Bio

Bio


Dr. Stice served as an assistant professor and associate professor at the University of Texas at Austin and as a Senior Research Scientist at Oregon Research Institute before joining the faculty at Stanford University. His research focuses on identifying risk factors that predict onset of eating disorders, obesity, substance abuse, and depression to advance knowledge regarding etiologic processes, including the use of functional neural imaging. He also designs, evaluates, and disseminates prevention and treatment interventions for eating disorders, obesity, and depression. For instance, he developed a dissonance-based eating disorder prevention program that has been implemented with over 4 million young girls in 139 countries. He has published 297 articles in high-impact outlets, including Science, Psychological Bulletin, Archives of General Biological Psychiatry, American Journal of Clinical Nutrition, and Journal of Neuroscience.

Academic Appointments


  • Professor - Med Center Line, Psychiatry and Behavioral Sciences

Honors & Awards


  • Christina Barz Award, World Psychiatric Association (2017)
  • Lori Irving Award for Excellence in Eating Disorder Prevention and Awareness, National Eating Disorder Association (2012)
  • Nan Tobler Award for Review of the Prevention Science Literature, Society for Prevention Research (2008)
  • Distinguished Scientific Award for Early Career Contributions to Psychopathology, American Psychological Association (2004)

Boards, Advisory Committees, Professional Organizations


  • Statistics Advisory Board, Cell Press (2019 - Present)
  • Statistical Review Board, Behaviour Research and Therapy (2016 - Present)
  • Associate Editor, Journal of Consulting and Clinical Psychology (2016 - Present)

Professional Education


  • B.S., University of Oregon, Psychology (1989)
  • M.A., Arizona State University, Clinical Psychology (1992)
  • Ph.D., Arizona State University, Clinical Psychology (1996)

Research & Scholarship

Clinical Trials


  • Peer-Led Dissonance Eating Disorder Prevention: Virtual Delivery Recruiting

    This proposed pilot study will evaluate whether this body acceptance class produces greater reductions in eating disorder risk factor symptoms (pursuit of the thin ideal, body dissatisfaction, dieting, dietary restraint and negative affect), eating disorder symptoms, and future onset of eating disorders over 6-month follow-up in this population.

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Publications

All Publications


  • A Randomized Controlled Trial of the Effectiveness of Virtually Delivered Body Project (vBP) Groups to Prevent Eating Disorders JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Ghaderi, A., Stice, E., Andersson, G., Persson, J., Allzen, E. 2020; 88 (7): 643?56

    Abstract

    To investigate the effectiveness of Body Project groups delivered virtually (vBP) by peer educators for prevention of eating disorders.In a randomized controlled trial vBP groups (N = 149) were compared with a placebo (expressive writing, EW: N = 148) over 24-month follow-up and to a waitlist control condition (N = 146) over 6-month follow-up among females (15-20 years old) with body image concerns. The primary outcome was incidence of eating disorder onset over 2-year follow-up measured by blinded diagnostic interviews. Waitlist participants were offered the vBP after 6 months.The incidence of eating disorders onset over 24 months follow up were 3 in vBP (2.0%) and 13 in EW (8.8%), a significant difference; Hazard Ratio (Experiment B) = 0.26, 95% confidence interval (CI) [0.075, 0.92], p = .037. Incidence of eating disorder onset in vBP participants was 77% 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 postintervention compared with the waitlist participants.The present reduction in the incidence of eating disorders is notable given that the intervention was implemented virtually, rather than in-person. The vBP might be a viable option for future evaluation of scalable prevention of eating disorders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

    View details for DOI 10.1037/ccp0000506

    View details for Web of Science ID 000542192200005

    View details for PubMedID 32551736

  • Weight suppression increases odds for future onset of anorexia nervosa, bulimia nervosa, and purging disorder, but not binge eating disorder. The American journal of clinical nutrition Stice, E., Rohde, P., Shaw, H., Desjardins, C. 2020

    Abstract

    BACKGROUND: Eating disorders affect 13% of females and contribute to functional impairment and mortality, but few studies have identified risk factors that prospectively correlate with future onset of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Identifying risk factors specific to each eating disorder is critical for advancing etiologic knowledge and designing effective prevention programs.OBJECTIVES: This study examined whether weight suppression (the difference between a person's highest past weight at their adult height and their current weight) correlates with future onset of AN, BN, BED, and PD.METHODS: Data from 1165 young women with body image concerns (mean±SD age: 21.9±6.4 y) who completed annual diagnostic interviews over a 3-y follow-up period were examined. Logistic regression models evaluated the relation of baseline weight suppression to onset risk of each eating disorder controlling for age, dietary restraint, and intervention condition.RESULTS: Elevated weight suppression predicted future onset of AN (OR: 1.36; 95% CI: 1.03, 1.80), BN (OR: 1.34; 95% CI: 1.11, 1.62), PD (OR: 1.46; 95% CI: 1.23, 1.74), and any eating disorder (OR: 1.32; 95% CI: 1.12, 1.56), but not BED (OR: 1.10; 95% CI: 0.89, 1.37). Highest past weight correlated with future onset of BN and PD but not onset of AN, BED, or any eating disorder, and baseline current weight was inversely related to future AN onset only, implying that women with the largest difference between their highest past weight and current weight are at greatest risk of eating disorders.CONCLUSIONS: The results provide novel evidence that weight suppression correlates with future onset of eating disorders characterized by dietary restriction or compensatory weight control behaviors and suggest weight-suppressed women constitute an important risk group to target with selective prevention programs.These trials were registered at clinicaltrials.gov as NCT01126918 and NCT01949649.

    View details for DOI 10.1093/ajcn/nqaa146

    View details for PubMedID 32534455

  • THE IMPACT OF WEIGHT SUPPRESSION AND DIETARY RESTRAINT ON OUTCOMES IN AN EATING DISORDER AND OBESITY PREVENTION TRIAL Call, C. C., D'Adamo, L., Butryn, M. L., Stice, E. OXFORD UNIV PRESS INC. 2020: S619
  • Preliminary Effects of Tailoring an Obesity Prevention Intervention Program for Latino Immigrant Families. Family & community health Linville, D., Mintz, B., Martinez, C., Gau, J. M., Shune, S., Stice, E. 2020; 43 (2): 118?30

    Abstract

    An obesity preventive intervention program for preschool families, Healthy Balance, was tested in 2 sequential pilot trials. The first pilot tested the original and translated group intervention in a heterogeneous population (65 families), and the second tested the feasibility of a culturally adapted version for Latinx immigrant families (27 families). No significant study 1 intervention effects were found. However, in study 2, there were significant improvements in parent body mass index, neck circumference, and blood pressure. These studies suggest that targeting family system change and tailoring the intervention for Latinx immigrant populations is feasible and has the potential to improve obesity-related biomarkers.

    View details for DOI 10.1097/FCH.0000000000000252

    View details for PubMedID 32079968

  • Multivariate neural signatures for health neuroscience: Assessing spontaneous regulation during food choice. Social cognitive and affective neuroscience Cosme, D., Zeithamova, D., Stice, E., Berkman, E. T. 2020

    Abstract

    Establishing links between neural systems and health can be challenging since there isn't a one-to-one mapping between brain regions and psychological states. Building sensitive and specific predictive models of health-relevant constructs using multivariate activation patterns of brain activation is a promising new direction. We illustrate the potential of this approach by building two 'neural signatures' of food craving regulation using multivariate machine learning and, for comparison, a univariate contrast. We applied the signatures to two large validation samples of overweight adults who completed tasks measuring craving regulation ability and valuation during food choice. Across these samples, the machine learning signature was more reliable. This signature decoded craving regulation from food viewing and higher signature expression was associated with less craving. During food choice, expression of the regulation signature was stronger for unhealthy foods and inversely related to subjective value, indicating that participants engaged in craving regulation despite never being instructed to control their cravings. Neural signatures thus have the potential to measure spontaneous engagement of mental processes in the absence of explicit instruction, affording greater ecological validity. We close by discussing the opportunities and challenges of this approach, emphasizing what machine learning tools bring to the field of health neuroscience.

    View details for DOI 10.1093/scan/nsaa002

    View details for PubMedID 31993654

  • The Potential Influence of Group Membership on Outcomes in Indicated Cognitive-Behavioral Adolescent Depression Prevention. International journal of environmental research and public health Rohde, P., Brière, F. N., Stice, E. 2020; 17 (18)

    Abstract

    Adolescent depression prevention programs are typically delivered in groups in which adolescents share a common setting and interventionist, but the influence of the group is usually ignored or statistically controlled. We tested whether the primary outcomes of reductions in depressive symptoms and future onset of major depressive disorder (MDD) varied as a function of group membership.Data were available from two randomized trials in which 220 adolescents received the Blues Program indicated prevention intervention in 36 separate groups; participants were assessed at baseline, post intervention, and at 6-, 12-, and 24-month follow-ups.Ten percent of participants had developed MDD 2 years post intervention. Group-level effects for MDD onset over follow-up were nonsignificant (accounted for <1% of variance; ICC = 0.004, ns). Group-level effects for depressive symptom change across the follow-up period were also nonsignificant (ICC = 0.001, ns) but group effects accounted for 16% of depressive symptom change immediately post intervention (ICC = 0.159, p < 0.05). Group-level clustering of posttest depressive symptoms was not associated with size of group or gender composition.Membership in specific adolescent cognitive-behavioral depression prevention groups may have an impact in terms of immediate symptom reduction but does not appear to have significant prevention effects in terms of long-term symptom change or MDD onset.

    View details for DOI 10.3390/ijerph17186553

    View details for PubMedID 32916855

  • 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 Stice, E., Rohde, P., Shaw, H., Gau, J. M. 2020

    Abstract

    Independent trials have found that the dissonance-based Body Project eating disorder prevention program is efficacious and effective; the present trial provided the first test of whether delivery could be task-shifted from clinician-delivery to peer educator-delivery or Internet-delivery without loss of effectiveness through 4-year follow-up.Young women at high-risk for eating disorders because of body image concerns (N = 680, Mage = 22.2) recruited at 3 colleges were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or educational video control.Participants in clinician- and peer-led Body Project groups and the eBody Project generally showed larger reductions in risk factors and eating disorder symptoms versus controls through 1- and 2-year follow-up (d = .16-.59), with some effects persisting through 3- and 4-year follow-ups (d = .28-.58). Peer-led Body Project participants showed greater reductions in some risk factors than eBody Project participants (d = .18-.19), but no other contrasts between Body Project interventions differed. Eating disorder onset over 4-year follow-up was significantly lower for peer-led Body Project participants (8.1%) than control participants (17.6%) and clinician-led Body Project participants (19.3%), and marginally lower than eBody Project participants (15.5%).The evidence that all three Body Project interventions outperformed educational video controls, peer-led groups outperformed the Internet-based intervention, and peer-led groups showed lower eating disorder onset over 4-year follow-up than the other conditions are novel. Results imply that it might be optimal to task-shift Body Project delivery to peer-leaders to address implementation barriers associated with clinician-led delivery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

    View details for DOI 10.1037/ccp0000493

    View details for PubMedID 32091226

  • Relation of FTO to BOLD response to receipt and anticipated receipt of food and monetary reward, food images, and weight gain in healthy weight adolescents. Social cognitive and affective neuroscience Stice, E., Yokum, S., Voelker, P. 2019

    Abstract

    Although the fat mass and obesity-associated gene (FTO) correlates with elevated body mass, it is unclear how it contributes to overeating. We tested if individuals with the A allele show greater reward region responsivity to receipt and anticipated receipt of food and money, and palatable food images. We also tested if these individuals show greater future weight gain. Initially healthy weight adolescents (Study 1N=162; Study 2N=135) completed different fMRI paradigms and had their body mass measured annually over 3years. Adolescents with the AA or AT genotypes showed less precuneus and superior parietal lobe response and greater cuneus and prefrontal cortex response to milkshake receipt and less putamen response to anticipated milkshake receipt than those with the TT genotype in separate analyses of each sample. Groups did not differ in response to palatable food images, and receipt and anticipated receipt of money, or in weight gain over 3-year follow-up. Results suggest that initially healthy-weight adolescents with versus without the FTO A allele show differential responsivity to receipt and anticipated receipt of food, but do not differ in neural response to palatable food images and monetary reward and do not show greater future weight gain.

    View details for DOI 10.1093/scan/nsz081

    View details for PubMedID 31680145

  • Weight gain is associated with changes in neural response to palatable food tastes varying in sugar and fat and palatable food images: a repeated-measures fMRI study. The American journal of clinical nutrition Yokum, S., Stice, E. 2019

    Abstract

    BACKGROUND: Emerging data suggest that weight gain is associated with changes in neural response to palatable food tastes and palatable food cues, which may serve to maintain overeating.OBJECTIVE: We investigated whether weight gain is associated with neural changes in response to tastes of milkshakes varying in fat and sugar content and palatable food images.METHODS: We compared changes in neural activity between initially healthy-weight adolescents who gained weight (n=36) and those showing weight stability (n=31) over 2-3 y.RESULTS: Adolescents who gained weight compared with those who remained weight stable showed decreases in activation in the postcentral gyrus, prefrontal cortex, insula, and anterior cingulate cortex, and increases in activation in the parietal lobe, posterior cingulate cortex, and inferior frontal gyrus in response to a high-fat/low-sugar compared with low-fat/low-sugar milkshake. Weight gainers also showed greater decreases in activation in the anterior insula and lateral orbitofrontal cortex in response to a high-fat/high-sugar compared with low-fat/low-sugar milkshake than those who remained weight stable. No group differences emerged in response to a low-fat/high-sugar compared with a low-fat/low-sugar milkshake. Weight gainers compared with those who remained weight stable showed greater decreases in activation in the middle temporal gyrus and increases in cuneus activation in response to appetizing compared with unappetizing food pictures. The significant interactions were partially driven by group differences in baseline responsivity and by opposite changes in neural activation in adolescents who remained weight stable.CONCLUSIONS: Data suggest that weight gain is associated with a decrease in responsivity of regions associated with taste and reward processing to palatable high-fat- and high-fat/high-sugar food tastes. Data also suggest that avoiding weight gain increases taste sensitivity, which may prevent future excessive weight gain.This trial was registered at clinicaltrials.gov as NCT01949636.

    View details for DOI 10.1093/ajcn/nqz204

    View details for PubMedID 31535135

  • Randomized Trial of a Dissonance-Based Transdiagnostic Group Treatment for Eating Disorders: An Evaluation of Target Engagement JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Yokum, S., Rohde, P., Shaw, H., Gau, J. M., Johnson, S., Johns, A. 2019; 87 (9): 772?86

    Abstract

    Test whether a dissonance-based transdiagnostic eating disorder treatment reduces valuation of the thin beauty ideal and high-calorie binge foods, the intervention targets, and eating pathology relative to waitlist controls.Women with Diagnostic and Statistical Manual of Mental Disorders-5 eating disorders (N = 100) were randomized to an 8-week group-implemented Body Project Treatment (BPT) redesigned to encourage rapid symptom reduction or a waitlist control condition, completing functional MRI paradigms assessing neural response to thin models and binge foods, questionnaires, and diagnostic interviews at pretest and posttest.Compared to controls, BPT participants showed greater reductions in responsivity of regions involved in reward valuation (ventromedial prefrontal cortex, dorsolateral prefrontal cortex, caudate) to thin models but not binge foods, pursuit of the thin ideal (d = .72), palatability ratings of binge foods (d = .78), and greater increases in attractiveness ratings of average-weight models (d = .44), the intervention targets. BPT participants also showed significantly greater reductions in body dissatisfaction (d = .83), negative affect (d = .76), and eating disorder symptoms (d = .59), and marginally greater abstinence from binge eating and compensatory behaviors (39% vs. 21%) than controls.Results provide novel evidence that BPT affected the hypothesized intervention targets and reduced variables that are putatively secondary to pursuit of the thin ideal, including body dissatisfaction, negative affect, and eating disorder symptoms. Symptom reductions were smaller than in past trials, suggesting that it may be optimal to reduce valuation of the thin ideal before asking participants to reduce disordered eating behaviors that are used to pursue this ideal. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

    View details for DOI 10.1037/ccp0000430

    View details for Web of Science ID 000480315100002

    View details for PubMedID 31403814

    View details for PubMedCentralID PMC6693644

  • Indirect Effects of a Cognitive-Behavioral Intervention on Adolescent Weight and Insulin Resistance Through Decreasing Depression in a Randomized Controlled Trial. Journal of pediatric psychology Gulley, L. D., Shomaker, L. B., Kelly, N. R., Chen, K. Y., Stice, E., Olsen, C. H., Tanofsky-Kraff, M., Yanovski, J. A. 2019

    Abstract

    OBJECTIVE: Depression is linked to excess weight, insulin resistance, and type 2 diabetes (T2D). We previously reported that in adolescent girls at-risk for T2D with moderately elevated depression, randomization to cognitive-behavioral therapy (CBT) produced greater decreases in depression at post-treament and greater decreases in fasting/2-h insulin at 1 year, compared to health education (HE). The current study is a secondary analysis of this parallel-group randomized controlled trial. We examined whether decreasing depression explained intervention effects on body composition and insulin outcomes. We hypothesized that decreases in depression would be an explanatory mediator and that indirect effects would be strongest at higher levels of baseline depression.METHODS: Participants were 12-17years girls with overweight/obesity and family history of T2D randomized to 6-week group CBT (n=58) or HE (n=61). Procedures took place at an outpatient pediatric clinic. At baseline, post-treatment, and 1 year, adolescents completed the Center for Epidemiologic Studies-Depression Scale to assess depression symptoms; body mass index (BMI [kg/m2]) was measured from height/fasting weight; insulin resistance was derived from 2-h oral glucose testing. Adiposity was assessed with dual-energy X-ray absorptiometry at baseline and 1 year. Indirect effects of intervention were tested on 1-year changes in BMI, adiposity, and insulin through decreases in depression. Baseline depression was tested as a moderator of mediation.RESULTS: There was an indirect effect of CBT on decreased 1-year fasting insulin via decreases in depression during treatment, among adolescents with more elevated baseline depression.CONCLUSIONS: Decreasing elevated depression may be one mechanism in the targeted prevention of T2D in at-risk adolescents.

    View details for DOI 10.1093/jpepsy/jsz064

    View details for PubMedID 31393981

  • Prevention of eating disorders: current evidence-base for dissonance-based programmes and future directions EATING AND WEIGHT DISORDERS-STUDIES ON ANOREXIA BULIMIA AND OBESITY Dakanalis, A., Clerici, M., Stice, E. 2019; 24 (4): 597?603

    View details for DOI 10.1007/s40519-019-00719-3

    View details for Web of Science ID 000475969800001

    View details for PubMedID 31147968

  • Cognitive dissonance-based eating disorder prevention: pilot study of a cultural adaptation for the Orthodox Jewish community EATING DISORDERS Casasnovas, A. F., Huryk, K. M., Levinson, D., Markowitz, S., Friedman, S., Stice, E., Loeb, K. L. 2019: 1?13

    Abstract

    The Body Project (BP) is a cognitive dissonance-based eating disorders (ED) prevention program that targets thin-ideal internalization and reduces ED risk factors and onset for higher-risk adolescent/young adult females. Although the more insular Orthodox Jewish communities reduce exposure to mainstream secular media, they are not immune to thin-ideal internalization and EDs. The present uncontrolled study evaluated the preliminary effects of a cultural adaptation of the BP for Orthodox Jewish girls. The modified manual improved fit with ultra-Orthodox Jewish norms, practices, and values. Eighty-nine 11th-graders in a private, all-female religious high school participated. ED risk factors and symptoms were assessed at baseline, end of 4-week intervention, and 6-month follow-up. Multi-level modeling showed that body dissatisfaction and negative affect significantly decreased across time. Findings demonstrate potential for the BP to be adapted for and implemented in cultural and religious communities wherein interactions with societal influences on thin-ideal internalization differ from dominant culture.

    View details for DOI 10.1080/10640266.2019.1644797

    View details for Web of Science ID 000479592100001

    View details for PubMedID 31354097

  • Moderators of two dual eating disorder and obesity prevention programs BEHAVIOUR RESEARCH AND THERAPY Stice, E., Desjardins, C. D., Shaw, H., Rohde, P. 2019; 118: 77?86

    Abstract

    Few trials have investigated factors that moderate the effects of eating disorder and obesity prevention programs, which may inform inclusion criteria and intervention refinements. We examined factors hypothesized to moderate the effects of the Healthy Weight eating disorder/obesity prevention program that promotes gradual healthy changes, and Project Health that adds cognitive dissonance activities. College students at risk for both outcomes because of weight concerns (N?=?364, 72% female) were randomized to these interventions or an educational video condition, completing pretest, posttest, and 6, 12, and 24-month follow-up assessments. Healthy Weight and Project Health produced significantly larger reductions in eating disorder symptoms versus video controls for individuals with higher negative affect, emotional eating, dietary fat/sugar intake, and perceived pressure to be thin. Project Health also produced significantly less increases in BMI versus video controls for individuals with lower negative affect. Results suggest that these interventions produce larger eating disorder symptom reductions for individuals at elevated risk for eating pathology but hint that weight gain prevention effects may be attenuated by elevated negative affect. Results imply that larger eating disorder symptom reductions will result when implemented with individuals with both weight concerns and one of the additionally identified risk factors.

    View details for DOI 10.1016/j.brat.2019.04.002

    View details for Web of Science ID 000471738600008

    View details for PubMedID 31005674

  • Disaggregating the predictive effects of impaired psychosocial functioning on future DSM-5 eating disorder onset in high-risk female adolescents. The International journal of eating disorders Mehl, A., Rohde, P., Gau, J. M., Stice, E. 2019; 52 (7): 817?24

    Abstract

    OBJECTIVE: Impaired psychosocial functioning previously emerged as the only risk factor to predict future onset of each of the four Diagnostic and Statistical Manual of Mental Disorder (5th ed.) (DSM-5) eating disorders. The goal of this follow-up report was to refine understanding of this newly identified risk factor.METHOD: Combining data from women at risk for eating disorders because of body image concerns (N=1,153, mean age=18.5 years, SD=4.2), we investigated which subdomain(s) and individual item(s) of psychosocial functioning (friends, family, school, and work) at baseline predicted onset of any eating disorder, using Cox regression (CRA) and classification tree analysis (CTA).RESULTS: Psychosocial impairment with friends, family, and at school, but not at work, significantly increased risk for disorder onset over 3-year follow-up in univariate models. A one-unit increase in each domain raw score was associated with a 107, 22, and 43% increased hazard of eating disorder onset, respectively. Multivariate CRA found friends functioning, with a 92% increased hazard of disorder onset, contributed the strongest unique effect. CTA suggested that loneliness was the most potent risk factor with a threefold increased onset risk (eating disorder incidence for high vs. low scorers was 27 and 8%). Three friends functioning items and one school functioning item produced additional CTA branches.DISCUSSION: Results refine understanding of the relation of psychosocial impairment to future onset of eating disorders, suggesting that peer functioning is the most critical. Data imply it would be useful to target young women with impaired psychosocial functioning in prevention programs.

    View details for DOI 10.1002/eat.23082

    View details for PubMedID 30977531

  • A controlled trial of a dissonance-based eating disorders prevention program with Brazilian girls PSICOLOGIA-REFLEXAO E CRITICA Soares Amaral, A., Stice, E., Caputo Ferreira, M. 2019; 32
  • Eating Disorder Prevention PSYCHIATRIC CLINICS OF NORTH AMERICA Stice, E., Johnson, S., Turgon, R. 2019; 42 (2): 309-+

    Abstract

    Thirteen percent of girls and women experience an eating disorder, yet most do not receive treatment. Thus, broad implementation of eating disorder prevention programs that reduce eating disorder symptoms and future eating disorder onset is a critical priority. This article (1) reviews risk factors that have been shown to predict future onset of eating disorders, because this should guide the content of prevention programs and high-risk subgroups to target with selective prevention programs; (2) reviews the evidence base for eating disorder prevention programs that have reduced eating disorder symptoms or future onset of eating disorders; and (3) discusses directions for future research.

