Community-based Agency / Organization / Provider
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Body Project includes a homework component:

Two home exercises are assigned per session, such as writing a letter to a younger adolescent girl about the costs of pursuing the thin beauty ideal and engaging in an activity that the participant typically avoids because of body image concerns.

Languages

Body Project has materials available in languages other than English:

Chinese, French, Icelandic, Japanese, Norwegian, Portuguese, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

A location to hold the group sessions, though they can also be implemented virtually. The room should have a marker board or large butcher paper for a few of the exercises.

Education and Training

Prerequisite/Minimum Provider Qualifications

Providers generally have the equivalent of a master’s degree in a mental health field but the program can be delivered by those with a bachelor’s degree and training in the program.

Education and Training Resources

There is a manual that describes how to deliver this program, and there is training available for this program.

Stice, E., Rohde, P., & Shaw, H. (2013). The Body Project: A dissonance-based eating disorder prevention program. Oxford University Press.

People can download an electronic copy of the intervention script from http://www.bodyprojectsupport.org/

Training Contact:
Training is obtained:

Training can be provided at Stanford or Oregon Research Institute, or trainings can be conducted at other institutions anywhere around the world. Trainings can also be conducted virtually through videoconferencing.

Number of days/hours:

Facilitator training for clinicians lasts 4 hours. Supervisors can also be trained to train others, using a train-the-trainer model.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Body Project.

Formal Support for Implementation

There is formal support available for implementation of Body Project as listed below:

Reviews of audio or video recordings of implemented sessions are offered in order to improve implementation fidelity and competence. These sessions are sent to the program developers using secure procedures for ratings using established scales. Session review is not required to deliver to the Body Project but is recommended if possible.

Fidelity Measures

There are fidelity measures for Body Project as listed below:

The Body Project Facilitators Support webpage has a fidelity checklist that can be used to monitor implementation fidelity.

Staff at the agency implementing the Body Project can be trained to rate fidelity or fidelity rating can be provided on a fee-for-service basis.

Established Psychometrics:

Interrater agreement reliability has been established.

Stice, E., Rohde, P., Shaw, H., & Gau, J. (2017). Clinician-led, peer-led, and Internet-delivered dissonance-based eating disorder prevention programs: Acute effectiveness of these delivery modalities. Journal of Consulting and Clinical Psychology, 85, 883–895. https://doi.org/10.1037/ccp0000211

Implementation Guides or Manuals

There are implementation guides or manuals for Body Project as listed below:

The Body Project facilitator’s guide provides information on implementation of this prevention program. Implementation tips are also summarized in the intervention script, which can be downloaded for free from the Body Project facilitators support web page.

Implementation Cost

There have been studies of the costs of implementing Body Project which are listed below:

Akers, L., Rohde, P., Stice, E., Butryn, M. L., & Shaw, H. (2017). Cost-effectiveness of achieving clinical improvement with a dissonance-based eating disorder prevention program. Eating Disorders, 25(3), 263–272. https://doi.org/10.1080/10640266.2017.1297107

Research on How to Implement the Program

Research has been conducted on how to implement Body Project as listed below:

Stice, E., Rohde, P., Shaw, H., & Gau, J. M. (2017). Clinician-led, peer-led, and Internet-delivered dissonance-based eating disorder prevention programs: Acute effectiveness of these delivery modalities. Journal of Consulting and Clinical Psychology, 85, 883–895. https://doi.org/10.1037/ccp0000211

Stice, E., Rohde, P., Shaw, H., & Gau, J. (2020). Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Effectiveness of these delivery modalities through 4-year follow-up. Journal of Consulting and Clinical Psychology, 88(5), 481-494. https://doi.org/10.1037/ccp0000493

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

A meta-analysis, see citation following, has been conducted on the Body Project, however, this article is not used for rating and therefore is not summarized:

  • Stice, E., Marti, N., Shaw, H., & Rohde, P. (2019). Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects. Clinical Psychology Review, 70, 91-107. https://doi.org/10.1016/j.cpr.2019.04.004

The CEBC reviews all of the articles that have been published in peer-reviewed journals as part of the rating process. When there are more than 10 published, peer-reviewed articles, the CEBC identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Body Project are summarized below:

Stice, E., Shaw, H., Burton, E., & Wade, E. (2006). Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 74(2), 263–275. https://doi.org/10.1037/0022-006X.74.2.263

Type of Study: Randomized controlled trial
Number of Participants: 481

Population:

  • Age — Mean=17 years
  • Race/Ethnicity — 58% Caucasian, 19% Hispanic, 10% Asian/Pacific Islander, 6% African American, and 7% who Specified Other or Mixed Racial Heritage
  • Gender — 100% Female
  • Status — Participants were adolescent girls with body dissatisfaction.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study discussed the efficacy of the Body Project. Participants were randomized to a dissonance intervention [now called the Body Project], healthy weight intervention, expressive writing control intervention, or assessment-only control condition. Measures utilized included the Ideal-Body Stereotype Scale—Revised, the Satisfaction and Dissatisfaction with Body Parts Scale, the Dutch Restrained Eating Scale (DRES), the Sadness, Guilt, and Fear/Anxiety subscales from the Positive Affect and Negative Affect Scale—Revised, the Social Adjustment Scale (SAS), and the Eating Disorder Diagnostic Interview. Results indicated that Body Project participants showed significantly greater reductions in eating disorder risk factors and bulimic symptoms than healthy weight, expressive writing, and assessment-only participants, and healthy weight participants showed significantly greater reductions in risk factors and symptoms than expressive writing and assessment-only participants from pretest to posttest. Although these effects faded over 6-month and 12-month follow-ups, Body Project and healthy weight participants showed significantly lower binge eating and obesity onset and reduced service utilization through 12-month follow-up, suggesting that both interventions have public health potential. Limitations include reliance on self-reported measures and generalizability due to gender.

Length of postintervention follow-up: 6 and 12 months.

Stice, E., Marti, C. N., Spoor, S., Presnell, K., & Shaw, H. (2008). Dissonance and healthy weight eating disorder prevention programs: long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76(2), 329–340. https://doi.org/10.1037/0022-006X.76.2.329

Type of Study: Randomized controlled trial
Number of Participants: 481

Population:

  • Age — Mean=17 years
  • Race/Ethnicity — 58% Caucasian, 19% Hispanic, 10% Asian/Pacific Islander, 6% African American, and 7% who Specified Other or Mixed Racial Heritage
  • Gender — 100% Female
  • Status — Participants were adolescent girls with body image concerns.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study used the same sample as Stice et al. (2006). This study discussed the efficacy of the Body Project. Participants were randomized to a dissonance intervention [now called the Body Project], healthy weight intervention, expressive writing control intervention, or assessment-only control condition. Measures utilized included the Ideal-Body Stereotype Scale—Revised, the Satisfaction and Dissatisfaction with Body Parts Scale, the Dutch Restrained Eating Scale (DRES), the Sadness, Guilt, and Fear/Anxiety subscales from the Positive Affect and Negative Affect Scale—Revised, the Social Adjustment Scale (SAS), and the Eating Disorder Diagnostic Interview. Results indicated that Body Project participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment and lower risk for eating pathology onset through 2- to 3-year follow-up than did assessment-only controls. Body Project participants showed greater decreases in thin-ideal internalization, body dissatisfaction, and psychosocial impairment than did expressive writing controls. Healthy weight participants showed greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment; less increases in weight; and lower risk for eating pathology and obesity onset through 2- to 3-year follow-up than did assessment-only controls. Healthy weight participants showed greater decreases in thin-ideal internalization and weight than did expressive writing controls. Body Project participants showed a 60% reduction in risk for eating pathology onset, and healthy weight. Participants showed a 61% reduction in risk for eating pathology onset and a 55% reduction in risk for obesity onset relative to assessment-only controls through 3-year follow-up, implying that the effects are clinically important and enduring. Limitations include reliance on self-reported measures and generalizability due to gender.

Length of postintervention follow-up: 6 months, 1 year, 2 years, and 3 years.

Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77(5), 825–834. https://doi.org/10.1037/a0016132

Type of Study: Randomized controlled trial
Number of Participants: 306

Population:

  • Age — Mean=15.7 years
  • Race/Ethnicity — 81% Caucasian, 9% Hispanic, 2% Asian/Pacific Islander, 2% African American, and 6% Other or Mixed Racial Heritage
  • Gender — 100% Female
  • Status — Participants were adolescent girls with body image concerns.