    View details for DOI 10.1016/j.psc.2019.01.012

    View details for Web of Science ID 000470052700014

    View details for PubMedID 31046932

  • Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects CLINICAL PSYCHOLOGY REVIEW Stice, E., Marti, C., Shaw, H., Rohde, P. 2019; 70: 91?107

    Abstract

    Many trials have provided support for dissonance-based eating disorder prevention programs. This meta-analytic review characterized the average intervention effects and tested whether various intervention, participant, and facilitator features correlated with larger effects to guide implementation of optimally effective versions of this program. We identified 56 trials that evaluated 68 dissonance-based eating disorder prevention programs (7808 participants). Average intervention effect sizes (d) relative to minimal intervention control conditions and credible alternative interventions (respectively) were 0.57 and 0.31 for thin-ideal internalization, 0.42 and 0.18 for body dissatisfaction, 0.37 and 0.17 for dieting, 0.29 and 0.21 for negative affect, and 0.31 and 0.13 for eating disorder symptoms. As hypothesized, effects were larger for interventions with more dissonance-inducing activities, more group sessions, and larger group sizes, as well as when delivered in-person versus on-line, sessions were recorded, participation was voluntary, body dissatisfaction was required, participants were mid-adolescents or adults (versus older adolescence), there were more ethnic minority participants, groups were led by clinicians versus researchers and at least two facilitators, and when facilitators received more training and supervision. Unexpectedly from a dissonance-induction perspective, effects were larger when participants were compensated. Results offer directions for maximizing the benefits of implementation efforts with dissonance-based eating disorder prevention programs, and may hold lessons for preventing other public health problems with dissonance-based interventions.

    View details for DOI 10.1016/j.cpr.2019.04.004

    View details for Web of Science ID 000470798900008

    View details for PubMedID 31004832

  • Good practice in food-related neuroimaging AMERICAN JOURNAL OF CLINICAL NUTRITION Smeets, P. M., Dagher, A., Hare, T. A., Kullmann, S., van der Laan, L. N., Poldrack, R. A., Preissl, H., Small, D., Stice, E., Veldhuizen, M. G. 2019; 109 (3): 491?503
  • Neural vulnerability factors for obesity CLINICAL PSYCHOLOGY REVIEW Stice, E., Burger, K. 2019; 68: 38?53

    Abstract

    Multiple theories identify neural vulnerability factors that may increase risk for overeating and weight gain. Early cross-sectional neuroimaging studies were unable to determine whether aberrant neural responsivity was a risk factor for or a consequence of overeating. More recent obesity risk, prospective, repeated-measures, and experimental neuroimaging studies with humans have advanced knowledge of etiologic processes and neural plasticity resulting from overeating. Herein, we review evidence from these more rigorous human neuroimaging studies, in conjunction with behavioral measures reflecting neural function, as well as experiments with animals that investigated neural vulnerability theories for overeating. Findings provide support for the reward surfeit theory that posits that individuals at risk for obesity initially show hyper-responsivity of reward circuitry to high-calorie food tastes, which theoretically drives elevated intake of such foods. However, findings provide little support for the reward deficit theory that postulates that individuals at risk for obesity show an initial hypo-responsivity of reward circuitry that motives overeating. Further, results provide support for the incentive sensitization and dynamic vulnerability theories that propose that overconsumption of high-calorie foods results in increased reward and attention region responsivity to cues that are associated with hedonic reward from intake of these high-calorie foods via conditioning, as well as a simultaneous decrease in reward region responsivity to high-calorie food tastes. However, there is little evidence that this induced reduction in reward region response to high-calorie food tastes drives an escalation in overeating. Finally, results provide support for the theory that an initial deficit in inhibitory control and a bias for immediate reward contribute to overconsumption of high-calorie foods. Findings imply that interventions that reduce reward and attention region responsivity to food cues and increase inhibitory control should reduce overeating and excessive weight gain, an intervention theory that is receiving support in randomized trials.

    View details for DOI 10.1016/j.cpr.2018.12.002

    View details for Web of Science ID 000460850200004

    View details for PubMedID 30587407

    View details for PubMedCentralID PMC6397091

  • A Prospective Test of the Temporal Sequencing of Risk Factor Emergence in the Dual Pathway Model of Eating Disorders JOURNAL OF ABNORMAL PSYCHOLOGY Stice, E., Van Ryzin, M. J. 2019; 128 (2): 119?28

    Abstract

    Prospective studies have identified risk factors that predict future onset of eating disorders, but none has provided a test of the temporal sequencing of the emergence of risk factors hypothesized in a multivariate etiologic model of eating disorder development. Using data from an 8-year prospective study of 496 adolescent girls, we first conducted receiver operator characteristic plots to identify cut-points for each risk factor that optimally predicted future onset of threshold or subthreshold bulimia nervosa, binge eating disorder, and purging disorder. We then used growth curve models to estimate the age at which each participant crossed the disorder-predictive cutpoint for each risk factor, or if they did not, during follow-up, permitting a test of whether the risk factors emerged in the sequence hypothesized in the Dual Pathway etiologic model. Overall, 47% of the 51 youth who showed onset of one of these eating disorders first showed emergence of disorder-predictive levels of perceived pressure to be thin and/or thin-ideal internalization, before showing onset of disorder-predictive levels of body dissatisfaction, before showing onset of disorder-predictive levels of dieting and/or negative affect, before showing onset of the eating disorder; another 29% had one of these steps out of order or did not cross one step in this model. Youth who did not show onset of an eating disorder were significantly less likely to cross the disorder-predictive cut-points for each risk factor or to conform to the sequence of risk factor emergence hypothesized in this model. Results provide novel support for the temporal sequencing of risk factor emergence hypothesized in this multivariate etiologic model and suggest that prevention programs that reduce perceived pressure to be thin and thin-ideal internalization among early adolescent girls with these factors should reduce eating disorder onset, as well as downstream risk factors that are also aversive (e.g., body dissatisfaction and negative affect). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

    View details for DOI 10.1037/abn0000400

    View details for Web of Science ID 000457471600003

    View details for PubMedID 30570269

    View details for PubMedCentralID PMC6361717

  • Individual differences in appeal of energy dense foods predicts lower body mass change during adolescence APPETITE Sadler, J. R., Stice, E., Shearrer, G. E., Burger, K. S. 2019; 133: 184?90

    Abstract

    Highly energy dense foods are often synonymous with high palatability, excess intake and weight gain. However, food preferences show individual differences. Food preferences are closely related to food intake, which can impact weight change over time. We examined whether the energy density of food images rated as appetizing and unappetizing foods related to baseline BMI and change in BMI over 3-year follow-up (n?=?117; 45% Male, Baseline BMI: 21.1 ± 1.9. Participants completed hedonic visual analog scales (-100 to 100) ratings of 103 food images, and reported dietary intake at baseline, and had their height and weight directly measured over 3-year follow-up. Energy density (ED) of the food depicted in each image was calculated. For each participant, food images (kcal/g) were categorized into appetizing (32 images) and unappetizing foods (32 images) based on each individual's hedonic ratings. We observed significant interaction between energy density and hedonic value driven by an inverse relation between unappetizing food energy density and BMI change (p?=?0.008). Specifically, participants who rated higher energy dense foods as unappetizing showed less weight gain (?= -0.83; p?=?0.00052). There was no significant relation between the energy density of appetizing foods and weight change (p?=?0.67), suggesting that dislike of highly energy dense foods more strongly associates with lower weight gain than preference for low energy dense foods. Post-hoc analyses revealed that individuals with a higher preference for low energy density foods showed less weight gain over 3-years (??=?- 0.007, p = 0.02). Results support the idea that individual hedonic ratings for foods varying in energy density is a determinant of weight change in adolescents and may represent an important intervention target for obesity prevention programs.

    View details for DOI 10.1016/j.appet.2018.11.001

    View details for Web of Science ID 000456752000023

    View details for PubMedID 30408506

  • A controlled trial of a dissonance-based eating disorders prevention program with Brazilian girls. Psicologia, reflexao e critica : revista semestral do Departamento de Psicologia da UFRGS Amaral, A. C., Stice, E., Ferreira, M. E. 2019; 32 (1): 13

    Abstract

    Given that most young women with eating disorders do not receive treatment, implementing effective prevention programs is a public health priority. The Body Project is a group-based eating disorder prevention program with evidence of both efficacy and effectiveness. This trial evaluated the efficacy of this prevention program with Brazilian girls, as no published study has tested whether this intervention is culturally sensitive and efficacious with Latin-American adolescents.Female students were allocated to a dissonance-based intervention (n?=?40) or assessment-only (n?=?22) condition. The intervention was a dissonance-based program, consisted of four group sessions aimed to reduce thin-ideal internalization. The sessions included verbal, written, and behavioral exercises. The intervention group was evaluated at pretest and posttest; assessment-only controls completed measures at parallel times.Compared to assessment-only controls, intervention 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.These results suggest that this dissonance-based eating disorder prevention program was culturally sensitive, or at least culturally adaptive, and efficacious with Brazilian female adolescents. Indeed, the average effect size was slightly larger than has been observed in the large efficacy trial of this prevention program and in recent meta-analytic reviews.RBR-7prdf2 . Registered 13 August 2018 (retrospectively registered).

    View details for DOI 10.1186/s41155-019-0126-3

    View details for PubMedID 32026167

    View details for PubMedCentralID PMC6967323

  • Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women EATING BEHAVIORS Cheng, Z., Perko, V. L., Fuller-Marashi, L., Gau, J. M., Stice, E. 2019; 32: 23?30

    Abstract

    Findings regarding ethnic differences in eating disorder diagnoses and risk factors have been mixed. This study evaluated whether there are ethnic differences in eating disorder prevalence, risk factors, and the predictive relations of the risk factors to future eating disorder onset. We used a large sample of young women followed longitudinally over three years to increase sensitivity to detect differences and to provide the first test of ethnic differences in the relation of risk factors to future onset of eating disorders. Females with body image concerns (N?=?1177) were recruited from high schools and colleges for trials of a body acceptance eating disorder prevention program. They completed surveys and interviews at baseline and at 1-, 6-, 12-, 24-, and 36-month follow-up. Significant differences between ethnic groups were found for two of the 13 baseline risk factors: thin-ideal internalization and body mass index. No significant differences in later onset rates among ethnic groups were found. There were also no reliable ethnic differences in the relation of risk factors for future eating disorder onset. These findings suggest that eating disorders affect ethnic minorities as much as Whites and that there are more overlapping risk factors shared among various ethnic groups than differences.

    View details for DOI 10.1016/j.eatbeh.2018.11.004

    View details for Web of Science ID 000459002400005

    View details for PubMedID 30529736

    View details for PubMedCentralID PMC6382562

  • Randomized Trial of a Dissonance-Based Group Treatment for Eating Disorders Versus a Supportive Mindfulness Group Treatment JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Rohde, P., Shaw, H., Gau, J. M. 2019; 87 (1): 79?90

    Abstract

    This report evaluates a dissonance-based group eating disorder treatment designed to be a cost-effective front-line transdiagnostic treatment that could be more widely implemented than extant treatments that are more intensive and expensive relative to a supportive mindfulness group treatment typical of that offered at colleges.Young women with eating disorders (N = 84) were randomized to 8-week dissonance-based Body Project treatment (BPT) or supportive mindfulness treatment, completing diagnostic interviews and questionnaires at pretest, posttest, and 6-month follow up.Regarding primary outcomes, by 6-month follow up 77% of BPT participants no longer met diagnosis for an eating disorder versus 60% of supportive mindfulness participants (relative risk ratio = 2.22; 95% CI [1.01, 4.93]), though groups did not differ on eating disorder symptom change. Regarding secondary outcomes, BPT versus supportive mindfulness participants showed significantly lower dissonance about affirming the thin ideal at posttest and 6-month follow up (d = .38 and .32), body dissatisfaction at posttest and 6-month follow up (d = .62 and .62), negative affect at posttest and 6-month follow up (d = .49 and .48), and functional impairment (d = .36) at 6-month follow up; differences in thin-ideal internalization and abstinence from binge eating and compensatory behaviors were not significant.Whereas both treatments appeared effective, BPT produced larger effects and significantly greater remission of eating disorder diagnoses than a credible alternative treatment, which is very rare for trials that have compared active eating disorder treatments. Results suggest it would be useful to refine BPT and conduct target engagement research and efficacy trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

    View details for DOI 10.1037/ccp0000365

    View details for Web of Science ID 000453749400008

    View details for PubMedID 30570303

    View details for PubMedCentralID PMC6309312

  • Weight suppression uniquely predicts body fat gain in first-year female college students EATING BEHAVIORS Lowe, M. R., Marti, C., Lesser, E., Stice, E. 2019; 32: 60?64

    Abstract

    Identifying predictors of increases in weight (or in fat mass) is important for understanding the genesis of obesity and for the design of prevention programs. We examined the predictive utility of 6 variables that have been predictive of weight gain in past research: depression, disinhibition, family history of overweight, body dissatisfaction, self-reported dieting and weight suppression (the difference between highest past and current weight). Percentage fat gain was evaluated with DEXA. We tested these variables as predictors of fat gain two years later in 294 female first-year students who were selected to have characteristics associated with future weight gain. Participants were categorized as weight stable or weight gainers at the two-year follow-up and logistic regression was used to evaluate the independent predictive ability of the 6 variables. Baseline body fat was entered as a covariate and predicted fat gain, as expected. The only significant predictor of the 6 tested was weight suppression, with those gaining weight showing greater weight suppression at baseline. Previous research has supported weight suppression as a robust predictor of future weight gain mostly among individuals with eating disorders. The current study indicates that weight suppression is a predictor of long-term fat gain among nonclinical female first-year students who were overwhelmingly in a healthy weight range.

    View details for DOI 10.1016/j.eatbeh.2018.11.005

    View details for Web of Science ID 000459002400010

    View details for PubMedID 30594109

  • Sexual orientation correlates with baseline characteristics but shows no moderating effects of dissonance-based eating disorder prevention programs for women. Body image Shaw, H., Rohde, P., Desjardins, C. D., Stice, E. 2019; 32: 94?102

    Abstract

    This study provided the first test of whether sexual orientation (categorized as heterosexual vs. sexual minority) is associated with baseline eating disorder risk factors and symptoms, moderated the intervention effects of variants of the dissonance-based Body Project, or moderated the relation of baseline risk factors to future change in eating disorder symptoms. A total of 680 women with body image concerns were randomized to clinician-or peer-led Body Project groups, the eBody Project, or educational video control and completed assessment of eating disorder risk factors and symptoms at pretest, posttest, and at six-, 12-, 24-, and 36-month follow-up. Results indicated that sexual minority women had significantly higher negative affect and impaired psychosocial functioning at baseline, but did not differ on other eating disorder risk factors or symptoms. We found no evidence that sexual orientation moderates the effects of the Body Project on risk factor or symptom change over follow-up or the relation of baseline risk factors to future change in eating disorder symptoms. Overall, sexual minority and heterosexual women differ on two, less specific eating disorder-related risk factors at baseline, but did not differ in response to different versions of the Body Project or the relations of risk factors to future symptom change.

    View details for DOI 10.1016/j.bodyim.2019.11.006

    View details for PubMedID 31841780

  • Translating Basic Science Into Clinical Practice Introduction JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Jansen, A. 2018; 86 (12): 961?63

    Abstract

    The goal of this special issue is to highlight examples of translational research, wherein findings or principles from basic science are translated into efficacious prevention and treatment interventions for a public health problem. Bridging the gap between basic research and clinical practice has several advantages. First, basic science findings often emerge from rigorous randomized experiments that have isolated the effects of a particular manipulation, which can allow firmer scientific inferences than findings from less rigorous research designs. Second, translational research is often more focused on the mechanism of intervention effects, also referred to as intervention targets or mediators, which can guide refinements to the interventions that maximize clinical efficacy. Finally and perhaps most importantly, translational research attempts to accelerate the development of more effective interventions for public health problems for which we do not have efficacious prevention programs or treatments. The authors sought articles that described the original basic research that was then used to design an effective intervention for a clinical problem as well as the process by which the basic findings were translated into the new clinical application. The new translational interventions bridge the gap between the basic research and clinical practice, which is consistent with the editorial priorities of the Journal of Consulting and Clinical Psychology. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

    View details for DOI 10.1037/ccp0000371

    View details for Web of Science ID 000451771200001

    View details for PubMedID 30507222

  • Design of a randomized controlled trial to decrease depression and improve insulin sensitivity in adolescents: Mood and INsulin sensitivity to prevent Diabetes (MIND) CONTEMPORARY CLINICAL TRIALS Shomaker, L. B., Gulley, L., Hilkin, A. M., Clark, E., Annameier, S., Rao, S., Rockette-Wagner, B., Kriska, A., Wright, K. P., Stice, E., Nadeau, K. J., Kelsey, M. M. 2018; 75: 19?28

    Abstract

    Depressive symptoms often manifest in adolescence and predict worsening insulin sensitivity, a key precursor in the path to ?-cell failure and type 2 diabetes (T2D).To assess the efficacy of a six-week cognitive-behavioral group versus six-week health education group for improving insulin sensitivity and preserving ?-cell function in adolescent girls at-risk for T2D with depressive symptoms and evaluate mechanisms underlying the association between depression and insulin dynamics.Randomized controlled trial of N?=?150 12-17-year-old girls with overweight/obesity (body mass index [BMI; kg/m2] ?85th percentile), elevated depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D] total score?>?20), and diabetes family history.Girls at-risk for T2D with elevated depressive symptoms are recruited from the Denver-metropolitan area and randomized to participate in one of two six-week interventions. The cognitive-behavioral group is a depression prevention program involving psycho-education, restructuring negative thoughts, and behavioral activation. The health education group is a didactic control that provides knowledge about healthy living. Participants are assessed at baseline, immediate post-intervention, and one-year follow-up. Primary outcomes are insulin sensitivity and ?-cell function from oral glucose tolerance tests. Secondary outcomes are disinhibited eating, physical activity, sleep, and cortisol.Results from this adequately powered randomized controlled trial will determine whether decreasing depressive symptoms with a behavioral health program preventatively alters insulin sensitivity and ?-cell function trajectories in adolescents at-risk for T2D. Results from the MIND Project will add to knowledge of the contribution of depressive symptoms to T2D risk.

    View details for DOI 10.1016/j.cct.2018.10.007

    View details for Web of Science ID 000453114000003

    View details for PubMedID 30342256

    View details for PubMedCentralID PMC6249074

  • Effects of gymnemic acids lozenge on reward region response to receipt and anticipated receipt of high-sugar food PHYSIOLOGY & BEHAVIOR Stice, E., Yokum, S. 2018; 194: 568?76

    Abstract

    A gymnemic acids lozenge that blocks sweet taste receptors reduced the decision to consume candy in humans even before the candy was tasted after the gymnemic acids dose, suggesting that blocking sweet taste receptors reduces valuation of sweet foods. The present study used functional magnetic resonance imaging (fMRI) to test whether the gymnemic acids lozenge reduces reward region response to both intake and anticipated intake of high-sugar food, as well as ad lib candy intake relative to a placebo lozenge. Here we show for the first time that a gymnemic acids lozenge versus placebo lozenge significantly reduced activation in the striatum and orbitofrontal cortex in response to anticipated tastes of high-sugar milkshake, and significantly reduced dorsolateral prefrontal cortex response to tastes of milkshake. We also replicated evidence that a gymnemic acids lozenge versus placebo lozenge significantly reduced ad lib candy intake. Results also provide novel evidence that an initial taste of a high-sugar food increases reward region (i.e., caudate) response to anticipated intake of more of the high-sugar food. Results suggest that blocking sweet taste receptors not only reduces reward region response to intake of high-sugar foods, but also reduces anticipated reward from high-sugar foods, potentially via a feedback loop regarding the availability of sweet taste receptors to convey perceptual input regarding sweet tastes. Collectively, results imply that the gymnemic acids lozenge might prove useful in decreasing high-sugar food intake.

    View details for DOI 10.1016/j.physbeh.2018.07.012

    View details for Web of Science ID 000442704900072

    View details for PubMedID 30031752

  • Attempt to Replicate Evidence that Weight and Shape Concerns Amplify the Effects of Gradual Lifestyle Improvement Obesity Prevention Programs OBESITY Stice, E., Rohde, P. 2018; 26 (8): 1254

    View details for DOI 10.1002/oby.22259

    View details for Web of Science ID 000442845100005

    View details for PubMedID 30138546

  • Using participant feedback to improve two selective eating disorder and obesity prevention programs EATING BEHAVIORS Shaw, H., Rohde, P., Stice, E. 2018; 30: 93?97

    Abstract

    To examine qualitative feedback from participants of Healthy Weight and Project Health eating disorder/obesity prevention programs to guide refinements to increase program efficacy.Feedback was collected from college students with weight concerns randomly assigned to one of these interventions (N?=?364, 72% female).Healthy Weight participants reported greater program satisfaction (p?=?0.02); no other quantitative differences emerged in opinions of the program or leaders. Project Health participants most valued goal setting (27%), the group setting (23%), and the provided information (16%). Healthy Weight participants most valued the group setting (21%), goal setting (19%), and accountability for behavior change (18%). Project Health participants reported home exercises most frequently as least valuable (22%), followed by role-plays (13%). Healthy Weight participants most frequently reported "nothing" as least valuable (24%), followed by food/exercise logs (9%). The top suggestion from participants from both groups was to add interactive activities.Weight gain preventive effects of Project Health were stronger, but Healthy Weight participants were more satisfied, perhaps because Project Health incorporates dissonance-induction strategies which produce psychological discomfort that promotes internalization of health lifestyle goals. Both interventions could be made more interactive by adding group exercises, encouraging group connection via social media, and adding icebreakers.

    View details for DOI 10.1016/j.eatbeh.2018.06.006

    View details for Web of Science ID 000438787700017

    View details for PubMedID 29990653

    View details for PubMedCentralID PMC6152876

  • Relation of Self-Weighing to Future Weight Gain and Onset of Disordered Eating Symptoms JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Rohde, P., Arigo, D., Shaw, H., Stice, E. 2018; 86 (8): 677?87

    Abstract

    Frequent self-weighing is recommended in weight loss interventions and may prevent weight gain. However, concerns regarding the associations between self-weighing and eating disorders have been expressed and the relations between self-weighing and weight gain/eating pathology have not been examined prospectively. We tested whether (a) frequency of baseline self-weighing in college students with weight concerns predicted weight change over 2-year follow-up, (b) this relation was moderated by eating disorder symptoms, and (c) self-weighing predicted future eating disorder symptoms.Data were merged from two trials evaluating obesity/eating disorder prevention programs in 762 students (Mage = 18.7; 86% women). Participants reported how often they weighed themselves at baseline; body mass index (BMI) and eating disorder symptoms were assessed over 2-year follow-up.Baseline self-weighing predicted weight gain, with more frequent weighers experiencing greater gains (i.e., +0.8 of BMI) over follow-up. This relation was moderated by the frequency of binge eating but not weight/shape concerns or compensatory behaviors; the combination of more frequent self-weighing and binge eating was associated with greatest weight gain (+1.6 of BMI). More frequent weighers also reported higher onset of compensatory behaviors, relative to non-self-weighers (odds ratio = 3.90, 95% confidence interval [1.76, 8.75]).Young adults who weighed themselves more frequently had greater weight gain than those who self-weighed less frequently, especially those who engaged in binge eating, and were at risk for future unhealthy compensatory behaviors. Findings suggest that frequent self-weighing may have negative effects for some young adults, and that relations between self-weighing and weight control outcomes require further investigation. (PsycINFO Database Record

    View details for DOI 10.1037/ccp0000325

    View details for Web of Science ID 000439917400004

    View details for PubMedID 30035584

    View details for PubMedCentralID PMC6061963

  • Mediators of two selective prevention interventions targeting both obesity and eating disorders BEHAVIOUR RESEARCH AND THERAPY Rohde, P., Desjardins, C. D., Arigo, D., Shaw, H., Stice, E. 2018; 106: 8?17

    Abstract

    The present study tested hypothesized mechanisms underlying the effects of two selective prevention interventions targeting both obesity and eating disorders (Healthy Weight and the newly developed Project Health), relative to video control. Tests examined mediation for the significant weight gain prevention and eating disorder symptom prevention effects previously reported. College students (N?=?364; 72% women) with weight concerns were randomized to condition and assessed for 2-years post-intervention. Project Health participants had significant improvements in 2 of the 7 proposed mediators relative to comparisons (i.e., cognitive dissonance, the unhealthy Western dietary pattern) but change in these variables did not mediate its effect on long-term BMI change. Two variables emerged as full mediators of the eating disorder prevention effects for both experimental interventions: body dissatisfaction and negative affect. Analyses failed to support the exploratory hypothesis that change in eating disorder symptoms mediated the effects of condition on BMI gain. This report is the among the first to examine mediation for programs aimed at preventing both weight gain and eating disorders, particularly in mixed-gender groups. Mediational analyses are essential in identifying the mechanism of intervention action, which can inform improvements to prevention programs.