Location/Institution: Mid-sized city in the Northwest United States

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study tested whether the Body Project produced effects when school staff recruit participants and deliver the intervention. Participants were randomized to a dissonance intervention [now called the Body Project], or to a psychoeducational brochure control condition. Measures utilized included the Ideal-Body Stereotype Scale—Revised, the Satisfaction and Dissatisfaction with Body Parts Scale, the Dutch Restrained Eating Scale (DRES), the Center for Epidemiologic Studies Depression Scale (CESD), and the Eating Disorder Diagnostic Interview. Results indicated that Body Project participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, dieting attempts, and eating disorder symptoms from pretest to posttest than did those assigned to a psychoeducational brochure control condition, with the effects for body dissatisfaction, dieting attempts, and eating disorder symptoms persisting through 1-year follow-up. Limitations include reliance on self-reported measures and sample was relatively homogeneous with regard to ethnicity and socioeconomic status, suggesting that care should be taken in generalizing the results to other populations.

Length of postintervention follow-up: 6 months and 1 year.

Stice, E., Rohde, P., Shaw, H., & Gau, J. (2011). An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects. Journal of Consulting and Clinical Psychology, 79(4), 500–508. https://doi.org/10.1037/a0024351

Type of Study: Randomized controlled trial
Number of Participants: 306

Population:

  • Age — 14–19 years (Mean=15.7 years)
  • Race/Ethnicity — 58% European American, 17% Asian, 13% Hispanic, 7% African American, 4% American Indian/Alaska Native, and 1% Native Hawaiian/Pacific Islander
  • Gender — 100% Female
  • Status — Participants were young women with body image concerns.

Location/Institution: 7 universities in Oregon, Texas, and Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study used the same sample as Stice, et al. (2009). The present effectiveness trial tested whether the Body Project produces effects through long-term follow-up when high school clinicians recruit students and deliver the intervention under real-world conditions. Participants were randomized to the Body Project or to a psychoeducational brochure control condition. Measures utilized included the Ideal-Body Stereotype Scale—Revised, the Satisfaction and Dissatisfaction with Body Parts Scale, the Social Adjustment Scale (SAS), the Dutch Restrained Eating Scale (DRES), the Beck Depression Inventory (BDI), the Patterns of Help Seeking Behavior Scale, and the Eating Disorder Diagnostic Interview (EDDI). Results indicated that Body Project participants showed significantly greater decreases in body dissatisfaction at 2-year follow-up and eating disorder symptoms at 3-year follow-up than controls; effects on other risk factors, risk for eating disorder onset, and other outcomes (e.g., body mass) were marginal or nonsignificant. Limitations include reliance on self-reported measures and sample was relatively homogeneous with regard to ethnicity and socioeconomic status, suggesting that care should be taken in generalizing the results to other populations.

Length of postintervention follow-up: 6 months, 1 year, 2 years, and 3 years.

Amaral, A., Stice, E., & Ferreira, M. (2019). A controlled trial of a dissonance-based eating disorder prevention program with Brazilian girls. Psicologia: Reflexao e Eritica, 32, Article 13. https://doi.org/10.1186/s41155-019-0126-3

Type of Study: Randomized controlled trial
Number of Participants: 141

Population:

  • Age — Mean=16.25 years
  • Race/Ethnicity — 100% Brazilian
  • Gender — 100% Female
  • Status — Participants were adolescents with body image concerns.

Location/Institution: Brazil

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This trial evaluated the efficacy of the Body Project with Brazilian girls, to determine if this intervention is culturally sensitive and efficacious with Latin-American adolescents. Participants were randomized to the Body Project or assessment-only condition. Measures utilized included the Body Shape Questionnaire (BSQ), the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ3), the Eating Attitudes Test (EAT-26), the Eating Disorder Diagnostic Scale (EDDS), the Children Depression Inventory (CDI), the Body Appreciation Scale (BAS), and the Positive Affect and Negative Affect Scale (PANAS). Results indicated that compared to assessment-only controls, Body Project participants showed a significantly greater reduction in body dissatisfaction, sociocultural influence of the media, depressive symptoms, negative affect, as well as significantly greater increases in body appreciation. There were no significant effects for disordered eating attitudes and eating disorder symptoms. Limitations include reliance on self-reported measures; large dropout rate; the assessment-only control condition was not a rigorous comparison condition because it did not control for demand characteristics inherent to randomized trials; and lack of follow-up.