    View details for DOI 10.1016/j.brat.2018.04.004

    View details for Web of Science ID 000435623300002

    View details for PubMedID 29715529

  • Elevated Thalamic Response to High-Sugar Milkshake in Ethnic and Racial Minorities JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES Gilbert, J. R., Stice, E., Burger, K. S. 2018; 5 (3): 580?87

    Abstract

    In the USA, Hispanics and African-Americans show elevated obesity, yet little is known about possible ethnic/racial differences in brain response during intake of palatable foods. To examine potential differences between non-Hispanic white (nHW) and racial/ethnic minority individuals, we used functional magnetic resonance imaging (fMRI) to assess brain response to intake of eucaloric milkshakes that were either high-sugar or high-fat and a calorie-free, tasteless control solution. Our sample included healthy-weight adolescents who identified as African-American and/or Hispanic (minority, n = 27) and non-Hispanic white (nHW, n = 106). Minority participants showed elevated response in the pre-/postcentral gyrus, precuneus, and left thalamus in response to the high-sugar milkshake compared to high-fat milkshake. To confirm these effects were not driven by differences in body mass or a function of unequal cell sizes, we performed the same analyses in minority participants and a randomly selected subsample of nHW participants (n = 27) that were matched on BMI percentile. Similar to the full sample, we observed an elevated ventral posterior thalamic response to high-sugar milkshake in minority participants. This effect held after controlling for self-reported sugar and fat intake. These results suggest that African-American and Hispanic groups may have elevated response to specifically high-sugar foods in regions of the brain associated with sensory processing, providing novel information regarding the possible neural underpinnings of the disproportional risk for obesity seen in African-American and Hispanic populations.

    View details for DOI 10.1007/s40615-017-0403-8

    View details for Web of Science ID 000439352900016

    View details for PubMedID 28779478

    View details for PubMedCentralID PMC5797505

  • Interactions between risk factors in the prediction of onset of eating disorders: Exploratory hypothesis generating analyses BEHAVIOUR RESEARCH AND THERAPY Stice, E., Desjardins, C. D. 2018; 105: 52?62

    Abstract

    Because no study has tested for interactions between risk factors in the prediction of future onset of each eating disorder, this exploratory study addressed this lacuna to generate hypotheses to be tested in future confirmatory studies.Data from three prevention trials that targeted young women at high risk for eating disorders due to body dissatisfaction (N?=?1271; M age 18.5, SD 4.2) and collected diagnostic interview data over 3-year follow-up were combined to permit sufficient power to predict onset of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) using classification tree analyses, an analytic technique uniquely suited to detecting interactions.Low BMI was the most potent predictor of AN onset, and body dissatisfaction amplified this relation. Overeating was the most potent predictor of BN onset, and positive expectancies for thinness and body dissatisfaction amplified this relation. Body dissatisfaction was the most potent predictor of BED onset, and overeating, low dieting, and thin-ideal internalization amplified this relation. Dieting was the most potent predictor of PD onset, and negative affect and positive expectancies for thinness amplified this relation.Results provided evidence of amplifying interactions between risk factors suggestive of cumulative risk processes that were distinct for each disorder; future confirmatory studies should test the interactive hypotheses generated by these analyses. If hypotheses are confirmed, results may allow interventionists to target ultra high-risk subpopulations with more intensive prevention programs that are uniquely tailored for each eating disorder, potentially improving the yield of prevention efforts.

    View details for DOI 10.1016/j.brat.2018.03.005

    View details for Web of Science ID 000432501600007

    View details for PubMedID 29653254

    View details for PubMedCentralID PMC5929474

  • Adolescents at high risk of obesity show greater striatal response to increased sugar content in milkshakes AMERICAN JOURNAL OF CLINICAL NUTRITION Shearrer, G. E., Stice, E., Burger, K. S. 2018; 107 (6): 859?66

    Abstract

    Children of overweight or obese parents are at a high risk of developing obesity.This study sought to examine the underlying neural factors related to parental obesity risk and the relative impact of sugar and fat when consuming a palatable food, as well as the impact of obesity risk status on brain response to appetizing food images.With the use of functional MRI, the responses of 108 healthy-weight adolescents [mean ± SD body mass index (kg/m2): 20.9 ± 1.9; n = 53 who were at high risk by virtue of parental obesity status, n = 55 who were low risk] to food stimuli were examined. Stimuli included 4 milkshakes, which systematically varied in sugar and fat content, a calorie-free tasteless solution, and images of appetizing foods and glasses of water.High-risk compared with low-risk adolescents showed greater blood oxygen-dependent response to milkshakes (all variants collapsed) compared with the tasteless solution in the primary gustatory and oral somatosensory cortices (P-family-wise error rate < 0.05), replicating a previous report. Notably, high-risk adolescents showed greater caudate, gustatory, and oral somatosensory responses to the high-sugar milkshake than to the tasteless solution; however, no effect of risk status was observed in the high-fat milkshake condition. Responses to food images were not related to obesity risk status.Collectively, the data presented here suggest that parental weight status is associated with greater striatal, gustatory, and somatosensory responses to palatable foods-in particular, high-sugar foods-in their adolescent offspring, which theoretically contributes to an increased risk of future overeating. This trial was registered at www.clinicaltrials.gov as NCT01949636.

    View details for DOI 10.1093/ajcn/nqy050

    View details for Web of Science ID 000435459400004

    View details for PubMedID 29771283

    View details for PubMedCentralID PMC6037118

  • Major depression prevention effects for a cognitive-behavioral adolescent indicated prevention group intervention across four trials BEHAVIOUR RESEARCH AND THERAPY Rohde, P., Briere, F. N., Stice, E. 2018; 100: 1?6

    Abstract

    Major depressive disorder (MDD) in young people is a leading cause of disability but most depressed youth are not treated, emphasizing the need for effective prevention. Our goal is to synthesize MDD onset prevention effects for the Blues Program, a brief cognitive-behavioral (CB) indicated prevention group, by merging data from four trials (three of which included CB bibliotherapy) and conducting an individual patient data (IPD) meta-analysis. Data were available from 766 high school/college students (M age = 16.4, SD = 2.3; 60% female, 64% White). CB group resulted in significantly lower MDD incidence rates relative to brochure control that persisted to 6-month follow-up; CB group also was associated with a lower 2-year MDD incidence rate relative to bibliotherapy but heterogeneity across trials was detected. Contrasts between bibliotherapy and brochure control were nonsignificant. For significant contrasts, the number needed to treat (NNT) by CB group to prevent one MDD onset relative to brochure or bibliotherapy ranged from 10 to 21. A brief CB group depression prevention intervention for at-risk adolescent is achieving meaningful effects compared to both active and minimal controls but outcomes need to be improved, perhaps by better screening or augmentations to produce more persistent intervention effects.

    View details for DOI 10.1016/j.brat.2017.10.013

    View details for Web of Science ID 000424720100001

    View details for PubMedID 29107762

    View details for PubMedCentralID PMC5794620

  • Eating disorders: Insights from imaging and behavioral approaches to treatment JOURNAL OF PSYCHOPHARMACOLOGY Stice, E., Shaw, H. 2017; 31 (11): 1485?95

    Abstract

    Understanding factors that contribute to eating disorders, which affect 13% of females, is critical to developing effective prevention and treatment programs. In this paper, we summarize results from prospective studies that identified factors predicting onset and persistence of eating disorders and core symptom dimensions. Next, implications for intervention targets for prevention, and treatment interventions from the risk- and maintenance-factor findings are discussed. Third, given that evidence suggests eating disorders are highly heritable, implying biological risk and maintenance factors for eating disorders, we offer working hypotheses about biological factors that might contribute to eating disorders, based on extant risk factor findings, theory, and cross-sectional studies. Finally, potentially fruitful directions for future research are presented. We suggest that it would be useful for experimental therapeutics trials to evaluate the effects of reducing the risk factors on future onset of eating pathology and on reducing maintenance factors on the risk for persistence of eating pathology, and encourage researchers to utilize prospective high-risk studies so that knowledge regarding potential intervention targets for prevention and treatment interventions for eating disorders can be advanced. Using the most rigorous research designs should help improve the efficacy of prevention and treatment interventions for eating disorders.

    View details for DOI 10.1177/0269881117722999

    View details for Web of Science ID 000416021800010

    View details for PubMedID 28892420

  • Age effects in eating disorder baseline risk factors and prevention intervention effects INTERNATIONAL JOURNAL OF EATING DISORDERS Rohde, P., Stice, E., Shaw, H., Gau, J. M., Ohls, O. C. 2017; 50 (11): 1273?80

    Abstract

    Examine the impact of age on baseline eating disorder symptoms/risk factors and on the effects of completing three variants of an eating disorder prevention program.Six hundred and eighty women (60% White) were randomized to clinician-led Body Project groups, peer-led Body Project groups, an Internet-based version of the Body Project (eBodyProject), or educational video control condition. Participants, who were on average 22.2 years old (SD?=?7.1, range 17-64, median?=?19), were assessed at pretest, posttest, and 6-month follow-up.Two of the seven baseline variables were significantly associated with age, indicating that older age was associated with lower reported dieting (r?=?-.12) and better psychosocial functioning (r?=?-.13). Interactions indicated that age moderated the intervention effects, such that group-based programs were superior to the Internet-delivered version in terms of eating disorder symptom reductions for women up to age 20, whereas the Internet-delivered program was superior to group-based interventions, particularly in terms of BMI reduction, for women over approximately age 25. None of the four tests examining whether age moderated the effects of delivering Body Project groups by mental health clinicians versus undergraduate peer educators were significant.Results suggest that group-based versions of the Body Project should be implemented with young women up to the age of 20, as they produce larger eating disorder symptom reductions, whereas the Internet version of the Body Project should be implemented with women aged 25 or older, as it produces superior weight loss/gain prevention effects.

    View details for DOI 10.1002/eat.22775

    View details for Web of Science ID 000414573000005

    View details for PubMedID 28861902

    View details for PubMedCentralID PMC5745064

  • Gymnemic acids lozenge reduces short-term consumption of high-sugar food: A placebo controlled experiment JOURNAL OF PSYCHOPHARMACOLOGY Stice, E., Yokum, S., Gau, J. M. 2017; 31 (11): 1496?1502

    Abstract

    Gymnemic acids (GA) suppress sweet taste and reduce consumption of high-sugar foods (HSF) which has been attributed to the reduction in pleasure. Herein we tested whether GA reduces the desire to eat HSF, before any HSF is tasted post GA dosing, which would implicate another mechanism of action not previously examined. In this double-blind experiment, 67 adults selected a favourite candy, consumed one standardized serving, rated candy pleasantness along with desire for more candy, and were randomly assigned to consume a GA or placebo lozenge. They subsequently completed candy desire ratings and were offered additional candy servings, one at a time. If an offering was accepted, it was consumed, pleasantness and desire ratings were reported, and another serving was offered. The GA lozenge versus the placebo produced a 31% reduction in participants who chose to eat the first candy offering after GA dosing and produced a 44% reduction in total candy intake. GA versus placebo participants who ate at least one optional serving reported reduced candy pleasantness, though reductions in reported desire did not reach significance. The GA lozenge reduced candy consumption and desire for candy, providing novel evidence that blockade of sweet taste receptors reduces desire for sweet food, even before the food is tasted after GA dosing. ClinicalTrials.gov ID: NCT02744885.

    View details for DOI 10.1177/0269881117728541

    View details for Web of Science ID 000416021800011

    View details for PubMedID 28944714

  • Prevention of insulin resistance in adolescents at risk for type 2 diabetes with depressive symptoms: 1-year follow-up of a randomized trial DEPRESSION AND ANXIETY Shomaker, L. B., Kelly, N. R., Radin, R. M., Cassidy, O. L., Shank, L. M., Brady, S. M., Demidowich, A. P., Olsen, C. H., Chen, K. Y., Stice, E., Tanofsky-Kraff, M., Yanovski, J. A. 2017; 34 (10): 866?76

    Abstract

    Depression is associated with poor insulin sensitivity. We evaluated the long-term effects of a cognitive behavioral therapy (CBT) program for prevention of depression on insulin sensitivity in adolescents at risk for type 2 diabetes (T2D) with depressive symptoms.One-hundred nineteen adolescent females with overweight/obesity, T2D family history, and mild-to-moderate depressive symptoms were randomized to a 6-week CBT group (n = 61) or 6-week health education (HE) control group (n = 58). At baseline, posttreatment, and 1 year, depressive symptoms were assessed, and whole body insulin sensitivity (WBISI) was estimated from oral glucose tolerance tests. Dual energy X-ray absorptiometry assessed fat mass at baseline and 1 year. Primary outcomes were 1-year changes in depression and insulin sensitivity, adjusting for adiposity and other relevant covariates. Secondary outcomes were fasting and 2-hr insulin and glucose. We also evaluated the moderating effect of baseline depressive symptom severity.Depressive symptoms decreased in both groups (P < .001). Insulin sensitivity was stable in CBT and HE (?WBISI: .1 vs. .3) and did not differ between groups (P = .63). However, among girls with greater (moderate) baseline depressive symptoms (N = 78), those in CBT developed lower 2-hr insulin than those in HE (?-16 vs. 16 ?IU/mL, P < .05). Additional metabolic benefits of CBT were seen for this subgroup in post hoc analyses of posttreatment to 1-year change.Adolescent females at risk for T2D decreased depressive symptoms and stabilized insulin sensitivity 1 year following brief CBT or HE. Further studies are required to determine if adolescents with moderate depression show metabolic benefits after CBT.

    View details for DOI 10.1002/da.22617

    View details for Web of Science ID 000412333600002

    View details for PubMedID 28370947

    View details for PubMedCentralID PMC5623599

  • 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 Stice, E., Rohde, P., Shaw, H., Gau, J. M. 2017; 85 (9): 883?95

    Abstract

    Because independent trials have provided evidence for the efficacy and effectiveness of the dissonance-based Body Project eating disorder prevention program, the present trial tested whether clinicians produce the largest intervention effects, or whether delivery can be task-shifted to less expensive undergraduate peer educators or to Internet delivery without effect size attenuation, focusing on acute effects.In this study, 680 young women (Mage = 22.2 years, SD = 7.1) recruited at colleges in 2 states were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or an educational video control condition.Participants in all 3 variants of the Body Project intervention showed significantly greater reductions in eating disorder risk factors and symptoms than did educational video controls. Participants in clinician-led and peer-led Body Project groups showed significantly greater reductions in risk factors than did eBody Project participants, but effects for the 2 types of groups were similar. Eating disorder onset over 7-month follow-up was significantly lower for peer-led Body Project group participants versus eBody Project participants (2.2% vs. 8.4%) but did not differ significantly between other conditions.The evidence that all 3 dissonance-based prevention programs outperformed an educational video condition, that both group-based interventions outperformed the Internet-based intervention in risk factor reductions, and that the peer-led groups showed lower eating disorder onset over follow-up than did the Internet-based intervention is novel. These acute-effects data suggest that both group-based interventions produce superior eating disorder prevention effects than does the Internet-based intervention and that delivery can be task-shifted to peer leaders. (PsycINFO Database Record

    View details for DOI 10.1037/ccp0000211

    View details for Web of Science ID 000409374500005

    View details for PubMedID 28425735

    View details for PubMedCentralID PMC5578897

  • From Efficacy to Effectiveness to Broad Implementation: Evolution of the Body Project JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Becker, C. B., Stice, E. 2017; 85 (8): 767?82

    Abstract

    At the turn of the millennium, eating disorders (EDs) prevention was largely nonexistent. No program had reduced future onset of EDs in even a single trial, and most had not reduced ED symptoms. Sixteen years later, the ED prevention field has translated basic risk factor research into interventions, with demonstrated efficacy and effectiveness in reducing ED risk factors and symptoms, as well as future ED onset in some trials. This article reviews the aforementioned progress focusing on a model intervention (i.e., the Body Project [BP]).The article is a qualitative review of the existing BP literature.Although clinical psychology has struggled with bridging the research practice gap and translating efficacy and effectiveness research into clinical implementation, researchers, clinicians, and community stakeholders working with the BP have made significant progress in addressing barriers to scalability, large-scale implementation, and sustainability, reaching 3.5 million girls and young women in 125 countries.The successful evolution of the BP from basic research to traversing the efficacy-to-effectiveness-to-dissemination/implementation continuum has yielded significant public health impact and is thus a fitting case for this special issue commemorating the 125th anniversary of the American Psychological Association. The BP example may help others broadly implement efficacious interventions for other mental health problems. (PsycINFO Database Record

    View details for DOI 10.1037/ccp0000204

    View details for Web of Science ID 000406288000002

    View details for PubMedID 28726480

    View details for PubMedCentralID PMC5520649

  • Pilot test of a novel food response and attention training treatment for obesity: Brain imaging data suggest actions shape valuation BEHAVIOUR RESEARCH AND THERAPY Stice, E., Yokum, S., Veling, H., Kemps, E., Lawrence, N. S. 2017; 94: 60?70

    Abstract

    Elevated brain reward and attention region response, and weaker inhibitory region response to high-calorie food images have been found to predict future weight gain. These findings suggest that an intervention that reduces reward and attention region response and increases inhibitory control region response to such foods might reduce overeating. We conducted a randomized pilot experiment that tested the hypothesis that a multi-faceted food response and attention training with personalized high- and low-calorie food images would produce changes in behavioral and neural responses to food images and body fat compared to a control training with non-food images among community-recruited overweight/obese adults. Compared to changes observed in controls, completing the intervention was associated with significant reductions in reward and attention region response to high-calorie food images (Mean Cohen's d = 1.54), behavioral evidence of learning, reductions in palatability ratings and monetary valuation of high-calorie foods (p = 0.009, d's = 0.92), and greater body fat loss over a 4-week period (p = 0.009, d = 0.90), though body fat effects were not significant by 6-month follow-up. Results suggest that this multifaceted response and attention training intervention was associated with reduced reward and attention region responsivity to food cues, and a reduction in body fat. Because this implicit training treatment is both easy and inexpensive to deliver, and does not require top-down executive control that is necessary for negative energy balance obesity treatment, it may prove useful in treating obesity if future studies can determine how to create more enduring effects.

    View details for DOI 10.1016/j.brat.2017.04.007

    View details for Web of Science ID 000403863800006

    View details for PubMedID 28505470

    View details for PubMedCentralID PMC5656010

  • Predicting persistence of eating disorder compensatory weight control behaviors INTERNATIONAL JOURNAL OF EATING DISORDERS Rohde, P., Stice, E., Gau, J. M. 2017; 50 (5): 561?68

    Abstract

    The study aimed to identify variables that predicted persistence versus desistence of eating disorder-related compensatory behaviors in a high-risk factor sample of women who reported repeated compensatory behaviors at baseline. Data came from a randomized trial evaluating two brief obesity prevention interventions for college students with weight concerns.Two hundred and sixty one young women (Mean age?=?19.1, 79% European American) with weight concerns were randomly assigned to one of two brief obesity prevention interventions or educational video control. Participants were assessed at baseline, post-intervention, 6- and 12-month follow-up by interview, survey, and physical measurements on 6 eating disorder features and 13 psychosocial variables hypothesized to predict onset or maintenance of eating pathology.Approximately half (48%) reported engaging in recurrent compensatory behaviors in the year preceding study involvement. Among this subset, 61% reported persistent compensatory behaviors over 12-month follow-up. Neither study condition and adjunctive treatment, nor eating disorder features predicted persistence. Persistent compensatory behavior was significantly associated with greater sociocultural pressure to be thin, impulsivity, and substance use, and lower perceived sexual attractiveness.Perceived pressure to be thin is an established risk factor for the initiation of disorder eating behaviors but also may serve as a maintenance factor for unhealthy compensatory behaviors. Impulsivity, either as a trait factor or resulting from substance misuse may contribute to poor judgment and ongoing compensatory behaviors. Additional research on factors that predict persistence of eating disordered behaviors is needed. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:561-568).

    View details for DOI 10.1002/eat.22639

    View details for Web of Science ID 000401851400012

    View details for PubMedID 27753127

    View details for PubMedCentralID PMC5395356

  • Cost-effectiveness of achieving clinical improvement with a dissonance-based eating disorder prevention program EATING DISORDERS Akers, L., Rohde, P., Stice, E., Butryn, M. L., Shaw, H. 2017; 25 (3): 263?72

    Abstract

    Using data from an effectiveness trial delivered by college clinicians, we examined the cost-effectiveness of the dissonance-based Body Project program for reducing eating disorder symptoms in women with body dissatisfaction. The outcome of interest was individual-level change; 14.9% of Body Project participants attained clinically meaningful improvement vs. 6.7% of controls. Delivering the intervention costs approximately $70 (2012 U.S. dollars) per person. Incremental cost-effectiveness was $838 for each additional at-risk person reducing eating disorder symptomology to a clinically meaningful degree. These analyses demonstrate the economic value of the Body Project for college-age women with symptoms below the eating disorder diagnosis threshold.

    View details for DOI 10.1080/10640266.2017.1297107

    View details for Web of Science ID 000400181900006

    View details for PubMedID 28287919

    View details for PubMedCentralID PMC6204073

  • Engaging stakeholder communities as body image intervention partners: The Body Project as a case example EATING BEHAVIORS Becker, C., Perez, M., Kilpela, L., Diedrichs, P. C., Trujillo, E., Stice, E. 2017; 25: 62?67

    Abstract

    Despite recent advances in developing evidence-based psychological interventions, substantial changes are needed in the current system of intervention delivery to impact mental health on a global scale (Kazdin & Blase, 2011). Prevention offers one avenue for reaching large populations because prevention interventions often are amenable to scaling-up strategies, such as task-shifting to lay providers, which further facilitate community stakeholder partnerships. This paper discusses the dissemination and implementation of the Body Project, an evidence-based body image prevention program, across 6 diverse stakeholder partnerships that span academic, non-profit and business sectors at national and international levels. The paper details key elements of the Body Project that facilitated partnership development, dissemination and implementation, including use of community-based participatory research methods and a blended train-the-trainer and task-shifting approach. We observed consistent themes across partnerships, including: sharing decision making with community partners, engaging of community leaders as gatekeepers, emphasizing strengths of community partners, working within the community's structure, optimizing non-traditional and/or private financial resources, placing value on cost-effectiveness and sustainability, marketing the program, and supporting flexibility and creativity in developing strategies for evolution within the community and in research. Ideally, lessons learned with the Body Project can be generalized to implementation of other body image and eating disorder prevention programs.

    View details for DOI 10.1016/j.eatbeh.2016.03.015

    View details for Web of Science ID 000404313000012

    View details for PubMedID 27017159

    View details for PubMedCentralID PMC5018412

  • Elevated reward response to receipt of palatable food predicts future weight variability in healthy-weight adolescents AMERICAN JOURNAL OF CLINICAL NUTRITION Winter, S. R., Yokum, S., Stice, E., Osipowicz, K., Lowe, M. R. 2017; 105 (4): 781?89

    Abstract

    Background: Both an elevated brain-reward-region response to palatable food and elevated weight variability have been shown to predict future weight gain.Objective: We examined whether the brain-reward response to food is related to future weight variability.Design: A total of 162 healthy-weight adolescents, who were aged 14-18 y at baseline, were enrolled in the study and were assessed annually over a 3-y follow-up period with 127 participants completing the final 3-y follow-up assessment. With the use of functional magnetic resonance imaging, we tested whether the neural responses to a cue that signaled an impending milkshake receipt and the receipt of the milkshake predicted weight variability over the follow-up period. Weight variability was modeled with a root mean squared error method to reflect fluctuations in weight independent of the net weight change.Results: Elevated activation in the medial prefrontal cortex and supplementary motor area, cingulate gyrus, cuneus and occipital gyrus, and insula in response to milkshake receipt predicted greater weight variability. Greater activation in the precuneus and middle temporal gyrus predicted lower weight variability.Conclusions: From our study data, we suggest that the elevated activation of reward and emotional-regulation brain regions (medial prefrontal cortex, cingulate cortex, and insula) and lower activation in self-reference regions (precuneus) in response to milkshake receipt predict weight variability over 3 y of follow-up. The fact that the reward response in the current study emerged in response to high-calorie palatable food receipt suggests that weight variability may be a measure of propensity periods of a positive energy balance and should be examined in addition to measures of the net weight change. With our collective results, we suggest that weight variability and its brain correlates should be added to other variables that are predictive of weight gain to inform the design of obesity-preventive programs in adolescents. This trial was registered at clinicaltrials.gov as NCT01807572.