Length of postintervention follow-up: None.

The following studies were not included in rating Body Project on the Scientific Rating Scale...

Stice, E., Yokum, S., & Waters, A. (2015). Dissonance-based eating disorder prevention program reduces reward region response to thin models: How actions shape valuation. PLoS ONE, 10(12), Article e0144530. https://doi.org/10.1371/journal.pone.0144530

This study tested whether completing the Body Project would reduce response of college students’ brain regions implicated in reward valuation to thin models. Participants were randomized to the Body Project or an educational control condition. Measures utilized included the Schedule for Affective Disorders and Schizophrenia for School Age Children—Epidemiologic Version 5 (K-SADS-E5), the Ideal-Body Stereotype Scale-Revised, the Satisfaction and Dissatisfaction with Body Parts Scale, and the Eating Disorder Diagnostic Interview. Results indicated that compared to controls, Body Project participants showed greater reductions in caudate response to images of thin versus average-weight models, though participants in the two conditions showed pretest differences in responsivity of other brain regions that might have contributed to this effect. Greater pretest–posttest reductions in caudate and putamen response to thin models correlated with greater reductions in body dissatisfaction. Limitations include reliance on self-reported measures, small sample size, and lack of follow-up. Note: This article was not reviewed for rating Body Project since it studied college students which are outside the age range of the topic area..

Ghaderi, A., Stice, E., Andersson, G., Enö Persson, J., & Allzén, E. (2020). A randomised controlled trial of the effectiveness of virtually delivered body project (vBP) groups to prevent eating disorders. Journal of Consulting and Clinical Psychology, 88(7), 643–656. https://doi.org/10.1037/ccp0000506

This randomized controlled trial was to investigate the effectiveness vBody Project: vBP groups by peer educators for prevention of eating disorders. Participants were randomized to one of the following: vBP group, a placebo (expressive writing, EW) group, or to a waitlist control condition. The postintervention follow-up evaluations lasted for 24 months for the EW group and 6 months for the waitlist control condition. Measures utilized included the Eating Disorders Examination (EDE), the Eating Disorder Diagnostic Scale (EDDS), the Restraint Subscale of the Eating Disorders Examination Questionnaire (EDE-Q-r), the Positive Affect and Negative Affect Scale (PANAS), and the Clinical Impairment Assessment (CIA), the Body Parts Dissatisfaction Scale (BPDS), the Body Shape Questionnaire-brief version (BSQ) and the Ideal Body Stereotype Scale–Revised (IBSS-R). Results indicate that the incidence of eating disorders onset over 24 months follow up were 3 in vBP and 13 in EW a significant difference. Incidence of eating disorder onset in vBP participants was less than in EW participants. The vBP participants generally showed significantly greater reduction in eating disorder symptoms, clinical impairment, body dissatisfaction, and internalization of thin ideal compared with the waitlist participants at postintervention and 6-month follow-up, and in eating disorder symptoms, restraint, body dissatisfaction, and internalization of thin ideal compared with the EW participants at postintervention, and 6-, 12-, 18-, or 24-months follow-up. EW participants reported significantly greater reduction in clinical impairment and body dissatisfaction at post intervention compared with the waitlist participants. Limitations include reliance on self-reported measures, drop-out was significant, and the EW intervention was not group-based to match the format of the vBP. Note: This article was not reviewed for rating Body Project since it is a study on vBody Project which is a modification of Body Project.

Additional References

Stice, E., Marti, N., Shaw, H., & Rohde, P. (2019). Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects. Clinical Psychology Review, 70, 91-107. https://doi.org/10.1016/j.cpr.2019.04.004

Becker, C., & Stice, E. (2017). From efficacy to effectiveness to broad implementation: Evolution of the Body Project. Journal of Consulting and Clinical Psychology, 85, 767-782. https://doi.org/10.1037/ccp0000204

Contact Information

Eric Stice, PhD
Agency/Affiliation: Stanford University
Website: www.bodyprojectsupport.org
Email:
Phone: (541) 222-0615

Date Research Evidence Last Reviewed by CEBC: May 2020

Date Program Content Last Reviewed by Program Staff: July 2020

Date Program Originally Loaded onto CEBC: August 2020