    View details for DOI 10.3945/ajcn.116.141143

    View details for Web of Science ID 000398941700004

    View details for PubMedID 28228422

    View details for PubMedCentralID PMC5366045

  • Energy balance, energy turnover, and risk of body fat gain Reply AMERICAN JOURNAL OF CLINICAL NUTRITION Stice, E., Yokum, S., Hume, D. 2017; 105 (2): 541?42

    View details for DOI 10.3945/ajcn.116.143651

    View details for Web of Science ID 000393348900030

    View details for PubMedID 28148506

    View details for PubMedCentralID PMC5267307

  • Initial Body Fat Gain is Related to Brain Volume Changes in Adolescents: A Repeated-Measures Voxel-Based Morphometry Study OBESITY Yokum, S., Stice, E. 2017; 25 (2): 401?7

    Abstract

    Individuals with obesity versus those within a healthy weight range show brain volume differences, but it is unclear whether these differences reflect initial vulnerability factors or are secondary to weight gain.One hundred sixty-two adolescents (M age?=?15.3?±?1.1; 81 females) with healthy weight were scanned at baseline. Sixty subjects (M baseline age: 15.2?±?1.1; M follow-up age: 17.7?±?1.2; 34 females) completed a second scan at 2- or 3-year follow-up. Voxel-based morphometry assessed global and regional gray matter (GM) and white matter (WM) volumes. Body fat percentage was assessed yearly over follow-up.Baseline global/regional GM/WM volume did not predict body fat gain over follow-up. Adolescents who gained body fat showed greater decreases in GM volume in the putamen compared with those who showed loss of body fat. Adolescents who gained body fat showed greater increases in WM volume in the anterior cingulate cortex compared with those who showed stability of or loss of body fat.Body fat gain versus stability and loss produce GM and WM volume changes, rather than baseline volumetric differences predicting body fat gain.

    View details for DOI 10.1002/oby.21728

    View details for Web of Science ID 000394970100024

    View details for PubMedID 28026902

    View details for PubMedCentralID PMC5269445

  • Risk Factors That Predict Future Onset of Each DSM-5 Eating Disorder: Predictive Specificity in High-Risk Adolescent Females JOURNAL OF ABNORMAL PSYCHOLOGY Stice, E., Gau, J. M., Rohde, P., Shaw, H. 2017; 126 (1): 38?51

    Abstract

    Because no single report has examined risk factors that predict future onset each type of eating disorder and core symptom dimensions that crosscut disorders, we addressed these aims to advance knowledge regarding risk factor specificity. Data from 3 prevention trials that targeted young women with body dissatisfaction (N = 1,272; Mage = 18.5, SD = 4.2) and collected annual diagnostic interview data over 3-year follow-up were combined to identify predictors of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Negative affect and functional impairment predicted onset of all eating disorders. Thin-ideal internalization, body dissatisfaction, dieting, overeating, and mental health care predicted onset of subthreshold/threshold BN, BED, and PD; positive thinness expectations, denial of cost of pursuing the thin ideal, and fasting predicted onset of 2 of these 3 disorders. Similar risk factors predicted core eating disorder symptom onset. Low BMI and dieting specifically predicted onset of subthreshold/threshold AN or low BMI. Only a subset of factors showed unique predictive effects in multivariate models, likely due to moderate correlations between the risk factors (M r = .14). Results provide support for the theory that pursuit of the thin ideal and the resulting body dissatisfaction, dieting, and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders, but suggest that youth who are inherently lean, rather than purposely pursuing the thin ideal, are at risk for AN. Impaired interpersonal functioning and negative affect are transdiagnostic risk factors, suggesting these factors should be targeted in prevention programs. (PsycINFO Database Record

    View details for DOI 10.1037/abn0000219

    View details for Web of Science ID 000392209900005

    View details for PubMedID 27709979

    View details for PubMedCentralID PMC5215960

  • Participant feedback from peer-led, clinician-led, and internet-delivered eating disorder prevention interventions INTERNATIONAL JOURNAL OF EATING DISORDERS Shaw, H., Rohde, P., Stice, E. 2016; 49 (12): 1087?92

    Abstract

    This article examines qualitative participant feedback to clinician-delivered groups, peer-delivered groups, and an Internet version of a dissonance-based eating disorder prevention program from a controlled trial. These data have not been systematically examined and can inform the refinement and implementation of eating disorder prevention programs.Feedback was collected from body dissatisfied young women (N?= 680; M age?=?22.2, SD?=?7.1) randomized to a clinician-led group, peer-led group, Internet version of this prevention program or to an educational video.Clinician and peer-led group participants reported the group setting, feeling that they were not alone, and the letter exercise as most valuable; the most common response of what was less valuable was "none." Many participants of the Internet version suggested increasing community support.Findings suggest the importance of considering the therapeutic value of group membership, and that online prevention programs could be enhanced by providing a mechanism for community support, such as an online forum. Results also inform selective prevention and suggest that screening potential participants to determine which delivery method best suits them should be considered. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1087-1092).

    View details for DOI 10.1002/eat.22605

    View details for Web of Science ID 000393671500006

    View details for PubMedID 27519180

    View details for PubMedCentralID PMC6140350

  • Testing for interactive and non-linear effects of risk factors for binge eating and purging eating disorders BEHAVIOUR RESEARCH AND THERAPY Allen, K. L., Byrne, S. M., Crosby, R. D., Stice, E. 2016; 87: 40?47

    Abstract

    Almost no research has tested whether risk factors interact in the prediction of future eating disorder onset, which might suggest qualitatively distinct etiologic pathways. Accordingly, this prospective study tested for possible interactions between risk factors in the prediction of binge eating and purging eating disorders in adolescents. It also examined sex differences in pathways to risk. Two analytical approaches were used: (1) classification tree analysis (CTA), which is ideally suited to identifying non-linear interactions and the optimal cut-points for defining risk, with follow-up random forest analyses; and (2) two-way interaction terms in a series of logistic regression models. Data were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a population-based study that followed participants from pre-birth to young adulthood. This study involved 1297 adolescents (49% male), 146 (11%) of whom developed bulimia nervosa, binge eating disorder or purging disorder in late adolescence. In CTA, sex was the first and most potent predictor of eating disorder risk with females showing a 5-fold increase in risk relative to males. For males and females, weight and eating concerns were the next most potent predictor of risk and three risk groups emerged, reflecting non-linear risk. For females with intermediate weight and eating concerns, externalizing problems emerged as an additional predictor. Interaction terms in logistic regression models did not produce significant results after correcting for multiple testing. Findings advance knowledge on risk pathways to eating disorder onset, highlight non-linear risk processes, and provide cut-points for prospectively identifying high-risk youth for prevention programs.

    View details for DOI 10.1016/j.brat.2016.08.019

    View details for Web of Science ID 000390499400005

    View details for PubMedID 27591686

  • A Meta-Analysis of Cultural Adaptations of Psychological Interventions BEHAVIOR THERAPY Hall, G., Ibaraki, A., Huang, E. R., Marti, C., Stice, E. 2016; 47 (6): 993?1014

    Abstract

    Forehand and Kotchick (1996) issued a wake-up call to the field to develop culturally responsive interventions. Since that time, 11 meta-analyses on culturally adapted interventions have been conducted. To reconcile the differences of the previous meta- analyses, a new meta-analysis was conducted that included 13,998 participants, 95% of whom were non-European American, in 78 studies evaluating culturally adapted interventions with psychopathology outcomes. Using a random effects multilevel regression model, the overall effect size (g = 0.67, p < .001) favored the effectiveness of culturally adapted interventions over other conditions (no intervention, other interventions). There was a medium effect size favoring the effectiveness of culturally adapted interventions over unadapted versions of the same intervention (g = .52). The overall effect size was moderated by whether the study involved treatment (g = .76) vs. prevention (g = .25, p = .03) and whether the study involved specific measures of mood or anxiety symptoms (g = .76) vs. general measures of psychopathology (g = .48, p = .02). Culturally adapted interventions had 4.68 times greater odds than other conditions to produce remission from psychopathology (p < .001) in 16 studies that reported remission. There were greater effects in no intervention control designs (marginal odds ratio = 9.80) than in manualized intervention (marginal odds ratio = 3.47, p = .03) or another active, nonmanualized intervention (marginal odds ratio = 3.38, p = .04) comparison designs in remission studies. Research has yet to adequately investigate whether culturally adapted or unadapted interventions impact culture-specific psychopathology. These findings indicate a continuing need for rigor in the conceptualization and measurement of culture- specific psychopathology and in developing culturally responsive interventions.

    View details for DOI 10.1016/j.beth.2016.09.005

    View details for Web of Science ID 000390979900016

    View details for PubMedID 27993346

  • Training motor responses to food: A novel treatment for obesity targeting implicit processes CLINICAL PSYCHOLOGY REVIEW Stice, E., Lawrence, N. S., Kemps, E., Veling, H. 2016; 49: 16?27

    Abstract

    The present review first summarizes results from prospective brain imaging studies focused on identifying neural vulnerability factors that predict excessive weight gain. Next, findings from cognitive psychology experiments evaluating various interventions involving food response inhibition training or food response facilitation training are reviewed that appear to target these neural vulnerability factors and that have produced encouraging weight loss effects. Findings from both of these reviewed research fields suggest that interventions that reduce reward and attention region responses to high calorie food cues and increase inhibitory region responses to high calorie food cues could prove useful in the treatment of obesity. Based on this review, a new conceptual model is presented to describe how different cognitive training procedures may contribute to modifying eating behavior and important directions for future research are offered. It is concluded that there is a need for evaluating the effectiveness of more intensive food response training interventions and testing whether adding such training to extant weight loss interventions increases their efficacy.

    View details for DOI 10.1016/j.cpr.2016.06.005

    View details for Web of Science ID 000386743000002

    View details for PubMedID 27498406

  • Misdefined energy flux and increased fatness Reply AMERICAN JOURNAL OF CLINICAL NUTRITION Stice, E., Yokum, S., Hume, D. 2016; 104 (5): 1486?87

    View details for DOI 10.3945/ajcn.116.140731

    View details for Web of Science ID 000386994500036

    View details for PubMedID 27802994

    View details for PubMedCentralID PMC5081723

  • Predicting Change in Physical Activity: a Longitudinal Investigation Among Weight-Concerned College Women ANNALS OF BEHAVIORAL MEDICINE Arigo, D., Butryn, M. L., Raggio, G. A., Stice, E., Lowe, M. R. 2016; 50 (5): 629?41

    Abstract

    Engaging in regular physical activity (PA) is critical for health, and adopting a consistent PA routine early in life is associated with greater PA over the lifespan. College women with weight concerns are at risk for weight gain, which may be prevented with regular PA. However, little is known about changes in PA engagement in this at-risk group.Using an outcome expectancy framework, this study used a prospective longitudinal design to examine changes in PA during the first 2 years of college. We tested for concurrent and prospective within-person relations between body satisfaction/perceived eating behavior and PA to determine when weight-concerned college women may increase or decrease PA.Women who reported weight concerns at the start of college (n?=?294) completed five assessments over 2 years, including measured weight, body/eating experiences, and 4 days of pedometer steps (per assessment). Multilevel models addressed the resulting nested data structure (days within assessments within participants).Over 2 years, within-person change accounted for 65 % of PA variability (ICC?=?0.35). PA was greatest at (and subsequent to) times when body satisfaction was lower, and when disinhibited eating and hedonic hunger were higher, than an individual's average (ps?

    View details for DOI 10.1007/s12160-016-9788-6

    View details for Web of Science ID 000385184000001

    View details for PubMedID 26984236

    View details for PubMedCentralID PMC5026630

  • A Randomized Controlled Trial to Prevent Depression and Ameliorate Insulin Resistance in Adolescent Girls at Risk for Type 2 Diabetes ANNALS OF BEHAVIORAL MEDICINE Shomaker, L. B., Kelly, N. R., Pickworth, C. K., Cassidy, O. L., Radin, R. M., Shank, L. M., Vannucci, A., Thompson, K. A., Armaiz-Flores, S. A., Brady, S. M., Demidowich, A. P., Galescu, O. A., Courville, A. B., Olsen, C., Chen, K. Y., Stice, E., Tanofsky-Kraff, M., Yanovski, J. A. 2016; 50 (5): 762?74

    Abstract

    Prospective data suggest depressive symptoms worsen insulin resistance and accelerate type 2 diabetes (T2D) onset.We sought to determine whether reducing depressive symptoms in overweight/obese adolescents at risk for T2D would increase insulin sensitivity and mitigate T2D risk.We conducted a parallel-group, randomized controlled trial comparing a 6-week cognitive-behavioral (CB) depression prevention group with a 6-week health education (HE) control group in 119 overweight/obese adolescent girls with mild-to-moderate depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D] ?16) and T2D family history. Primary outcomes were baseline to post-intervention changes in CES-D and whole body insulin sensitivity index (WBISI), derived from 2-h oral glucose tolerance tests. Outcome changes were compared between groups using ANCOVA, adjusting for respective baseline outcome, puberty, race, facilitator, T2D family history degree, baseline age, adiposity, and adiposity change. Multiple imputation was used for missing data.Depressive symptoms decreased (p??0.29) in CB and HE (?WBISI?=?0.1 vs. 0.2, 95 % CI difference?=?-0.6 to +0.4, p?=?0.63). Among all participants, reductions in depressive symptoms were associated with improvements in insulin sensitivity (p?=?0.02).Girls at risk for T2D displayed reduced depressive symptoms following 6 weeks of CB or HE. Decreases in depressive symptoms related to improvements in insulin sensitivity. Longer-term follow-up is needed to determine whether either program causes sustained decreases in depressive symptoms and improvements in insulin sensitivity.The trial was registered with clinicaltrials.gov (NCT01425905).

    View details for DOI 10.1007/s12160-016-9801-0

    View details for Web of Science ID 000385184000013

    View details for PubMedID 27333897

    View details for PubMedCentralID PMC5055426

  • Pilot trial of a dissonance-based cognitive-behavioral group depression prevention with college students BEHAVIOUR RESEARCH AND THERAPY Rohde, P., Stice, E., Shaw, H., Gau, J. M. 2016; 82: 21?27

    Abstract

    Conduct a pilot trial testing whether a new cognitive-behavioral (CB) group prevention program that incorporated cognitive-dissonance change principles was feasible and appeared effective in reducing depressive symptoms and major depressive disorder onset relative to a brochure control condition in college students with elevated depressive symptoms.59 college students (M age = 21.8, SD = 2.3; 68% female, 70% White) were randomized to the 6-session Change Ahead group or educational brochure control condition, completing assessments at pretest, posttest, and 3-month follow-up.Recruitment and screening methods were effective and intervention attendance was high (86% attended all 6 sessions). Change Ahead participants showed medium-large reductions in depressive symptoms at posttest (M d = 0.64), though the effect attenuated by 3-month follow-up. Incidence of major depression onset at 3-month follow-up was 4% for Change Ahead participants versus 13% (difference ns).Change Ahead appears highly feasible and showed positive indications of reduced acute phase depressive symptoms and MDD onset relative to a minimal intervention control in this initial pilot. Given the brevity of the intervention, its apparent feasibility, and the lack of evidence-based depression prevention programs for college students, continued evaluation of Change Ahead appears warranted.

    View details for DOI 10.1016/j.brat.2016.05.001

    View details for Web of Science ID 000378190800003

    View details for PubMedID 27176493

    View details for PubMedCentralID PMC4891249

  • Gain in Body Fat Is Associated with Increased Striatal Response to Palatable Food Cues, whereas Body Fat Stability Is Associated with Decreased Striatal Response JOURNAL OF NEUROSCIENCE Stice, E., Yokum, S. 2016; 36 (26): 6949?56

    Abstract

    Cross-sectional brain-imaging studies reveal that obese versus lean humans show greater responsivity of reward and attention regions to palatable food cues, but lower responsivity of reward regions to palatable food receipt. However, these individual differences in responsivity may result from a period of overeating. We conducted a repeated-measures fMRI study to test whether healthy weight adolescent humans who gained body fat over a 2 or 3 year follow-up period show an increase in responsivity of reward and attention regions to a cue signaling impending milkshake receipt and a simultaneous decrease in responsivity of reward regions to milkshake receipt versus adolescents who showed stability of or loss of body fat. Adolescents who gained body fat, who largely remained in a healthy weight range, showed increases in activation in the putamen, mid-insula, Rolandic operculum, and precuneus to a cue signaling impending milkshake receipt versus those who showed stability of or loss of body fat, though these effects were partially driven by reductions in responsivity among the latter groups. Adolescents who gained body fat reported significantly greater milkshake wanting and milkshake pleasantness ratings at follow-up compared to those who lost body fat. Adolescents who gained body fat did not show a reduction in responsivity of reward regions to milkshake receipt or changes in responsivity to receipt and anticipated receipt of monetary reward. Data suggest that initiating a prolonged period of overeating may increase striatal responsivity to food cues, and that maintaining a balance between caloric intake and expenditure may reduce striatal, insular, and Rolandic operculum responsivity.This novel, repeated-measures brain-imaging study suggests that adolescents who gained body fat over our follow-up period experienced an increase in striatal responsivity to cues for palatable foods compared to those who showed stability of or loss of body fat. Results also imply that maintaining a balance between caloric intake and expenditure over time may reduce striatal, insular, and Rolandic operculum responsivity to food cues, which might decrease risk for future overeating.

    View details for DOI 10.1523/JNEUROSCI.4365-15.2016

    View details for Web of Science ID 000379020200011

    View details for PubMedID 27358453

    View details for PubMedCentralID PMC4926241

  • Low energy intake plus low energy expenditure (low energy flux), not energy surfeit, predicts future body fat gain AMERICAN JOURNAL OF CLINICAL NUTRITION Hume, D., Yokum, S., Stices, E. 2016; 103 (6): 1389?96

    Abstract

    There is a paucity of studies that have prospectively tested the energy surfeit theory of obesity with the use of objectively estimated energy intake and energy expenditure in humans. An alternative theory is that homeostatic regulation of body weight is more effective when energy intake and expenditure are both high (high energy flux), implying that low energy flux should predict weight gain.We aimed to examine the predictive relations of energy balance and energy flux to future weight gain and tested whether results were replicable in 2 independent samples.Adolescents (n = 154) and college-aged women (n = 75) underwent 2-wk objective doubly labeled water, resting metabolic rate, and percentage of body fat measures at baseline. Percentage of body fat was measured annually for 3 y of follow-up for the adolescent sample and for 2 y of follow-up for the young adult sample.Low energy flux, but not energy surfeit, predicted future increases in body fat in both studies. Furthermore, high energy flux appeared to prevent fat gain in part because it was associated with a higher resting metabolic rate.Counter to the energy surfeit model of obesity, results suggest that increasing energy expenditure may be more effective for reducing body fat than caloric restriction, which is currently the treatment of choice for obesity. This trial was registered at clinicaltrials.gov as NCT02084836.

    View details for DOI 10.3945/ajcn.115.127753

    View details for Web of Science ID 000377054000005

    View details for PubMedID 27169833

    View details for PubMedCentralID PMC4880998

  • GROUP-BASED SYMPTOM TRAJECTORIES IN INDICATED PREVENTION OF ADOLESCENT DEPRESSION DEPRESSION AND ANXIETY Briere, F. N., Rohde, P., Stice, E., Morizot, J. 2016; 33 (5): 444?51

    Abstract

    Adolescent depression prevention research has focused on mean intervention outcomes, but has not considered heterogeneity in symptom course. Here, we empirically identify subgroups with distinct trajectories of depressive symptom change among adolescents enrolled in two indicated depression prevention trials and examine how cognitive-behavioral (CB) interventions and baseline predictors relate to trajectory membership.Six hundred thirty-one participants were assigned to one of three conditions: CB group intervention, CB bibliotherapy, and brochure control. We used group-based trajectory modeling to identify trajectories of depressive symptoms from pretest to 2-year follow-up. We examined associations between class membership and conditions using chi-square tests and baseline predictors using multinomial regressions.We identified four trajectories in the full sample. Qualitatively similar trajectories were found in each condition separately. Two trajectories of positive symptom course (low-declining, high-declining) had declining symptoms and were distinguished by baseline symptom severity. Two trajectories of negative course (high-persistent, resurging), respectively, showed no decline in symptoms or decline followed by symptom reappearance. Participants in the brochure control condition were significantly more likely to populate the high-persistent trajectory relative to either CB condition and were significantly less likely to populate the low-declining trajectory relative to CB group. Several baseline factors predicted trajectory classes, but gender was the most informative prognostic factor, with males having increased odds of membership in a high-persistent trajectory relative to other trajectories.Findings suggest that CB preventive interventions do not alter the nature of trajectories, but reduce the risk that adolescents follow a trajectory of chronically elevated symptoms.

    View details for DOI 10.1002/da.22440

    View details for Web of Science ID 000375154800011

    View details for PubMedID 26457813

    View details for PubMedCentralID PMC4835266

  • Neural Vulnerability Factors That Increase Risk for Future Weight Gain PSYCHOLOGICAL BULLETIN Stice, E., Yokum, S. 2016; 142 (5): 447?71

    Abstract

    Theorists have proposed several neural vulnerability factors that may increase overeating and consequent weight gain. Early cross-sectional imaging studies could not determine whether aberrant neural responsivity was a precursor or consequence of overeating. However, recent prospective imaging studies examining predictors of future weight gain and response to obesity treatment, and repeated-measures imaging studies before and after weight gain and loss have advanced knowledge of etiologic processes and neural plasticity resulting from weight change. The present article reviews evidence from prospective studies using imaging and behavioral measures reflecting neural function, as well as randomized experiments with humans and animals that are consistent or inconsistent with 5 neural vulnerability theories for excessive weight gain. Extant data provide strong support for the incentive sensitization theory of obesity and moderate support for the reward surfeit theory, inhibitory control deficit theory, and dynamic vulnerability model of obesity, which attempted to synthesize the former theories into a single etiologic model. However, existing data provide only minimal support for the reward deficit theory. Findings are synthesized into a new working etiologic model that is based on current scientific knowledge. Important directions for future studies, which have the potential to support or refute this working etiologic model, are delineated. (PsycINFO Database Record

    View details for DOI 10.1037/bul0000044

    View details for Web of Science ID 000375051600001

    View details for PubMedID 26854866

    View details for PubMedCentralID PMC4824640

  • Hedonic Hunger Prospectively Predicts Onset and Maintenance of Loss of Control Eating Among College Women HEALTH PSYCHOLOGY Lowe, M. R., Arigo, D., Butryn, M. L., Gilbert, J. R., Sarwer, D., Stice, E. 2016; 35 (3): 238?44

    Abstract

    The subjective feeling of loss of control (LOC) over eating is common among eating-disordered individuals and has predicted weight gain in past research. Restrained eating and negative affect are risk factors for binge eating (which involves LOC), but intense feelings of pleasure derived from palatable foods might also predict the emergence or intensification of LOC eating. The Power of Food Scale (PFS) assesses preoccupation with the pleasure derived from palatable food.The current sample (n = 294) comprised female college freshmen at risk for weight gain. LOC was assessed using an abbreviated version of the Eating Disorders Examination interview. LOC was assessed at baseline and at 6-week and 12- and 24-month follow-ups.Among those exhibiting LOC eating at baseline (and controlling for baseline depression, restrained eating, and body image dissatisfaction), those scoring higher on the PFS at baseline showed a smaller reduction in LOC frequency over time relative to those scoring lower. Using the same covariates, the PFS predicted the first emergence of LOC over 2 years among those showing no LOC at baseline.These results suggest that powerful hedonic attraction to palatable foods may represent a risk factor for the maintenance of LOC in those initially experiencing it and the emergence of LOC eating in those who are not. An enhanced ability to identify individuals at increased risk of developing or maintaining LOC eating could be useful in prevention programs.

    View details for DOI 10.1037/hea0000291

    View details for Web of Science ID 000373477000005

    View details for PubMedID 26690638

    View details for PubMedCentralID PMC4859341

  • Interactive and Mediational Etiologic Models of Eating Disorder Onset: Evidence from Prospective Studies ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, VOL 12 Stice, E., Cannon, T. D., Widiger, T. 2016; 12: 359?81

    Abstract

    It is vital to elucidate how risk factors work together to predict eating disorder onset because it should improve the yield of prevention efforts. Risk factors that have predicted eating disorder onset in multiple studies include low body mass index (BMI) for anorexia nervosa; thin-ideal internalization, perceived pressure to be thin, body dissatisfaction, dieting, and negative affect for bulimia nervosa; and body dissatisfaction and dieting for purging disorder. No such risk factors have been identified for binge eating disorder. Classification tree analyses have identified several amplifying interactions, mitigating interactions, and alternative pathway interactions between risk factors, such as evidence that elevated BMI amplifies the risk between appearance overvaluation and the future onset of recurrent binge eating. However, there have been no tests of mediational risk factor models in the prediction of eating disorder onset. Gaps in the literature are identified and procedures for providing rigorous tests of interactive and mediational etiologic models are outlined.

    View details for DOI 10.1146/annurev-clinpsy-021815-093317

    View details for Web of Science ID 000373171600015

    View details for PubMedID 26651521

  • The implementation of evidence-based eating disorder prevention programs EATING DISORDERS Shaw, H., Stice, E. 2016; 24 (1): 71?78
  • Dissonance-Based Eating Disorder Prevention Program Reduces Reward Region Response to Thin Models; How Actions Shape Valuation PLOS ONE Stice, E., Yokum, S., Waters, A. 2015; 10 (12): e0144530

    Abstract

    Research supports the effectiveness of a dissonance-based eating disorder prevention program wherein high-risk young women with body dissatisfaction critique the thin ideal, which reduces pursuit of this ideal, and the theory that dissonance induction contributes to these effects. Based on evidence that dissonance produces attitudinal change by altering neural representation of valuation, we tested whether completing the Body Project would reduce response of brain regions implicated in reward valuation to thin models. Young women with body dissatisfaction were randomized to this intervention or an educational control condition, completing assessments and fMRI scans while viewing images of thin versus average-weight female models at pre and post. Whole brain analyses 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 pre-post reductions in caudate and putamen response to thin models correlated with greater reductions in body dissatisfaction. The finding that the Body Project reduces caudate response to thin models provides novel preliminary evidence that this intervention reduces valuation of media images thought to contribute to body dissatisfaction and eating disorders, providing support for the intervention theory by documenting that this intervention alters an objective biological outcome.

    View details for DOI 10.1371/journal.pone.0144530

    View details for Web of Science ID 000366902700142

    View details for PubMedID 26641854

    View details for PubMedCentralID PMC4671712

  • Effectiveness of an eating disorder preventative intervention in primary care medical settings BEHAVIOUR RESEARCH AND THERAPY Linville, D., Cobb, E., Lenee-Bluhm, T., Lopez-Zeron, G., Gau, J. M., Stice, E. 2015; 75: 32?39

    Abstract

    To conduct a pilot effectiveness trial of a brief dissonance-based eating disorder preventative program, the Body Project, when implemented at primary care medical clinics.Sixty-six female adolescents between the ages of 13 and 17 who reported at least some body image dissatisfaction were recruited at two primary care clinics and randomized to Body Project groups or an educational video control condition; eating disorder risk factors and symptoms were measured at pretest, posttest, and 3-month follow-up.Body Project versus educational video control participants showed significantly greater reductions in thin-ideal internalization, pressure to be thin, dieting, and eating disorder symptoms at posttest, which were medium to large effect sizes. Body Project participants also showed greater decreases in body dissatisfaction and negative affect at posttest, though these moderate sized effects were not significant. Effects persisted through 3-month follow-up.Average pre-post effect sizes (d = 0.58) compare favorably to those observed in past Body Project efficacy (average d = 0.59) and effectiveness trials (average ds of 0.43 and 0.69), suggesting that primary care clinics may represent a novel venue for offering and extending the reach of this eating disorder prevention program.

    View details for DOI 10.1016/j.brat.2015.10.004

    View details for Web of Science ID 000367636800004

    View details for PubMedID 26523886

  • Moderators of the effects of indicated group and bibliotherapy cognitive behavioral depression prevention programs on adolescents' depressive symptoms and depressive disorder onset BEHAVIOUR RESEARCH AND THERAPY Mueller, S., Rohde, P., Gau, J. M., Stice, E. 2015; 75: 1?10

    Abstract

    We investigated factors hypothesized to moderate the effects of cognitive behavioral group-based (CB group) and bibliotherapy depression prevention programs. Using data from two trials (N = 631) wherein adolescents (M age = 15.5, 62% female, 61% Caucasian) with depressive symptoms were randomized into CB group, CB bibliotherapy, or an educational brochure control condition, we evaluated the moderating effects of individual, demographic, and environmental factors on depressive symptom reductions and major depressive disorder (MDD) onset over 2-year follow-up. CB group and bibliotherapy participants had lower depressive symptoms than controls at posttest but these effects did not persist. No MDD prevention effects were present in the merged data. Relative to controls, elevated depressive symptoms and motivation to reduce depression amplified posttest depressive symptom reduction for CB group, and elevated baseline symptoms amplified posttest symptom reduction effects of CB bibliotherapy. Conversely, elevated substance use mitigated the effectiveness of CB group relative to controls on MDD onset over follow-up. Findings suggest that both CB prevention programs are more beneficial for youth with at least moderate depressive symptoms, and that CB group is more effective for youth motivated to reduce their symptoms. Results also imply that substance use reduces the effectiveness of CB group-based depression prevention.

    View details for DOI 10.1016/j.brat2015.10.002

    View details for Web of Science ID 000367636800001

    View details for PubMedID 26480199

    View details for PubMedCentralID PMC4690747

  • Anorexia nervosa NATURE REVIEWS DISEASE PRIMERS Treasure, J., Zipfel, S., Micali, N., Wade, T., Stice, E., Claudino, A., Schmidt, U., Frank, G. K., Bulik, C. M., Wentz, E. 2015; 1: 15074

    Abstract

    Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.

    View details for DOI 10.1038/nrdp.2015.74

    View details for Web of Science ID 000381352000001

    View details for PubMedID 27189821

  • Short-term variability in body weight predicts long-term weight gain AMERICAN JOURNAL OF CLINICAL NUTRITION Lowe, M. R., Feig, E. H., Winter, S. R., Stice, E. 2015; 102 (5): 995?99

    Abstract

    Body weight in lower animals and humans is highly stable despite a very large flux in energy intake and expenditure over time. Conversely, the existence of higher-than-average variability in weight may indicate a disruption in the mechanisms responsible for homeostatic weight regulation.In a sample chosen for weight-gain proneness, we evaluated whether weight variability over a 6-mo period predicted subsequent weight change from 6 to 24 mo.A total of 171 nonobese women were recruited to participate in this longitudinal study in which weight was measured 4 times over 24 mo. The initial 3 weights were used to calculate weight variability with the use of a root mean square error approach to assess fluctuations in weight independent of trajectory. Linear regression analysis was used to examine whether weight variability in the initial 6 mo predicted weight change 18 mo later.Greater weight variability significantly predicted amount of weight gained. This result was unchanged after control for baseline body mass index (BMI) and BMI change from baseline to 6 mo and for measures of disinhibition, restrained eating, and dieting.Elevated weight variability in young women may signal the degradation of body weight regulatory systems. In an obesogenic environment this may eventuate in accelerated weight gain, particularly in those with a genetic susceptibility toward overweight. Future research is needed to evaluate the reliability of weight variability as a predictor of future weight gain and the sources of its predictive effect. The trial on which this study is based is registered at clinicaltrials.gov as NCT00456131.

    View details for DOI 10.3945/ajcn.115.115402

    View details for Web of Science ID 000364273300005

    View details for PubMedID 26354535

    View details for PubMedCentralID PMC4625595

  • Elevated BMI and Male Sex Are Associated with Greater Underreporting of Caloric Intake as Assessed by Doubly Labeled Water JOURNAL OF NUTRITION Stice, E., Palmrose, C. A., Burger, K. S. 2015; 145 (10): 2412?18

    Abstract

    Inaccuracies in energy intake (EI) measurement hinder identification of risk factors that predict weight gain and evaluation of obesity prevention and treatment interventions. Research has used objective measures of EI to identify underreporting correlates, producing mixed results, suggesting the need to examine novel potential correlates.With the use of an objective measure of EI from doubly labeled water (DLW) this report examined multiple potential underreporting correlates.Adolescents from 2 studies (study 1, n = 91; mean age: 18.4 ± 0.58 y; 100% female; study 2, n = 162; mean age: 15.2 ± 1.99 y; 82 female adolescents; 80 male adolescents) completed a DLW assessment of EI, a food-frequency questionnaire, and measures of perceived pressure for thinness, thin-ideal internalization, body dissatisfaction, dieting, food-cue reactivity, eating disorder symptoms, socioeconomic status, and neural response to food; BMI (in kg/m(2)) was measured over a 2-y follow-up.Elevated BMI correlated with underreported EI in study 1 (r = 0.26, P < 0.05) and study 2 (r = 0.20, P = 0.01), as did male sex in study 2 (r = 0.24, P < 0.01); the other survey measures did not. Underreporting correlated negatively (r = -0.29; uncorr P < 0.001) with responsivity of brain regions implicated in motor control to palatable food receipt and positively (r = 0.31; uncorr P < 0.001) with responsivity of a region implicated in taste processing to cues signaling impending milkshake receipt. Underreporting did not predict future change in BMI in either study.Findings document marked underreporting and replicate evidence that BMI correlates positively with underreporting and extends this literature by revealing that several novel factors were unrelated to underreporting and further that neural responsivity to food correlated with underreporting, suggesting that adolescents who showed reduced responsivity in a motor control region to food receipt and elevated responsivity of gustatory regions to anticipated palatable food receipt showed greater underreporting. This trial was registered at clinicaltrials.gov as NCT00433680 and NCT02084836.

    View details for DOI 10.3945/jn.115.216366

    View details for Web of Science ID 000362387700030

    View details for PubMedID 26338886

    View details for PubMedCentralID PMC4580962

  • Assessing program sustainability in an eating disorder prevention effectiveness trial delivered by college clinicians BEHAVIOUR RESEARCH AND THERAPY Rohde, P., Shaw, H., Butryn, M. L., Stice, E. 2015; 72: 1?8

    Abstract

    Sustainability of the Body Project, a dissonance-based selective eating disorder prevention program supported by efficacy and effectiveness trials, has not previously been examined. This mixed-methods study collected qualitative and quantitative data on training, supervision, and the intervention from 27 mental health clinicians from eight US universities who participated in an effectiveness trial and quantitative data on 2-year sustainability of program delivery. Clinicians, who were primarily masters-level mental health providers, had limited experience delivering manualized interventions. They rated the training and manual favorably, noting that they particularly liked the role-plays of session activities and intervention rationale, but requested more discussion of processes and group management issues. Clinicians were satisfied receiving emailed supervision based on videotape review. They reported enjoying delivering the Body Project but reported some challenges with the manualized format and time constraints. Most clinicians anticipated running more groups after the study ended but only four universities (50%) reported providing additional Body Project groups at the 1-year follow-up assessment and sustained delivery of the groups decreased substantially two years after study completion, with only one university (12%) continuing to deliver groups. The most commonly reported barriers for conducting additional groups were limited time and high staff turnover.

    View details for DOI 10.1016/j.brat.2015.06.009

    View details for Web of Science ID 000359883800001

    View details for PubMedID 26143559

    View details for PubMedCentralID PMC4529800

  • Effectiveness Trial of an Indicated Cognitive-Behavioral Group Adolescent Depression Prevention Program Versus Bibliotherapy and Brochure Control at 1-and 2-Year Follow-Up JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Rohde, P., Stice, E., Shaw, H., Gau, J. M. 2015; 83 (4): 736?47

    Abstract

    The main goal of this study was to evaluate the long-term effects of a brief group cognitive-behavioral (CB) adolescent depression indicated prevention program through 2-year follow-up, relative to CB bibliotherapy and brochure control, when high school personnel recruited students and delivered the program.Three hundred seventy-eight adolescents (M age = 15.5, SD = 1.2; 68% female, 72% White) with elevated self-assessed depressive symptoms who were randomized to CB group, CB bibliotherapy, or educational brochure control were assessed at pretest, posttest, and 6-, 12-, 18-, and 24-month follow-up.By 2 years postintervention, CB group participants showed significantly lower major depressive disorder (MDD) onset versus CB bibliotherapy (10% vs. 25%, respectively; hazard ratio = 2.48, p = .006), but the incidence difference relative to brochure controls (17%) was nonsignificant; MDD incidence for bibliotherapy and brochure controls did not differ. Although CB group participants showed lower depressive symptoms at posttest versus brochure controls, there were no effects for this outcome or for social adjustment or substance use over 2-year follow-up. Moderator analyses suggested that participants with higher baseline depressive symptoms showed greater long-term symptom reductions in the CB group intervention versus bibliotherapy.The evidence that a brief CB group intervention delivered by real-world providers significantly reduced MDD onset versus CB bibliotherapy is potentially encouraging. However, the lack of MDD prevention effects relative to brochure control and lack of long-term symptom effects (though consistent with results from other depression prevention trials), suggest that the delivery of the CB group should be refined to strengthen its effectiveness.

    View details for DOI 10.1037/ccp0000022

    View details for Web of Science ID 000358683000008

    View details for PubMedID 25894666

    View details for PubMedCentralID PMC4516674

  • Effectiveness trial of a selective dissonance-based eating disorder prevention program with female college students: Effects at 2-and 3-year follow-up BEHAVIOUR RESEARCH AND THERAPY Stice, E., Rohde, P., Butryn, M. L., Shaw, H., Marti, C. 2015; 71: 20?26

    Abstract

    An efficacy trial found that a dissonance-based prevention program reduced risk factors, eating disorder symptoms, and future eating disorder onset, but smaller effects emerged when high school clinicians recruited students and delivered the program under real-world conditions in an effectiveness trial. The current report describes results at 2- and 3-year follow-up from an effectiveness trial that tested whether a new enhanced dissonance version of this program produced larger effects when college clinicians recruit students and deliver the intervention using improved train and supervision procedures.Young women from eight universities (N = 408, M age = 21.6, SD = 5.64) were randomized to the prevention program or an educational brochure control condition.Dissonance participants showed greater decreases in risk factors, eating disorder symptoms, and psychosocial impairment by 3-year follow-up than controls, but not healthcare utilization, BMI, or eating disorder onset.This novel multisite effectiveness trial found that the enhanced dissonance intervention and improved training and supervision procedures produced an average effect size at 3-year follow-up that was 290% and 160% larger than effects observed in the high school effectiveness trial and efficacy trial respectively. Yet, the lack of eating disorder onset effects may imply that factors beyond pursuit of the thin ideal now contribute to eating disorder onset.

    View details for DOI 10.1016/j.brat.2015.05.012

    View details for Web of Science ID 000358391400003

    View details for PubMedID 26056749

    View details for PubMedCentralID PMC4501883

  • Reward Region Responsivity Predicts Future Weight Gain and Moderating Effects of the TaqIA Allele JOURNAL OF NEUROSCIENCE Stice, E., Burger, K. S., Yokum, S. 2015; 35 (28): 10316?24

    Abstract

    Because no large prospective study has investigated neural vulnerability factors that predict future weight gain, we tested whether neural response to receipt and anticipated receipt of palatable food and monetary reward predicted body fat gain over a 3-year follow-up in healthy-weight adolescent humans and whether the TaqIA polymorphism moderates these relations. A total of 153 adolescents completed fMRI paradigms assessing response to these events; body fat was assessed annually over follow-up. Elevated orbitofrontal cortex response to cues signaling impending milkshake receipt predicted future body fat gain (r = 0.32), which is a novel finding that provides support for the incentive sensitization theory of obesity. Neural response to receipt and anticipated receipt of monetary reward did not predict body fat gain, which has not been tested previously. Replicating an earlier finding (Stice et al., 2008a), elevated caudate response to milkshake receipt predicted body fat gain for adolescents with a genetic propensity for greater dopamine signaling by virtue of possessing the TaqIA A2/A2 allele, but lower caudate response predicted body fat gain for adolescents with a genetic propensity for less dopamine signaling by virtue of possessing a TaqIA A1 allele, though this interaction was only marginal [p-value <0.05 corrected using voxel-level familywise error rate (pFWE) = 0.06]. Parental obesity, which correlated with TaqIA allele status (odds ratio = 2.7), similarly moderated the relation of caudate response to milkshake receipt to future body fat gain, which is another novel finding. The former interaction implies that too much or too little dopamine signaling and reward region responsivity increases risk for overeating, suggesting qualitatively distinct reward surfeit and reward deficit pathways to obesity.Because no large prospective study has investigated neural vulnerability factors that predict future weight gain we tested whether neural response to receipt and anticipated receipt of palatable food and monetary reward predicted body fat gain over 3-year follow-up in healthy-weight adolescent humans and whether the TaqIA polymorphism moderates these relations. Elevated reward activation in response to food cues predicted future body fat gain. Elevated reward response to food receipt predicted body fat gain for adolescents with a TaqIA A2/A2 allele and lower reward response predicted body fat gain for those with a TaqIA A1 allele. Results imply that too much or too little dopamine signaling and reward region responsivity increases risk for overeating.

    View details for DOI 10.1523/JNEUROSCI.3607-14.2015

    View details for Web of Science ID 000358298500020

    View details for PubMedID 26180206

    View details for PubMedCentralID PMC4502268

  • Relation of the multilocus genetic composite reflecting high dopamine signaling capacity to future increases in BMI APPETITE Yokum, S., Marti, C., Smolen, A., Stice, E. 2015; 87: 38?45

    Abstract

    Because food intake exerts its rewarding effect by increasing dopamine (DA) signaling in reward circuitry, it theoretically follows that individuals with a greater number of genotypes putatively associated with high DA signaling capacity are at increased risk for overeating and subsequent weight gain. We tested the association between the multilocus genetic composite risk score, defined by the total number of genotypes putatively associated with greater DA signaling capacity (i.e. TaqIA A2 allele, DRD2-141C Ins/Del and Del/Del genotypes, DRD4-S allele, DAT1-S allele, and COMT Val/Val genotype), and future increases in Body Mass Index (BMI) in three prospective studies. Participants in Study 1 (N?=?30; M age?=?15.2; M baseline BMI?=?26.9), Study 2 (N?=?34; M age?=?20.9; M baseline BMI?=?28.2), and Study 3 (N?=?162; M age?=?15.3, M baseline BMI?=?20.8) provided saliva samples from which epithelial cells were collected, permitting DNA extraction. The multilocus genetic composite risk score was associated with future increases in BMI in all three studies (Study 1, r?=?0.37; Study 2, r?=?0.22; Study 3, r?=?0.14) and the overall sample (r?=?0.19). DRD4-S was associated with increases in BMI in Study 1 (r?=?0.42), Study 2 (r?=?0.27), and in the overall sample (r?=?0.17). DAT1-S was associated with increases in BMI in Study 3 (r?=?0.17) and in the overall sample (r?=?0.12). There were no associations between the other genotypes (TaqIA, COMT, and DRD2-141C) and change in BMI over 2-year follow-up. Data suggest that individuals with a genetic propensity for greater DA signaling capacity are at risk for future weight gain and that combining alleles that theoretically have a similar function may provide a more reliable method of modeling genetic risk associated with future weight gain than individual genotypes.

    View details for DOI 10.1016/j.appet.2014.12.202

    View details for Web of Science ID 000350517800005

    View details for PubMedID 25523644

    View details for PubMedCentralID PMC4333052

  • Development and Predictive Effects of Eating Disorder Risk Factors During Adolescence: Implications for Prevention Efforts INTERNATIONAL JOURNAL OF EATING DISORDERS Rohde, P., Stice, E., Marti, C. 2015; 48 (2): 187?98

    Abstract

    Although several prospective studies have identified factors that increase risk for eating disorders, little is known about when these risk factors emerge and escalate, or when they begin to predict future eating disorder onset. The objective of this report was to address these key research gaps.Data were examined from a prospective study of 496 community female adolescents (M?=?13.5, SD?=?0.7 at baseline) who completed eight annual assessments of potential risk factors and eating disorders from preadolescence to young adulthood.Three variables exhibited positive linear increases: Perceived pressure to be thin, thin-ideal internalization, and body dissatisfaction; three were best characterized as quadratic effects: dieting (essentially little change); negative affectivity (overall decrease), and BMI (overall increase). Elevated body dissatisfaction at ages 13, 14, 15, and 16 predicted DSM-5 eating disorders onset in the 4-year period after each assessment, but the predictive effects of other risk factors were largely confined to age 14; BMI did not predict eating disorders at any age.The results imply that these risk factors are present by early adolescence, although eating disorders tend to emerge in late adolescence and early adulthood. These findings emphasize the need for efficacious eating disorder prevention programs for early adolescent girls, perhaps targeting 14-year olds, when risk factors seem to be most predictive. In early adolescence, it might be fruitful to target girls with body dissatisfaction, as this was the most consistent predictor of early eating disorder onset in this study.

    View details for DOI 10.1002/eat.22270

    View details for Web of Science ID 000349601100004

    View details for PubMedID 24599841

    View details for PubMedCentralID PMC4156929

  • Preventing Obesity in the Military Community (POMC): The Development of a Clinical Trials Research Network INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Spieker, E. A., Sbrocco, T., Theim, K. R., Maurer, D., Johnson, D., Bryant, E., Bakalar, J. L., Schvey, N. A., Ress, R., Seehusen, D., Klein, D. A., Stice, E., Yanovski, J. A., Chan, L., Gentry, S., Ellsworth, C., Hill, J. W., Tanofsky-Kraff, M., Stephens, M. B. 2015; 12 (2): 1174?95

    Abstract

    Obesity impacts the U.S. military by affecting the health and readiness of active duty service members and their families. Preventing Obesity in Military Communities (POMC) is a comprehensive research program within Patient Centered Medical Homes (PCMHs) in three Military Training Facilities. This paper describes three pilot randomized controlled trials that target critical high risk periods for unhealthy weight gain from birth to young adulthood: (1) pregnancy and early infancy (POMC-Mother-Baby), (2) adolescence (POMC-Adolescent), and (3) the first tour of duty after boot camp (POMC-Early Career). Each study employs a two-group randomized treatment or prevention program with follow up. POMC offers a unique opportunity to bring together research and clinical expertise in obesity prevention to develop state-of-the-art programs within PCMHs in Military Training Facilities. This research builds on existing infrastructure that is expected to have immediate clinical benefits to DoD and far-reaching potential for ongoing collaborative work. POMC may offer an economical approach for widespread obesity prevention, from conception to young adulthood, in the U.S. military as well as in civilian communities.

    View details for DOI 10.3390/ijerph120201174

    View details for Web of Science ID 000350209800008

    View details for PubMedID 25648176

    View details for PubMedCentralID PMC4344661

  • Young woman smokers gain significantly more weight over 2-year follow-up than non-smokers. How Virginia doesn't slim APPETITE Stice, E., Marti, C., Rohde, P., Shaw, H. 2015; 85: 155?59

    Abstract

    Although young women often report smoking for weight control purposes, no prospective study has tested whether smokers subsequently gain less weight over time than non-smokers. As this is an important lacuna because smoking results in greater mortality than obesity, the present study addresses this question.Female college students (N?=?398; M age?=?18.4, SD?=0.6; M BMI?=?23.7, SD?=4.3) recruited for a body acceptance intervention trial provided data on smoking behavior and had their body mass measured at baseline and at 1-mo, 6-mo, 1-yr, and 2-yr follow-ups.Counter to the belief that smoking is an effective weight control strategy, baseline smokers (n?=?29) gained significantly more weight (r?=?.29) than baseline non-smokers (n?=?304), controlling for baseline BMI, parental obesity status, socio-economic status, and intervention condition; over 2-yr follow-up smokers gained 2.9?kg versus 0.9?kg for non-smokers. Descriptive data indicated that weight gain was greater for young women who quit smoking during follow-up (n?=?13; M?=?4.8?kg) than for persistent smokers (n?=?16; M?=?1.4?kg), though both groups gained more weight than non-smokers.RESULTS challenge the widely held belief that smoking is an effective weight control strategy, ironically suggesting that smokers gain more weight than non-smokers during young adulthood, though non-experimental prospective studies do not establish causal relations and future research with larger representative samples is needed.

    View details for DOI 10.1016/j.appet.2014.11.026

    View details for Web of Science ID 000347867000021

    View details for PubMedID 25433235

    View details for PubMedCentralID PMC4277721

  • Randomized Controlled Pilot Trial of a Novel Dissonance-Based Group Treatment for Eating Disorders BEHAVIOUR RESEARCH AND THERAPY Stice, E., Rohde, P., Butryn, M., Menke, K. S., Marti, C. 2015; 65: 67?75

    Abstract

    The authors conducted a pilot trial of a new dissonance-based group eating disorder treatment designed to be a cost-effective front-line transdiagnostic treatment that could be more widely disseminated than extant individual or family treatments that are more expensive and difficult to deliver. Young women with a DSM-5 eating disorder (N = 72) were randomized to an 8-week dissonance-based Counter Attitudinal Therapy group treatment or a usual care control condition, completing diagnostic interviews and questionnaires at pre, post, and 2-month follow-up. Intent-to-treat analyses revealed that intervention participants showed greater reductions in outcomes than usual care controls in a multivariate multilevel model (?(2)[6] = 34.1, p < .001), producing large effects for thin-ideal internalization (d = .79), body dissatisfaction (d = 1.14), and blinded interview-assessed eating disorder symptoms (d = .95), and medium effects for dissonance regarding perpetuating the thin ideal (d = .65) and negative affect (d = .55). Midway through this pilot we refined engagement procedures, which was associated with increased effect sizes (e.g., the d for eating disorder symptoms increased from .51 to 2.30). This new group treatment produced large reductions in eating disorder symptoms, which is encouraging because it requires about 1/20th the therapist time necessary for extant individual and family treatments, and has the potential to provide a cost-effective and efficacious approach to reaching the majority of individuals with eating disorders who do not presently received treatment.

    View details for DOI 10.1016/j.brat.2014.12.012

    View details for Web of Science ID 000349428900010

    View details for PubMedID 25577189

    View details for PubMedCentralID PMC4343210

  • A pilot randomized trial of a cognitive reappraisal obesity prevention program PHYSIOLOGY & BEHAVIOR Stice, E., Yokum, S., Burger, K., Rohde, P., Shaw, H., Gau, J. M. 2015; 138: 124?32

    Abstract

    Evaluate a selective obesity prevention program promoting use of cognitive reappraisals to reduce reward region response and increase inhibitory region response to high-fat/high-sugar foods and reduce intake of fat and sugar to prevent blunted reward region response to intake of such foods.Young adults at risk for future weight gain by virtue of weight concerns (N=148) were randomized to this new prevention program (Minding Health), an alternative prevention program promoting participant-driven gradual reductions in caloric intake and increases in physical activity (Healthy Weight), or an obesity education video control condition, completing assessments at pre-, post-, and 6-month follow-up. A subset of Minding Health and control participants completed an fMRI scan at pre- and post-assessing neural response to images of high-fat/sugar foods and to receipt and anticipated receipt of a high-fat/sugar food.Minding Health participants showed significantly greater reductions in body fat than controls and caloric intake from fat and sugar than Healthy Weight participants. Minding Health participants also showed greater activation of an inhibitory control region and reduced activation of an attention/expectation region in response to palatable food images relative to pretest and controls. However, Healthy Weight participants showed greater reductions in BMI and eating disorder symptoms than Minding Health participants.Although the Minding Health intervention produced some of the hypothesized effects, it did not produce lasting reductions in body fat or BMI and showed limited effects on neural responsivity, implying it will be vital to increase the efficacy of this new prevention program.

    View details for DOI 10.1016/j.physbeh.2014.10.022

    View details for Web of Science ID 000348882900018

    View details for PubMedID 25447334

    View details for PubMedCentralID PMC4258533

  • Effects of a Prototype Internet Dissonance-Based Eating Disorder Prevention Program at 1-and 2-Year Follow-Up HEALTH PSYCHOLOGY Stice, E., Durant, S., Rohde, P., Shaw, H. 2014; 33 (12): 1558?67

    Abstract

    A group-based eating disorder prevention program wherein young women explore the costs of pursuing the thin ideal reduces eating disorder risk factors and symptoms. However, it can be challenging to identify school clinicians to effectively deliver the intervention. The present study compares the effects of a new Internet-based version of this prevention program, which could facilitate dissemination, to the group-based program and to educational video and educational brochure control conditions at 1- and 2-year follow-up.Female college students with body dissatisfaction (n = 107; M age = 21.6, SD = 6.6) were randomized to these 4 conditions.Internet participants showed reductions in eating disorder risk factors and symptoms relative to the 2 control conditions at 1- and 2-year follow-up (M -d = .34 and .17, respectively), but the effects were smaller than parallel comparisons for the group participants (M -d = .48 and .43, respectively). Yet the Internet intervention produced large weight gain prevention effects relative to the 2 control conditions at 1- and 2-year follow-up (M -d = .80 and .73, respectively), which were larger than the parallel effects for the group intervention (M -d = .19 and .47, respectively).Although the effects for the Internet versus group intervention were similar at posttest, results suggest that the effects faded more quickly for the Internet intervention. However, the Internet intervention produced large weight gain prevention effects, implying that it might be useful for simultaneously preventing eating disordered behavior and unhealthy weight gain.

    View details for DOI 10.1037/hea0000090

    View details for Web of Science ID 000345741900012

    View details for PubMedID 25020152

    View details for PubMedCentralID PMC4250406

  • Individual Differences in Striatum Activity to Food Commercials Predict Weight Gain in Adolescents OBESITY Yokum, S., Gearhardt, A. N., Harris, J. L., Brownell, K. D., Stice, E. 2014; 22 (12): 2544?51

    Abstract

    Adolescents view thousands of food commercials annually, but little is known about how individual differences in neural response to food commercials relate to weight gain. To add to our understanding of individual risk factors for unhealthy weight gain and environmental contributions to the obesity epidemic, we tested the associations between reward region (striatum and orbitofrontal cortex [OFC]) responsivity to food commercials and future change in body mass index (BMI).Adolescents (N = 30) underwent a scan session at baseline while watching a television show edited to include 20 food commercials and 20 nonfood commercials. BMI was measured at baseline and 1-year follow-up.Activation in the striatum, but not OFC, in response to food commercials relative to nonfood commercials and in response to food commercials relative to the television show was positively associated with change in BMI over 1-year follow-up. Baseline BMI did not moderate these effects.The results suggest that there are individual differences in neural susceptibility to food advertising. These findings highlight a potential mechanism for the impact of food marketing on adolescent obesity.

    View details for DOI 10.1002/oby.20882

    View details for Web of Science ID 000345409500014

    View details for PubMedID 25155745

    View details for PubMedCentralID PMC4236252

  • Food reinforcement and parental obesity predict future weight gain in non-obese adolescents APPETITE Epstein, L. H., Yokum, S., Feda, D. M., Stice, E. 2014; 82: 138?42

    Abstract

    Food reinforcement, the extent to which people are willing to work to earn a preferred snack food, and parental obesity are risk factors for weight gain, but there is no research comparing the predictive effects of these factors for adolescent weight gain.130 non-obese adolescents (M age=15.2 ± 1.0; M BMI=20.7 ± 2.0; M zBMI=0.16 ± 0.64) at differential risk for weight gain based on parental obesity completed baseline food and money reinforcement tasks, and provided zBMI data over a 2-year follow-up.The number of obese (BMI ? 30) parents (p=0.007) and high food reinforcement (p=0.046) were both significant independent predictors of greater zBMI increases, controlling for age, sex, parent education and minority status. Having no obese parents or being low or average in food reinforcement was associated with reductions in zBMI, but those high in food reinforcement showed larger zBMI increases (0.102) than having one obese parent (0.025) but less than having two obese parents (0.177).Food reinforcement and parental obesity independently predict future weight gain among adolescents. It might be fruitful for obesity prevention programs to target both high risk groups.

    View details for DOI 10.1016/j.appet.2014.07.018

    View details for Web of Science ID 000343385500020

    View details for PubMedID 25045864

    View details for PubMedCentralID PMC4209946

  • Do participant, facilitator, or group factors moderate effectiveness of the Body Project? Implications for dissemination BEHAVIOUR RESEARCH AND THERAPY Butryn, M. L., Rohde, P., Marti, C., Stice, E. 2014; 61: 142?49

    Abstract

    The Body Project is a dissonance-based selective eating disorder prevention program with a broad evidence-base. The study sought to determine if previous findings regarding participant moderators replicate in an effectiveness trial under more real-world conditions. This study also had the novel aim of examining facilitator characteristics and group-level variables as potential outcome predictors. These aims are critical for understanding when the intervention is most effective and for whom. Participants were 408 young women with body image concerns recruited from seven universities. Change in eating disorder symptoms at 1-year follow-up was the primary outcome. Intervention effects were significant for both participants who had low or high baseline symptom levels, but the effect size was approximately twice as large for participants with high initial symptom levels (d = 0.58 vs. 0.24). Intervention effects were not predicted by facilitator factors (education, age, BMI, sex) or by group size or attendance rate. This study demonstrates that participants with either low or high eating disorder symptoms will benefit from the intervention but if resources are limited, targeting those with elevated eating disorder symptoms may be sensible. Results also suggest that a wide variety of facilitators can effectively deliver the Body Project, which has encouraging implications for dissemination.

    View details for DOI 10.1016/j.brat.2014.08.004

    View details for Web of Science ID 000343350800015

    View details for PubMedID 25199580

    View details for PubMedCentralID PMC4172533

  • Greater striatopallidal adaptive coding during cue-reward learning and food reward habituation predict future weight gain NEUROIMAGE Burger, K. S., Stice, E. 2014; 99: 122?28

    Abstract

    Animal experiments indicate that after repeated pairings of palatable food receipt and cues that predict palatable food receipt, dopamine signaling increases in response to predictive cues, but decreases in response to food receipt. Using functional MRI and mixed effects growth curve models with 35 females (M age=15.5±0.9; M BMI=24.5±5.4) we documented an increase in BOLD response in the caudate (r=.42) during exposure to cues predicting impending milkshake receipt over repeated exposures, demonstrating a direct measure of in vivo cue-reward learning in humans. Further, we observed a simultaneous decrease in putamen (r=-.33) and ventral pallidum (r=-.45) response during milkshake receipt that occurred over repeated exposures, putatively reflecting food reward habitation. We then tested whether cue-reward learning and habituation slopes predicted future weight over 2-year follow-up. Those who exhibited the greatest escalation in ventral pallidum responsivity to cues and the greatest decrease in caudate response to milkshake receipt showed significantly larger increases in BMI (r=.39 and -.69 respectively). Interestingly, cue-reward learning propensity and food reward habituation were not correlated, implying that these factors may constitute qualitatively distinct vulnerability pathways to excess weight gain. These two individual difference factors may provide insight as to why certain people have shown obesity onset in response to the current obesogenic environment in western cultures, whereas others have not.

    View details for DOI 10.1016/j.neuroimage.2014.05.066

    View details for Web of Science ID 000339860000013

    View details for PubMedID 24893320

    View details for PubMedCentralID PMC4142439

  • Elevated objectively measured but not self-reported energy intake predicts future weight gain in adolescents APPETITE Stice, E., Durant, S. 2014; 81: 84?88

    Abstract

    Although obesity putatively occurs when individuals consume more calories than needed for metabolic needs, numerous risk factor studies have not observed significant positive relations between reported caloric intake and future weight gain, potentially because reported caloric intake is inaccurate.The present study tested the hypothesis that objectively measured habitual energy intake, estimated with doubly labeled water, would show a stronger positive relation to future weight gain than self-reported caloric intake based on a widely used food frequency measure.Two hundred and fifty-three adolescents completed a doubly labeled water (DLW) assessment of energy intake (EI), a food frequency measure, and a resting metabolic rate (RMR) assessment at baseline, and had their body mass index (BMI) measured at baseline and at 1- and 2-year follow-ups.Controlling for baseline RMR, elevated objectively measured EI, but not self-reported habitual caloric intake, predicted increases in BMI over a 2-year follow-up. On average, participants under-reported caloric intake by 35%.RESULTS provide support for the thesis that self-reported caloric intake has not predicted future weight gain because it is less accurate than objectively measured habitual caloric intake, suggesting that food frequency measures can lead to misleading findings. However, even objectively measured caloric intake showed only a moderate relation to future weight gain, implying that habitual caloric intake fluctuates over time and that it may be necessary to conduct serial assessments of habitual intake to better reflect the time-varying effects of caloric intake on weight gain.

    View details for DOI 10.1016/j.appet.2014.06.012

    View details for Web of Science ID 000340987000012

    View details for PubMedID 24930597

    View details for PubMedCentralID PMC4128488

  • Brain Reward Region Responsivity of Adolescents With and Without Parental Substance Use Disorders PSYCHOLOGY OF ADDICTIVE BEHAVIORS Stice, E., Yokum, S. 2014; 28 (3): 805?15

    Abstract

    The present study tested the competing hypotheses that adolescents at risk for future substance abuse and dependence by virtue of parental substance use disorders show either weaker or stronger responsivity of brain regions implicated in reward relative to youth without parental history of substance use disorders. Adolescents (n = 52) matched on demographics with and without parental substance use disorders, as determined by diagnostic interviews, who denied substance use in the past year were compared on functional MRI (fMRI) paradigms assessing neural response to receipt and anticipated receipt of monetary and food reward. Parental-history-positive versus -negative adolescents showed greater activation in the left dorsolateral prefrontal cortex and bilateral putamen, and less activation in the fusiform gyrus and inferior temporal gyrus in response to anticipating winning money, as well as greater activation in the left midbrain and right paracentral lobule, and less activation in the right middle frontal gyrus in response to milkshake receipt. Results indicate that adolescents at risk for future onset of substance use disorders show elevated responsivity of brain regions implicated in reward, extending results from 2 smaller prior studies that found that individuals with versus without parental alcohol use disorders showed greater reward region response to anticipated monetary reward and pictures of alcohol. Collectively, results provide support for the reward surfeit model of substance use disorders, rather than the reward deficit model.

    View details for DOI 10.1037/a0034460

    View details for Web of Science ID 000342223300018

    View details for PubMedID 24128289

    View details for PubMedCentralID PMC3986351

  • Relation of obesity to neural activation in response to food commercials SOCIAL COGNITIVE AND AFFECTIVE NEUROSCIENCE Gearhardt, A. N., Yokum, S., Stice, E., Harris, J. L., Brownell, K. D. 2014; 9 (7): 932?38

    Abstract

    Adolescents view thousands of food commercials annually, but the neural response to food advertising and its association with obesity is largely unknown. This study is the first to examine how neural response to food commercials differs from other stimuli (e.g. non-food commercials and television show) and to explore how this response may differ by weight status. The blood oxygen level-dependent functional magnetic resonance imaging activation was measured in 30 adolescents ranging from lean to obese in response to food and non-food commercials imbedded in a television show. Adolescents exhibited greater activation in regions implicated in visual processing (e.g. occipital gyrus), attention (e.g. parietal lobes), cognition (e.g. temporal gyrus and posterior cerebellar lobe), movement (e.g. anterior cerebellar cortex), somatosensory response (e.g. postcentral gyrus) and reward [e.g. orbitofrontal cortex and anterior cingulate cortex (ACC)] during food commercials. Obese participants exhibited less activation during food relative to non-food commercials in neural regions implicated in visual processing (e.g. cuneus), attention (e.g. posterior cerebellar lobe), reward (e.g. ventromedial prefrontal cortex and ACC) and salience detection (e.g. precuneus). Obese participants did exhibit greater activation in a region implicated in semantic control (e.g. medial temporal gyrus). These findings may inform current policy debates regarding the impact of food advertising to minors.

    View details for DOI 10.1093/scan/nst059

    View details for Web of Science ID 000339953300006

    View details for PubMedID 23576811

    View details for PubMedCentralID PMC4090951

  • Dissonance-based Prevention of Eating Disorder Risk Factors in Middle School Girls: Results from Two Pilot Trials INTERNATIONAL JOURNAL OF EATING DISORDERS Rohde, P., Auslander, B. A., Shaw, H., Raineri, K. M., Gau, J. M., Stice, E. 2014; 47 (5): 483?94

    Abstract

    Although several eating disorder prevention programs reduce eating disorder risk factors and symptoms for female high school and college students, few efficacious prevention programs exist for female middle school students, despite the fact that body image and eating disturbances often emerge then. Two pilot trials evaluated a new dissonance-based eating disorder prevention program for middle school girls with body image concerns.Female middle school students with body dissatisfaction from two sites [Study 1: N = 81, M age = 12.1, standard deviation (SD) = 0.9; Study 2: N = 52, M age = 12.5, SD = 0.8] were randomized to a dissonance intervention (MS Body Project) or educational brochure control; Study 2 included a 3-month follow-up.Intervention participants showed significant post-test reductions in only one of the six variables with both Studies 1 and 2 (i.e., pressure to be thin and negative affect, respectively), though post-test effect sizes suggested medium reductions in eating disorder risk factors and symptoms (Study 1: M d = .40; Study 2: M d = .65); reductions at 3-month follow-up in Study 2 were not evident (M d = .19).Results suggest that this new middle school version of the Body Project is producing medium magnitude reductions in eating disorder risk factors at post-test but that effects are showing limited persistence. Continued refinement and evaluation of this intervention appears warranted to develop more effective prevention programs for this age group.

    View details for DOI 10.1002/eat.22253

    View details for Web of Science ID 000337700300007

    View details for PubMedID 24590419

    View details for PubMedCentralID PMC4053817

  • Cognitive-behavioral group depression prevention compared to bibliotherapy and brochure control: Nonsignificant effects in pilot effectiveness trial with college students BEHAVIOUR RESEARCH AND THERAPY Rohde, P., Stice, E., Shaw, H., Gau, J. M. 2014; 55: 48?53

    Abstract

    Conduct a pilot trial testing whether a brief cognitive-behavioral (CB) group reduced depressive symptoms and secondary outcomes relative to bibliotherapy and brochure controls in college students with elevated depressive symptoms.82 college students (M age=19.0, SD=0.9; 70% female, 80% White) with elevated self-assessed depressive symptoms were randomized to a 6-session CB group, bibliotherapy, or educational brochure control condition, completing assessments at pretest, posttest, and at 6- and 12-month follow-up.Planned contrasts found no significant effects for CB group on depressive symptoms compared to either bibliotherapy or brochure controls at posttest (d=-.08 and .06, respectively) or over follow-up (d=-.04 and -.10, respectively). There were no intervention effects for social adjustment and substance use, though CB group participants had improved knowledge of CB concepts at posttest, versus brochure controls. Condition differences in major depression onset were nonsignificant but suggested support for CB interventions (CB group=7.4%, bibliotherapy=4.5%, brochure control=15.2%).Unexpectedly modest support was found for a brief CB group depression prevention intervention, compared to bibliotherapy or brochure control, when provided to self-selected college students, suggesting that alternative screening or interventions approaches are needed for this population.

    View details for DOI 10.1016/j.brat.2014.02.003

    View details for Web of Science ID 000334823100006

    View details for PubMedID 24655464

    View details for PubMedCentralID PMC3990276

  • Effectiveness of a dissonance-based eating disorder prevention program for ethnic groups in two randomized controlled trials BEHAVIOUR RESEARCH AND THERAPY Stice, E., Marti, C., Cheng, Z. 2014; 55: 54?64

    Abstract

    As young women from certain ethnic minority groups have reported less pursuit of the thin ideal and body dissatisfaction than European American young women we tested whether a dissonance-based prevention program designed to reduce thin-ideal internalization among women with body dissatisfaction is less effective for the former relative to the later groups. We also tested whether intervention effects are larger when participants from minority groups worked with a facilitator matched versus not matched on ethnicity.In Study 1, 426 female undergraduates (M age=21.6, SD=5.6) were randomized to clinician-led Body Project groups or an educational control group. In Study 2, 189 female undergraduates were randomized to peer-led Body Project groups or a waitlist control condition.Although there was some variation in risk factor scores across ethnic groups, ethnic minority participants did not demonstrate consistently higher or lower risk relative to European American participants. Intervention effects did not significantly differ for participants from minority groups versus European American participants in either trial. There was no evidence that effects were significantly larger when minority participants and facilitators were matched on ethnicity.Results suggest that the Body Project is similarly effective for African American, Asian American, European American, and Hispanic female college students, and when participants and facilitators are matched or not on minority ethnicity status, implying that this prevention program can be broadly disseminated in this population.

    View details for DOI 10.1016/j.brat.2014.02.002

    View details for Web of Science ID 000334823100007

    View details for PubMedID 24655465

    View details for PubMedCentralID PMC4014461

  • Moderators of two indicated cognitive-behavioral depression prevention approaches for adolescents in a school-based effectiveness trial BEHAVIOUR RESEARCH AND THERAPY Briere, F. N., Rohde, P., Shaw, H., Stice, E. 2014; 53: 55?62

    Abstract

    Our aim was to identify moderators of the effects of a cognitive behavioral group-based prevention program (CB group) and CB bibliotherapy, relative to an educational brochure control condition and to one another, in a school-based effectiveness randomized controlled prevention trial.378 adolescents (M age = 15.5, 68% female) with elevated depressive symptoms were randomized in one of three conditions and were assessed at pretest, posttest, and 6-month follow-up. We tested the moderating effect of three individual (baseline depressive symptoms, negative attributional style, substance use), three environmental (negative life events, parental support, peer support), and two sociodemographic (sex, age) characteristics.Baseline depressive symptoms interacted with condition and time. Decomposition indicated that elevated baseline depressive symptoms amplified the effect of CB bibliotherapy at posttest (but not 6-month follow-up) relative to the control condition, but did not modify the effect of CB group relative to the control condition or relative to bibliotherapy. Specifically, CB bibliotherapy resulted in lower posttest depressive symptoms than the control condition in individuals with elevated, but not average or low baseline symptoms. We found no interaction effect for other putative moderators.Our findings suggest that bibliotherapy is effective only in participants who have elevated depressive symptoms at baseline. The fact that no study variable moderated the effects of CB group, which had a significant main effect in reducing depressive symptoms relative to the control condition, suggests that this indicated prevention intervention is effective for a wide range of adolescents.

    View details for DOI 10.1016/j.brat.2013.12.005

    View details for Web of Science ID 000331680500007

    View details for PubMedID 24418653

    View details for PubMedCentralID PMC3919661

  • Indicated Cognitive Behavioral Group Depression Prevention Compared to Bibliotherapy and Brochure Control: Acute Effects of an Effectiveness Trial With Adolescents JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Rohde, P., Stice, E., Shaw, H., Briere, F. N. 2014; 82 (1): 65?74

    Abstract

    We tested whether a brief cognitive behavioral (CB) group and bibliotherapy prevention reduce major depressive disorder (MDD) onset, depressive symptoms, and secondary outcomes relative to brochure controls in adolescents with self-reported depressive symptoms when school personnel recruit participants and deliver the intervention.Three hundred seventy-eight adolescents (M age = 15.5 years, SD = 1.2; 68% female, 72% White) with elevated self-assessed depressive symptoms were randomized to a 6-session CB group, minimal contact CB bibliotherapy, or educational brochure control. Participants were assessed at pretest, posttest, and 6-month follow-up.CB group participants showed a significantly lower risk for major depressive disorder onset (0.8%), compared to both CB bibliotherapy (6.3%) and brochure control (6.5%; hazard ratio = 8.1 and 8.3, respectively). Planned contrasts indicated that CB group resulted in lower depressive symptom severity than brochure control at posttest (p = .03, d = 0.29) but not 6-month follow-up; differences between CB group and bibliotherapy were nonsignificant at posttest and 6-month follow-up. Condition effects were nonsignificant for social adjustment and substance use.The finding that a brief CB group intervention delivered by real-world providers significantly reduced MDD onset relative to both brochure control and bibliotherapy is very encouraging, although effects on continuous outcome measures were small or nonsignificant and approximately half the magnitude of those found in efficacy research, potentially because the present sample reported lower initial depression.

    View details for DOI 10.1037/a0034640

    View details for Web of Science ID 000330842700007

    View details for PubMedID 24099432

    View details for PubMedCentralID PMC3932106

  • Neural Responsivity During Soft Drink Intake, Anticipation, and Advertisement Exposure in Habitually Consuming Youth OBESITY Burger, K. S., Stice, E. 2014; 22 (2): 441?50

    Abstract

    Although soft drinks are heavily advertised, widely consumed, and have been associated with obesity, little is understood regarding neural responsivity to soft drink intake, anticipated intake, and advertisements.Functional MRI was used to assess examine neural response to carbonated soft drink intake, anticipated intake and advertisement exposure as well as milkshake intake in 27 adolescents that varied on soft drink consumer status.Intake and anticipated intake of carbonated Coke® activated regions implicated in gustatory, oral somatosensory, and reward processing, yet high-fat/sugar milkshake intake elicited greater activation in these regions vs. Coke intake. Advertisements highlighting the Coke product vs. nonfood control advertisements, but not the Coke logo, activated gustatory and visual brain regions. Habitual Coke consumers vs. nonconsumers showed greater posterior cingulate responsivity to Coke logo ads, suggesting that the logo is a conditioned cue. Coke consumers exhibited less ventrolateral prefrontal cortex responsivity during anticipated Coke intake relative to nonconsumers.Results indicate that soft drinks activate reward and gustatory regions, but are less potent in activating these regions than high-fat/sugar beverages, and imply that habitual soft drink intake promotes hyper-responsivity of regions encoding salience/attention toward brand specific cues and hypo-responsivity of inhibitory regions while anticipating intake.

    View details for DOI 10.1002/oby.20563

    View details for Web of Science ID 000332224200018

    View details for PubMedID 23836764

    View details for PubMedCentralID PMC4005612

  • An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students BEHAVIOUR RESEARCH AND THERAPY Stice, E., Butryn, M. L., Rohde, P., Shaw, H., Marti, C. 2013; 51 (12): 862?71

    Abstract

    Efficacy trials indicate that a dissonance-based prevention program in which female high school and college students with body image concerns critique the thin-ideal reduced risk factors, eating disorder symptoms, and future eating disorder onset, but weaker effects emerged from an effectiveness trial wherein high school clinicians recruited students and delivered the program under real-world conditions. The present effectiveness trial tested whether a new enhanced dissonance version of this program produced larger effects when college clinicians recruited students and delivered the intervention using improved procedures to select, train, and supervise clinicians.Young women recruited from seven universities across the US (N = 408, M age = 21.6, SD = 5.64) were randomized to the dissonance intervention or an educational brochure control condition.Dissonance participants showed significantly greater decreases in risk factors (thin-ideal internalization, body dissatisfaction, dieting, negative affect) and eating disorder symptoms versus controls at posttest and 1-year follow-up, resulting in medium average effect size (d = .60). Dissonance participants also reported significant improvements in psychosocial functioning, but not reduced health care utilization or unhealthy weight gain.This novel multisite effectiveness trial with college clinicians found that the enhanced dissonance version of this program and the improved facilitator selection/training procedures produced average effects that were 83% larger than effects observed in the high school effectiveness trial.

    View details for DOI 10.1016/j.brat.2013.10.003

    View details for Web of Science ID 000328719400011

    View details for PubMedID 24189570

    View details for PubMedCentralID PMC3954852

  • Relative ability of fat and sugar tastes to activate reward, gustatory, and somatosensory regions AMERICAN JOURNAL OF CLINICAL NUTRITION Stice, E., Burger, K. S., Yokum, S. 2013; 98 (6): 1377?84

    Abstract

    Although the intake of high-fat and high-sugar food activates mesolimbic reward, gustatory, and oral somatosensory brain regions, contributing to overeating, few studies have examined the relative role of fat and sugar in the activation of these brain regions, which would inform policy, prevention, and treatment interventions designed to reduce obesity.We evaluated the effect of a high-fat or high-sugar equicaloric chocolate milkshake and increasing fat or sugar milkshake content on the activation of these regions.Functional magnetic resonance imaging was used to assess the neural response to the intake of high-fat/high-sugar, high-fat/low-sugar, low-fat/high-sugar, and low-fat/low-sugar chocolate milkshakes and a tasteless solution in 106 lean adolescents (mean ± SD age = 15.00 ± 0.88 y). Analyses contrasted the activation to the various milkshakes.High-fat compared with high-sugar equicaloric milkshakes caused greater activation in the bilateral caudate, postcentral gyrus, hippocampus, and inferior frontal gyrus. High-sugar compared with high-fat equicaloric milkshakes caused greater activation in the bilateral insula extending into the putamen, the Rolandic operculum, and thalamus, which produced large activation regions. Increasing sugar in low-fat milkshakes caused greater activation in the bilateral insula and Rolandic operculum; increasing fat content did not elicit greater activation in any region.Fat caused greater activation of the caudate and oral somatosensory regions than did sugar, sugar caused greater activation in the putamen and gustatory regions than did fat, increasing sugar caused greater activity in gustatory regions, and increasing fat did not affect the activation. Results imply that sugar more effectively recruits reward and gustatory regions, suggesting that policy, prevention, and treatment interventions should prioritize reductions in sugar intake. This trial was registered at clinicaltrials.gov as DK092468.

    View details for DOI 10.3945/ajcn.113.069443

    View details for Web of Science ID 000328002000003

    View details for PubMedID 24132980

    View details for PubMedCentralID PMC3831532

  • The contribution of brain reward circuits to the obesity epidemic NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS Stice, E., Figlewicz, D. P., Gosnell, B. A., Levine, A. S., Pratt, W. E. 2013; 37 (9): 2047?58

    Abstract

    One of the defining characteristics of the research of Ann E. Kelley was her recognition that the neuroscience underlying basic learning and motivation processes also shed significant light upon mechanisms underlying drug addiction and maladaptive eating patterns. In this review, we examine the parallels that exist in the neural pathways that process both food and drug reward, as determined by recent studies in animal models and human neuroimaging experiments. We discuss contemporary research that suggests that hyperphagia leading to obesity is associated with substantial neurochemical changes in the brain. These findings verify the relevance of reward pathways for promoting consumption of palatable, calorically dense foods, and lead to the important question of whether changes in reward circuitry in response to intake of such foods serve a causal role in the development and maintenance of some cases of obesity. Finally, we discuss the potential value for future studies at the intersection of the obesity epidemic and the neuroscience of motivation, as well as the potential concerns that arise from viewing excessive food intake as an "addiction". We suggest that it might be more useful to focus on overeating that results in frank obesity, and multiple health, interpersonal, and occupational negative consequences as a form of food "abuse".

    View details for DOI 10.1016/j.neubiorev.2012.12.001

    View details for Web of Science ID 000329884200012

    View details for PubMedID 23237885

    View details for PubMedCentralID PMC3604128

  • Eating disorder prevention: Current evidence-base and future directions INTERNATIONAL JOURNAL OF EATING DISORDERS Stice, E., Becker, C., Yokum, S. 2013; 46 (5): 478?85

    Abstract

    This narrative review sought to (a) characterize prevention programs that have produced reliable, reproducible, and clinically meaningful effects in efficacy trials, (b) discuss effectiveness trials that have tested whether prevention programs produce intervention effects under ecologically valid real-world conditions, (c) discuss dissemination efforts and research on dissemination, and (d) offer suggestions regarding directions for future research in this field.A literature revealed that 6 prevention programs have produced significant reductions in eating disorder symptoms through at least 6-month follow-up and that 2 have significantly reduced future eating disorder onset. Effectiveness trials indicate that 2 prevention programs have produced effects under ecologically valid conditions that are only slightly attenuated. Although there have been few dissemination efforts, evidence suggests that a community participatory approach is most effective. Lastly, it would be useful to develop programs that produce larger and more persistent reductions in eating disorder symptoms and eating disorder onset, focus more on effectiveness trials that confirm that prevention programs produce clinically meaningful effects under real-world conditions, conduct meditational, mechanisms of action, and moderator research that provides stronger support for the intervention theory of prevention programs, and investigate the optimal methods of disseminating and implementing evidence-based prevention programs.

    View details for DOI 10.1002/eat.22105

    View details for Web of Science ID 000318779000021

    View details for PubMedID 23658095

    View details for PubMedCentralID PMC3926692

  • Elevated energy intake is correlated with hyperresponsivity in attentional, gustatory, and reward brain regions while anticipating palatable food receipt AMERICAN JOURNAL OF CLINICAL NUTRITION Burger, K. S., Stice, E. 2013; 97 (6): 1188?94

    Abstract

    Obese compared with lean individuals show greater attention-, gustatory-, and reward-region responsivity to food cues but reduced reward-region responsivity during food intake. However, to our knowledge, research has not tested whether an objectively measured caloric intake is positively associated with neural responsivity independent of excess adipose tissue.We tested the hypothesis that objectively measured energy intake, which accounts for basal needs and the percentage of body fat, correlates positively with the neural response to anticipated palatable food intake but negatively with a response to food intake in healthy-weight adolescents.Participants (n = 155; mean ± SD age: 15.9 ± 1.1 y) completed functional magnetic resonance imaging scans while anticipating and receiving palatable food compared with a tasteless solution, a doubly labeled water assessment of energy intake, and assessments of resting metabolic rate and body composition.Energy intake correlated positively with activation in the lateral visual and anterior cingulate cortices (visual processing and attention), frontal operculum (primary gustatory cortex) when anticipating palatable food, and greater striatal activation when anticipating palatable food in a more-sensitive region of interest analysis. Energy intake was not significantly related to neural responsivity during palatable food intake.Results indicate that objectively measured energy intake that accounts for basal needs and adipose tissue correlates positively with activity in attentional, gustatory, and reward regions when anticipating palatable food. Although hyperresponsivity of these regions may increase risk of overeating, it is unclear whether this is an initial vulnerability factor or a result of previous overeating. This trial was registered at clinicaltrials.gov as NCT01807572.

    View details for DOI 10.3945/ajcn.112.055285

    View details for Web of Science ID 000319371500006

    View details for PubMedID 23595877

    View details for PubMedCentralID PMC3652919

  • Functional Connectivity While Viewing Cues for Taste Delivery Related to Body Mass in Healthy-Weight Adolescents Bohon, C., Burger, K. S., Stice, E. ELSEVIER SCIENCE INC. 2013: 197S?198S
  • Effectiveness of peer-led dissonance-based eating disorder prevention groups: Results from two randomized pilot trials BEHAVIOUR RESEARCH AND THERAPY Stice, E., Rohde, P., Durant, S., Shaw, H., Wade, E. 2013; 51 (4-5): 197?206

    Abstract

    The present preliminary trials tested whether undergraduate peer leaders can effectively deliver a dissonance-based eating disorder prevention program, which could facilitate broad dissemination of this efficacious intervention.In Study 1, female undergraduates (N=171) were randomized to peer-led groups, clinician-led groups, or an educational brochure control condition. In Study 2, which improved a design limitation of Study 1 by using completely parallel outcome measures across conditions, female undergraduates (N=148) were randomized to either immediate peer-led groups or a waitlist control condition.In Study 1, participants in peer- and clinician-led groups showed significantly greater pre-post reductions in risk factors and eating disorder symptoms than controls (M d=.64 and .98 respectively), though clinician- versus peer-led groups had higher attendance and competence ratings, and produced stronger effects at posttest (M d=.32) and at 1-year follow-up (M d=.26). In Study 2, participants in peer-led groups showed greater pre-post reductions in all outcomes than waitlist controls (M d=.75).Results provide novel evidence that dissonance-based eating disorder prevention groups led by undergraduate peers are feasible and produce greater reductions in eating disorder risk factors and symptoms than minimal-intervention control conditions, but indicate that effects are smaller for peer- versus clinician-led groups.

    View details for DOI 10.1016/j.brat.2013.01.004

    View details for Web of Science ID 000316830600003

    View details for PubMedID 23419888

    View details for PubMedCentralID PMC3917500

  • Elevated Reward Region Responsivity Predicts Future Substance Use Onset But Not Overweight/Obesity Onset BIOLOGICAL PSYCHIATRY Stice, E., Yokum, S., Burger, K. S. 2013; 73 (9): 869?76

    Abstract

    We tested the hypotheses that adolescents who show elevated reward region responsivity are at increased risk for initial onset of overweight/obesity and substance use, which is important because there have been no such prospective tests of the reward surfeit model of these motivated behaviors.One hundred sixty-two adolescents (mean age = 15.3±1.06 years) with healthy weights (mean body mass index = 20.8±1.90) completed functional magnetic resonance imaging paradigms that assessed neural activation in response to receipt and anticipated receipt of palatable food and monetary reward; body fat and substance use were assessed at baseline and 1-year follow-up.Elevated caudate (r = .31, p<.001) and putamen (r = .28, p<.001) response to monetary reward predicted substance use onset over 1-year follow-up, but reward circuitry responsivity did not predict future overweight/obesity onset. Adolescents who reported substance use versus abstinence at baseline also showed less caudate (r =-.31, p<.001) response to monetary reward.Results show that hyper-responsivity of reward circuitry increases risk for future substance use onset, providing novel support for the reward surfeit model. Results also imply that even a limited substance use history was associated with reduced reward region responsivity, extending results from studies that compared substance-dependent individuals with healthy control subjects and suggesting that substance use downregulates reward circuitry. However, aberrant reward region responsivity did not predict initial unhealthy weight gain.

    View details for DOI 10.1016/j.biopsych.2012.11.019

    View details for Web of Science ID 000317583700015

    View details for PubMedID 23312561

    View details for PubMedCentralID PMC3774523

  • Prevalence, Incidence, Impairment, and Course of the Proposed DSM-5 Eating Disorder Diagnoses in an 8-Year Prospective Community Study of Young Women JOURNAL OF ABNORMAL PSYCHOLOGY Stice, E., Marti, C., Rohde, P. 2013; 122 (2): 445?57

    Abstract

    We examined prevalence, incidence, impairment, duration, and course for the proposed DSM-5 eating disorders in a community sample of 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 was 0.8% for anorexia nervosa (AN), 2.6% for bulimia nervosa (BN), 3.0% for binge eating disorder (BED), 2.8% for atypical AN, 4.4% for subthreshold BN, 3.6% for subthreshold BED, 3.4% for purging disorder (PD), and combined prevalence of 13.1% (5.2% had AN, BN, or BED; 11.5% had feeding and eating disorders not elsewhere classified; FED-NEC). Peak onset age was 19-20 for AN, 16-20 for BN, and 18-20 for BED, PD, and FED-NEC. Youth with these eating disorders typically reported greater functional impairment, distress, suicidality, mental health treatment, and unhealthy body mass index, though effect sizes were relatively smaller for atypical AN, subthreshold BN, and PD. Average episode duration in months ranged from 2.9 for BN to 11.2 for atypical AN. One-year remission rates ranged from 71% for atypical AN to 100% for BN, subthreshold BN, and BED. Recurrence rates ranged from 6% for PD to 33% for BED and subthrehold BED. Diagnostic progression from subthreshold to threshold eating disorders was higher for BN and BED (32% and 28%) than for AN (0%), suggesting some sort of escalation mechanism for binge eating. Diagnostic crossover was greatest from BED to BN. Results imply that the new DSM-5 eating disorder criteria capture clinically significant psychopathology and usefully assign eating disordered individuals to homogeneous diagnostic categories.

    View details for DOI 10.1037/a0030679

    View details for Web of Science ID 000319241100014

    View details for PubMedID 23148784

    View details for PubMedCentralID PMC3980846

  • Moderators of the intervention effects for a dissonance-based eating disorder prevention program; results from an amalgam of three randomized trials BEHAVIOUR RESEARCH AND THERAPY Mueller, S., Stice, E. 2013; 51 (3): 128?33

    Abstract

    To investigate factors hypothesized to moderate the effects of a dissonance-based eating disorder prevention program, including initial elevations in thin-ideal internalization, body dissatisfaction, eating disorders symptoms, and older participant age.Adolescent female high school and college students with body image concerns (N=977; M age=18.6) were randomized to a dissonance-based thin-ideal internalization reduction program or an assessment-only control condition in three prevention trials.The intervention produced (a) significantly stronger reductions in thin-ideal internalization for participants with initial elevations in thin-ideal internalization and a threshold/subthreshold DSM-5 eating disorder at baseline, (b) significantly greater reductions in eating disorder symptoms for participants with versus without a DSM-5 eating disorder at baseline, and (c) significantly stronger reductions in body dissatisfaction for late adolescence/young adulthood versus mid-adolescent participants. Baseline body dissatisfaction did not moderate the intervention effects.Overall, intervention effects tended to be amplified for individuals with initial elevations in risk factors and a DSM-5 eating disorder at baseline. Results suggest that this prevention program is effective for a broad range of individuals, but is somewhat more beneficial for the subgroups identified in the moderation analyses.

    View details for DOI 10.1016/j.brat.2012.12.001

    View details for Web of Science ID 000315252700003

    View details for PubMedID 23337181

    View details for PubMedCentralID PMC3773613

  • Caloric deprivation increases responsivity of attention and reward brain regions to intake, anticipated intake, and images of palatable foods NEUROIMAGE Stice, E., Burger, K., Yokum, S. 2013; 67: 322?30

    Abstract

    Dietary restraint theoretically increases risk for binge eating, but prospective and experimental studies have produced contradictory findings, apparently because dietary restraint scales do not identify individuals who are reducing caloric intake. Yet, experimentally manipulated caloric deprivation increases responsivity of brain regions implicated in attention and reward to food images, which may contribute to binge eating. We tested whether self-imposed acute and longer-term caloric restriction increases responsivity of attention and reward regions to images, anticipated receipt, and receipt of palatable food using functional magnetic resonance imaging among female and male adolescents (Study 1 n=34; Study 2 n=51/81). Duration of acute caloric deprivation correlated positively with activation in regions implicated in attention, reward, and motivation in response to images, anticipated receipt, and receipt of palatable food (e.g., anterior cingulate cortex, orbitofrontal cortex, putamen, and precentral gyrus respectively). Youth in a longer-term negative energy balance likewise showed greater activation in attention (anterior cingulate cortex, ventral medial prefrontal cortex), visual processing (superior visual cortex), reward (caudate) and memory (hippocampus) regions in response to receipt and anticipated receipt of palatable food relative to those in neutral or positive energy balance. Results confirm that self-imposed caloric deprivation increases responsivity of attention, reward, and motivation regions to food, which may explain why caloric deprivation weight loss diets typically do not produce lasting weight loss.

    View details for DOI 10.1016/j.neuroimage.2012.11.028

    View details for Web of Science ID 000314144600030

    View details for PubMedID 23201365

    View details for PubMedCentralID PMC3693571

  • Efficacy Trial of a Selective Prevention Program Targeting Both Eating Disorders and Obesity Among Female College Students: 1- and 2-Year Follow-Up Effects JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Rohde, P., Shaw, H., Marti, C. 2013; 81 (1): 183?89

    Abstract

    Evaluate the effects of a prevention program targeting both eating disorders and obesity at 1- and 2-year follow-ups.Female college students at risk for these outcomes because of body image concerns (N = 398) were randomized to the Healthy Weight 2 group-based 4-hr prevention program, which promotes lasting healthy improvements to dietary intake and physical activity and nutrition science health behavior change principles, or an educational brochure control condition.Intervention participants showed significantly less body dissatisfaction and eating disorder symptoms and lower eating disorder onset through 2-year follow-up versus controls, but the former 2 effects were small. There were no main effects for body mass index (BMI), depressive symptoms, dieting, caloric intake, physical activity, or obesity onset. Moderator analyses revealed stronger eating disorder symptom effects for youths with initially elevated symptoms and lower pressure to be thin, stronger BMI effects for youths with initially elevated symptoms and BMI scores, and weaker eating disorder symptom effects for youths with initially elevated pressure to be thin.The 60% reduction in eating disorder onset over the 2-year follow-up was clinically significant and a novel effect for a prevention program, but the main effects on continuous outcomes were small, suggesting that adding nutrition science principles weakened the intervention efficacy. Effects on both eating disorder symptoms and BMI were greater for those with elevated eating disorder symptoms and BMI at pretest, implying that it might be useful to target these individuals in future trials.

    View details for DOI 10.1037/a0031235

    View details for Web of Science ID 000314255400018

    View details for PubMedID 23231574

    View details for PubMedCentralID PMC3689421

  • Effects of Three Depression Prevention Interventions on Risk for Depressive Disorder Onset in the Context of Depression Risk Factors PREVENTION SCIENCE Rohde, P., Stice, E., Gau, J. M. 2012; 13 (6): 584?93

    Abstract

    Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N?=?341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: Youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: Those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample.

    View details for DOI 10.1007/s11121-012-0284-3

    View details for Web of Science ID 000311537800004

    View details for PubMedID 22932745

    View details for PubMedCentralID PMC3660992

  • Future Directions in Etiologic, Prevention, and Treatment Research for Eating Disorders JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY Stice, E., South, K., Shaw, H. 2012; 41 (6): 845?55

    Abstract

    Significant advances have occurred regarding the understanding of etiologic processes that give rise to eating disorders and the design and evaluation of efficacious prevention programs and treatment interventions. Herein we offer suggestions regarding potentially fruitful directions for future research in these areas. We suggest it would be useful to conduct more methodologically rigorous prospective risk factor studies that involve larger samples, longer follow-up periods, validated and objective measures of a broader array of risk factors, multiple informant data, and prediction of eating disorder onset. We also argue that it will be valuable to conduct experiments to confirm the causal influence of putative risk factors. With regard to prevention research, it would be useful to develop programs that produce larger and more persistent reductions in eating disorder symptoms and eating disorder onset; conduct effectiveness trials that confirm that prevention programs produce clinically meaningful effects under real-world conditions; conduct mediational, mechanisms of action, and moderator research that provides stronger support for the intervention theory of prevention programs; and investigate the optimal methods of disseminating and implementing effective programs. In terms of treatment research, there would be value in conducting more research on maintenance factors for eating pathology, rigorous treatment trials that involve credible placebo interventions and comparisons between the most effective treatments, effectiveness trials, research on novel treatments for recently recognized eating disorders, and research on the dissemination and broad implementation of effective treatments.

    View details for DOI 10.1080/15374416.2012.728156

    View details for Web of Science ID 000315218600013

    View details for PubMedID 23057638

  • A Preliminary Trial of a Prototype Internet Dissonance-Based Eating Disorder Prevention Program for Young Women With Body Image Concerns JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Rohde, P., Durant, S., Shaw, H. 2012; 80 (5): 907?16

    Abstract

    A group dissonance-based eating disorder prevention program, in which young women critique the thin ideal, reduces eating disorder risk factors and symptoms, but it can be difficult to identify school clinicians with the time and expertise to deliver the intervention. Thus, we developed a prototype Internet version of this program and evaluated it in a preliminary trial.Female college students with body dissatisfaction (N = 107; M age = 21.6 years, SD = 6.6) were randomized to the Internet intervention, group intervention, educational video condition, or educational brochure condition.Internet and group participants showed greater pre-post reductions in eating disorder risk factors and symptoms than video controls (M ds = 0.47 and 0.54, respectively) and brochure controls (M ds = 0.75 and 0.72, respectively), with many effects reaching significance. Effects did not differ significantly for Internet versus group participants (M ds = -0.13) or for video versus brochure controls (M d = 0.25). Effect sizes for the Internet intervention were similar to those previously observed for group versions of this intervention.Results suggest that this prototype Internet intervention is as efficacious as the group intervention, implying that there would be merit in completing this intervention and evaluating it in a fully powered trial.

    View details for DOI 10.1037/a0028016

    View details for Web of Science ID 000309312400019

    View details for PubMedID 22506791

    View details for PubMedCentralID PMC3402630

  • Reduced Substance Use as a Secondary Benefit of an Indicated Cognitive-Behavioral Adolescent Depression Prevention Program PSYCHOLOGY OF ADDICTIVE BEHAVIORS Rohde, P., Stice, E., Gau, J. M., Marti, C. 2012; 26 (3): 599?608

    Abstract

    Our first aim was to test whether a group cognitive-behavioral (CB) depression prevention program reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. Our second aim examined whether reductions in depressive symptoms mediate intervention effects, as posited by the affect-regulation model of substance use. In this indicated prevention trial, 341 high school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Group CB intervention, group supportive-expressive group intervention, CB bibliotherapy, or educational brochure control condition. Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Mediational analyses suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Group CB relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Results suggest that a secondary benefit of this CB group indicated depression prevention program is lower rates of long-term substance use. Findings supported the hypothesis that, relative to a nonactive comparison condition, reductions in depressive symptoms mediated the effects of Group CB prevention on substance use escalation.

    View details for DOI 10.1037/a0028269

    View details for Web of Science ID 000308784700024

    View details for PubMedID 22564206

    View details for PubMedCentralID PMC3457800

  • Multilocus Genetic Composite Reflecting Dopamine Signaling Capacity Predicts Reward Circuitry Responsivity JOURNAL OF NEUROSCIENCE Stice, E., Yokum, S., Burger, K., Epstein, L., Smolen, A. 2012; 32 (29): 10093?100

    Abstract

    The objective of the study was to test the hypotheses that humans with genotypes putatively associated with low dopamine (DA) signaling capacity, including the TaqIA A1 allele, DRD2-141C Ins/Ins genotype, DRD4 7-repeat or longer allele, DAT1 10-repeat allele, and the Met/Met COMT genotype, and with a greater number of these genotypes per a multilocus composite, show less responsivity of reward regions that primarily rely on DA signaling. Functional magnetic resonance imaging (fMRI) paradigms were used to investigate activation in response to receipt and anticipated receipt of palatable food and monetary reward. DNA was extracted from saliva using standard methods. Participants were 160 adolescents (mean age = 15.3 years, SD = 1.07 years; mean body mass index = 20.8, SD = 1.9). The main outcome was blood oxygenation level-dependent activation in the fMRI paradigms. Data confirmed that these fMRI paradigms activated reward, attention, somatosensory, and gustatory regions. Individuals with, versus without, these five genotypes did not show less activation of DA-based reward regions, but those with the Met/Met versus the Val/Val COMT genotype showed less middle temporal gyrus activation and those with the DRD4-L versus the DRD4-S genotype showed less middle occipital gyrus activation in response to monetary reward. Critically, the multilocus composite score revealed that those with a greater number of these genotypes showed less activation in reward regions, including the putamen, caudate, and insula, in response to monetary reward. The results suggest that the multilocus genetic composite is a more sensitive index of vulnerability for low reward region responsivity than individual genotypes.

    View details for DOI 10.1523/JNEUROSCI.1506-12.2012

    View details for Web of Science ID 000306528200033

    View details for PubMedID 22815523

    View details for PubMedCentralID PMC3479152

  • Effect of a Dissonance-Based Prevention Program on Risk for Eating Disorder Onset in the Context of Eating Disorder Risk Factors PREVENTION SCIENCE Stice, E., Rohde, P., Gau, J., Shaw, H. 2012; 13 (2): 129?39

    Abstract

    Test (a) whether a dissonance-based eating disorder prevention program that reduces thin-ideal internalization mitigates the effects of risk factors for eating disorder onset and (b) whether the risk factors moderate the effects of this intervention on risk for eating disorder onset, to place the effects of this intervention within the context of established risk factors. Female adolescents (N=481) with body image concerns were randomized to the dissonance-based program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Denial of costs of pursuing the thin-ideal was the most potent risk factor for eating disorder onset during the 3-year follow-up (OR=5.0). The dissonance program mitigated the effect of this risk factor. For participants who did not deny costs of pursuing the thin-ideal, emotional eating and externalizing symptoms increased risk for eating disorder onset. Negative affect attenuated the effects of each of the active interventions in this trial. Results imply that this brief prevention program offsets the risk conveyed by the most potent risk factor for eating disorder onset in this sample, implicate three vulnerability pathways to eating pathology involving thin-ideal pursuit, emotional eating, and externalizing symptoms, and suggest that negative affect mitigates the effects of eating disorder prevention programs.

    View details for DOI 10.1007/s11121-011-0251-4

    View details for Web of Science ID 000301789300003

    View details for PubMedID 21975593

    View details for PubMedCentralID PMC3697758

  • Frequent ice cream consumption is associated with reduced striatal response to receipt of an ice cream-based milkshake AMERICAN JOURNAL OF CLINICAL NUTRITION Burger, K. S., Stice, E. 2012; 95 (4): 810?17

    Abstract

    Weight gain leads to reduced reward-region responsivity to energy-dense food receipt, and consumption of an energy-dense diet compared with an isocaloric, low-energy-density diet leads to reduced dopamine receptors. Furthermore, phasic dopamine signaling to palatable food receipt decreases after repeated intake of that food, which collectively suggests that frequent intake of an energy-dense food may reduce striatal response to receipt of that food.We tested the hypothesis that frequent ice cream consumption would be associated with reduced activation in reward-related brain regions (eg, striatum) in response to receipt of an ice cream-based milkshake and examined the influence of adipose tissue and the specificity of this relation.Healthy-weight adolescents (n = 151) underwent fMRI during receipt of a milkshake and during receipt of a tasteless solution. Percentage body fat, reported food intake, and food craving and liking were assessed.Milkshake receipt robustly activated the striatal regions, yet frequent ice cream consumption was associated with a reduced response to milkshake receipt in these reward-related brain regions. Percentage body fat, total energy intake, percentage of energy from fat and sugar, and intake of other energy-dense foods were not related to the neural response to milkshake receipt.Our results provide novel evidence that frequent consumption of ice cream, independent of body fat, is related to a reduction in reward-region responsivity in humans, paralleling the tolerance observed in drug addiction. Data also imply that intake of a particular energy-dense food results in attenuated reward-region responsivity specifically to that food, which suggests that sensory aspects of eating and reward learning may drive the specificity.

    View details for DOI 10.3945/ajcn.111.027003

    View details for Web of Science ID 000301894400004

    View details for PubMedID 22338036

    View details for PubMedCentralID PMC3302359

  • Efficacy Trial of a Selective Prevention Program Targeting Both Eating Disorder Symptoms and Unhealthy Weight Gain Among Female College Students JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Rohde, P., Shaw, H., Marti, C. 2012; 80 (1): 164?70

    Abstract

    Evaluate a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain in young women.Female college students at high-risk for these outcomes by virtue of body image concerns (N = 398; M age = 18.4 years, SD = 0.6) were randomized to the Healthy Weight group-based 4-hr prevention program, which promotes gradual lasting healthy improvements to dietary intake and physical activity, or an educational brochure control condition.Compared to controls, intervention participants showed significantly greater reductions in body dissatisfaction and eating disorder symptoms, and greater increases in physical activity, at posttest and significantly greater reductions in body mass index (BMI) and self-reported dieting at 6-month follow-up. Moderator analyses revealed significantly greater reductions in eating disorder symptoms for those with initially elevated symptoms and pressure to be thin and significantly greater reductions in BMI for those with initially elevated eating disorder symptoms.Results indicate that this intervention reduced both eating disorder symptoms and unhealthy weight gain, but suggest it should be improved to produce stronger and more persistent effects, and that it may be useful to target young women with both body image and eating disturbances.

    View details for DOI 10.1037/a0026484

    View details for Web of Science ID 000299585300015

    View details for PubMedID 22122289

    View details for PubMedCentralID PMC3265656

  • Negative life events and substance use moderate cognitive behavioral adolescent depression prevention intervention. Cognitive behaviour therapy Gau, J. M., Stice, E., Rohde, P., Seeley, J. R. 2012; 41 (3): 241?50

    Abstract

    Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n = 173) in which adolescents (M age=15.5, SD=1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.

    View details for DOI 10.1080/16506073.2011.649781

    View details for PubMedID 22414236

  • Variability in reward responsivity and obesity: evidence from brain imaging studies. Current drug abuse reviews Burger, K. S., Stice, E. 2011; 4 (3): 182?89

    Abstract

    Advances in neuroimaging techniques have provided insight into the role of the brain in the regulation of food intake and weight. Growing evidence demonstrate that energy dense, palatable foods elicit similar responses in reward-related brain regions that mimic those of addictive substances. Currently, various models of obesity's relation to reward from food have been theorized. There is evidence to support a theory of hypo-responsivity of reward regions to food, where individuals consume excess amounts to overcome this reward deficit. There is also data to support a theory of hyper-responsivity of reward regions, where individuals who experience greater reward from food intake are at risk for overeating. However, these seemingly discordant theories are static in nature and do not account for the possible effects of repeated overeating on brain responsivity to food and initial vulnerability factors. Here we review data that support these theories and propose a dynamic vulnerability model of obesity that appears to offer a parsimonious theory that accommodates extant findings.

    View details for PubMedID 21999692

  • Attentional Bias to Food Images Associated With Elevated Weight and Future Weight Gain: An fMRI Study OBESITY Yokum, S., Ng, J., Stice, E. 2011; 19 (9): 1775?83

    Abstract

    Behavioral studies reveal that obese vs. lean individuals show attentional bias to food stimuli. Yet research has not investigated this relation using objective brain imaging or tested whether attentional bias to food stimuli predicts future weight gain, which are important aims given the prominence of food cues in the environment. We used functional magnetic resonance imaging (fMRI) to examine attentional bias in 35 adolescent girls ranging from lean to obese using an attention network task involving food and neutral stimuli. BMI correlated positively with speed of behavioral response to both appetizing food stimuli and unappetizing food stimuli, but not to neutral stimuli. BMI correlated positively with activation in brain regions related to attention and food reward, including the anterior insula/frontal operculum, lateral orbitofrontal cortex (OFC), ventrolateral prefrontal cortex (vlPFC), and superior parietal lobe, during initial orientation to food cues. BMI also correlated with greater activation in the anterior insula/frontal operculum during reallocation of attention to appetizing food images and with weaker activation in the medial OFC and ventral pallidum during reallocation of attention to unappetizing food images. Greater lateral OFC activation during initial orientation to appetizing food cues predicted future increases in BMI. Results indicate that overweight is related to greater attentional bias to food cues and that youth who show elevated reward circuitry responsivity during food cue exposure are at increased risk for weight gain.

    View details for DOI 10.1038/oby.2011.168

    View details for Web of Science ID 000294410100010

    View details for PubMedID 21681221

    View details for PubMedCentralID PMC4007087

  • 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 Stice, E., Rohde, P., Shaw, H., Gau, J. 2011; 79 (4): 500?508

    Abstract

    Efficacy trials found that a dissonance-based eating disorder prevention program in which female high school and college students with body image concerns critique the thin ideal reduced eating disorder risk factors, eating disorder symptoms, and future eating disorder onset. The present effectiveness trial tested whether this program produces effects through long-term follow-up when high school clinicians recruit students and deliver the intervention under real-world conditions.Female high school students with body image concerns (N = 306; M age = 15.7 years, SD = 1.1) were randomized to the dissonance intervention or an educational brochure control condition and completed assessments through 3-year follow-up.Dissonance 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.Although it was encouraging that some key effects persisted over long-term follow-up, effects were on average smaller in this effectiveness trial than previous efficacy trials, which could be due to (a) facilitator selection, training, and supervision; (b) the lower risk status of participants; or (c) the use of a control condition that produces some effects.

    View details for DOI 10.1037/a0024351

    View details for Web of Science ID 000293376900009

    View details for PubMedID 21707136

    View details for PubMedCentralID PMC3144302

  • Weight suppression and risk of future increases in body mass: effects of suppressed resting metabolic rate and energy expenditure AMERICAN JOURNAL OF CLINICAL NUTRITION Stice, E., Durant, S., Burger, K. S., Schoeller, D. A. 2011; 94 (1): 7?11

    Abstract

    Weight suppression, which reflects the difference between the highest previous weight and current weight, has predicted future increases in body mass index (BMI) and bulimic pathology; however, the mechanisms underlying these predictive effects are unclear.The current study sought to test whether weight suppression predicts future increases in BMI and bulimic symptoms and whether suppressed resting metabolic rate (RMR) and suppressed total energy expenditure (TEE) drive these relations.A randomly selected subsample of 91 young women in their first year of college with body image concerns completed an RMR assessment--a doubly labeled water assessment of TEE--and provided data on weight suppression and change in BMI and bulimic symptoms over a 6-mo follow-up period.Weight suppression predicted future increases in BMI and correlated inversely with suppressed RMR and TEE, yet this predictive effect did not decrease when suppressed RMR and TEE were controlled for. Weight suppression, however, did not predict future increases in bulimic symptoms.The results provide additional evidence that weight suppression predicts future increases in BMI but not in bulimic symptoms. Weight suppression showed moderate relations with suppressed RMR and TEE, but these variables do not appear to drive the predictive effect on future increases in BMI. This trial was registered at clinicaltrials.gov as NCT00433680.

    View details for DOI 10.3945/ajcn.110.010025

    View details for Web of Science ID 000291794800004

    View details for PubMedID 21525201

    View details for PubMedCentralID PMC3127521

  • Testing Mediators Hypothesized to Account for the Effects of a Dissonance-Based Eating Disorder Prevention Program Over Longer Term Follow-Up JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Marti, C., Rohde, P., Shaw, H. 2011; 79 (3): 398?405

    Abstract

    Test the hypothesis that reductions in thin-ideal internalization and body dissatisfaction mediate the effects of a dissonance-based eating disorder prevention program on reductions in eating disorder symptoms over 1-year follow-up.Data were drawn from a randomized effectiveness trial in which 306 female high school students (mean age = 15.7 years, SD = 1.1) with body image concerns were randomized to the 4-session dissonance-based prevention program or an educational brochure control condition, wherein school counselors and nurses were responsible for participant recruitment and intervention delivery.Dissonance-intervention participants showed greater reductions in thin-ideal internalization, body dissatisfaction, and eating disorder symptoms; change in thin-ideal internalization predicted change in body dissatisfaction and symptoms; change in body dissatisfaction predicted change in symptoms; and all indirect effects were significant. Change in thin-ideal internalization fully mediated the effects of intervention condition on change in body dissatisfaction and partially mediated the effects on symptoms; change in body dissatisfaction partially mediated the effect of intervention condition on change in symptoms.Findings provided support for the intervention theory of this eating disorder prevention program over longer term follow-up, extending the evidence base for this effective intervention.

    View details for DOI 10.1037/a0023321

    View details for Web of Science ID 000291129600014

    View details for PubMedID 21500884

    View details for PubMedCentralID PMC3109095

  • Youth at Risk for Obesity Show Greater Activation of Striatal and Somatosensory Regions to Food JOURNAL OF NEUROSCIENCE Stice, E., Yokum, S., Burger, K. S., Epstein, L. H., Small, D. M. 2011; 31 (12): 4360?66

    Abstract

    Obese humans, compared with normal-weight humans, have less striatal D2 receptors and striatal response to food intake; weaker striatal response to food predicts weight gain for individuals at genetic risk for reduced dopamine (DA) signaling, consistent with the reward-deficit theory of obesity. Yet these may not be initial vulnerability factors, as overeating reduces D2 receptor density, D2 sensitivity, reward sensitivity, and striatal response to food. Obese humans also show greater striatal, amygdalar, orbitofrontal cortex, and somatosensory region response to food images than normal-weight humans do, which predicts weight gain for those not at genetic risk for compromised dopamine signaling, consonant with the reward-surfeit theory of obesity. However, after pairings of palatable food intake and predictive cues, DA signaling increases in response to the cues, implying that eating palatable food contributes to increased responsivity. Using fMRI, we tested whether normal-weight adolescents at high- versus low-risk for obesity showed aberrant activation of reward circuitry in response to receipt and anticipated receipt of palatable food and monetary reward. High-risk youth showed greater activation in the caudate, parietal operculum, and frontal operculum in response to food intake and in the caudate, putamen, insula, thalamus, and orbitofrontal cortex in response to monetary reward. No differences emerged in response to anticipated food or monetary reward. Data indicate that youth at risk for obesity show elevated reward circuitry responsivity in general, coupled with elevated somatosensory region responsivity to food, which may lead to overeating that produces blunted dopamine signaling and elevated responsivity to food cues.

    View details for DOI 10.1523/JNEUROSCI.6604-10.2011

    View details for Web of Science ID 000288750700003

    View details for PubMedID 21430137

    View details for PubMedCentralID PMC3260083

  • Relation of dietary restraint scores to activation of reward-related brain regions in response to food intake, anticipated intake, and food pictures NEUROIMAGE Burger, K. S., Stice, E. 2011; 55 (1): 233?39

    Abstract

    Prospective studies indicate that individuals with elevated dietary restraint scores are at increased risk for future bulimic symptom onset, suggesting that these individuals may show hyper-responsivity of reward regions to food and food cues. Thus, we used functional magnetic resonance imaging (fMRI) to examine the relation of dietary restraint scores to activation of reward-related brain regions in response to receipt and anticipated receipt of chocolate milkshake and exposure to pictures of appetizing foods in 39 female adolescents (mean age=15.5 ± 0.94). Dietary restraint scores were positively correlated with activation in the right orbitofrontal cortex (OFC) and bilateral dorsolateral prefrontal cortex (DLPFC) in response to milkshake receipt. However, dietary restraint scores did not correlate with activation in response to anticipated milkshake receipt or exposure to food pictures. Results indicate that individuals who report high dietary restraint have a hyper-responsivity in reward-related brain regions when food intake is occurring, which may increase risk for overeating and binge eating.

    View details for DOI 10.1016/j.neuroimage.2010.12.009

    View details for Web of Science ID 000287008900021

    View details for PubMedID 21147234

    View details for PubMedCentralID PMC3032532

  • Dopamine-Based Reward Circuitry Responsivity, Genetics, and Overeating BEHAVIORAL NEUROBIOLOGY OF EATING DISORDERS Stice, E., Yokum, S., Zald, D., Dagher, A., Adan, R. A., Kaye, W. H. 2011; 6: 81?93

    Abstract

    Data suggest that low levels of dopamine D2 receptors and attenuated responsivity of dopamine-target regions to food intake is associated with increased eating and elevated weight. There is also growing (although mixed) evidence that genotypes that appear to lead to reduced dopamine signaling (e.g., DRD2, DRD4, and DAT) and certain appetite-related hormones and peptides (e.g., ghrelin, orexin A, leptin) moderate the relation between dopamine signaling, overeating, and obesity. This chapter reviews findings from studies that have investigated the relation between dopamine functioning and food intake and how certain genotypes and appetite-related hormones and peptides affect this relation.

    View details for DOI 10.1007/7854_2010_89

    View details for Web of Science ID 000286843100005

    View details for PubMedID 21243471

  • Moving from efficacy to effectiveness trials in prevention research BEHAVIOUR RESEARCH AND THERAPY Marchand, E., Stice, E., Rohde, P., Becker, C. 2011; 49 (1): 32?41

    Abstract

    Efficacy trials test whether interventions work under optimal, highly controlled conditions whereas effectiveness trials test whether interventions work with typical clients and providers in real-world settings. Researchers, providers, and funding bodies have called for more effectiveness trials to understand whether interventions produce effects under ecologically valid conditions, which factors predict program effectiveness, and what strategies are needed to successfully implement programs in practice settings. The transition from efficacy to effectiveness with preventive interventions involves unique considerations, some of which are not shared by treatment research. The purpose of this article is to discuss conceptual and methodological issues that arise when making the transition from efficacy to effectiveness research in primary, secondary, and tertiary prevention, drawing on the experiences of two complimentary research groups as well as the existing literature. We address (a) program of research, (b) intervention design and conceptualization, (c) participant selection and characteristics, (d) providers, (e) context, (f) measurement and methodology, (g) outcomes, (h) cost, and (i) sustainability. We present examples of research in eating disorder prevention that demonstrate the progression from efficacy to effectiveness trials.

    View details for DOI 10.1016/j.brat.2010.10.008

    View details for Web of Science ID 000287061500005

    View details for PubMedID 21092935

    View details for PubMedCentralID PMC3883560

  • Effects of an indicated cognitive-behavioral depression prevention program are similar for Asian American, Latino, and European American adolescents BEHAVIOUR RESEARCH AND THERAPY Marchand, E., Ng, J., Rohde, P., Stice, E. 2010; 48 (8): 821?25

    Abstract

    The authors tested whether a brief indicated cognitive-behavioral depression prevention program produced similar effects for Asian American, Latino, and European American adolescents (M age = 17.3, SD = 1.6) with elevated depressive symptoms using data from two randomized trials. The first trial involved 37 Asian-American/Pacific Islanders, 32 Latinos, and 98 European Americans and the second trial involved 61 Latinos and 72 European Americans. Reductions in depressive symptoms from pre- to post-intervention and from pre to 6-month follow-up for intervention participants versus assessment-only controls did not differ significantly for the various ethnic groups in either trial, despite sufficient power to detect clinically meaningful differences. These findings suggest that this indicated depression prevention intervention is similarly efficacious for Asian American, Latino and European American adolescents.

    View details for DOI 10.1016/j.brat.2010.05.005

    View details for Web of Science ID 000281102400019

    View details for PubMedID 20537319

    View details for PubMedCentralID PMC2918730

  • Reward circuitry responsivity to food predicts future increases in body mass: Moderating effects of DRD2 and DRD4 NEUROIMAGE Stice, E., Yokum, S., Bohon, C., Marti, N., Smolen, A. 2010; 50 (4): 1618-1625

    Abstract

    To determine whether responsivity of reward circuitry to food predicts future increases in body mass and whether polymorphisms in DRD2 and DRD4 moderate these relations.The functional magnetic resonance imaging (fMRI) paradigm investigated blood oxygen level dependent activation in response to imagined intake of palatable foods, unpalatable foods, and glasses of water shown in pictures. DNA was extracted from saliva samples using standard salting-out and solvent precipitation methods.Forty-four adolescent female high school students ranging from lean to obese.Future increases in body mass index (BMI).Weaker activation of the frontal operculum, lateral orbitofrontal cortex, and striatum in response to imagined intake of palatable foods, versus imagined intake of unpalatable foods or water, predicted future increases in body mass for those with the DRD2 TaqIA A1 allele or the DRD4-7R allele. Data also suggest that for those lacking these alleles, greater responsivity of these food reward regions predicted future increases in body mass.This novel prospective fMRI study indicates that responsivity of reward circuitry to food increases risk for future weight gain, but that genes that impact dopamine signaling capacity moderate the predictive effects, suggesting two qualitatively distinct pathways to unhealthy weight gain based on genetic risk.

    View details for DOI 10.1016/j.neuroimage.2010.01.081

    View details for Web of Science ID 000276023500028

    View details for PubMedID 20116437

  • Testing Mediators of Intervention Effects in Randomized Controlled Trials: An Evaluation of Three Depression Prevention Programs JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Rohde, P., Seeley, J. R., Gau, J. M. 2010; 78 (2): 273?80

    Abstract

    Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs.In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive-behavioral (CB) intervention, group supportive expressive intervention, CB bibliotherapy, or assessment-only control condition.The group CB intervention reduced depressive symptoms and negative cognitions and increased pleasant activities. Change in these mediators predicted change in depression, and intervention effects became weaker controlling for change in the mediators; yet, change in depression appeared typically to occur before change in the mediators. The supportive expressive intervention reduced depressive symptoms but affected only 1 of 2 mediators (emotional expression but not loneliness). Change in emotional expression did not correlate with change in depression, and change in depression usually occurred before change in the mediators. Bibliotherapy did not significantly affect depressive symptoms or the ostensive mediators (negative cognitions and pleasant activities), and change in depression usually occurred before change in the mediators.Results imply that this procedure provides a sensitive test of mediation but yielded limited support for the hypothesized mediators, suggesting that nonspecific factors may play an important mediational role.

    View details for DOI 10.1037/a0018396

    View details for Web of Science ID 000276572800014

    View details for PubMedID 20350038

    View details for PubMedCentralID PMC2859826

  • Risk factors and prodromal eating pathology JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY Stice, E., Ng, J., Shaw, H. 2010; 51 (4): 518?25

    Abstract

    Prospective studies have identified factors that increase risk for eating pathology onset, including perceived pressure for thinness, thin-ideal internalization, body dissatisfaction, dietary restraint, and negative affect. Research also suggests that body dissatisfaction and dietary restraint may constitute prodromal stages of the development of eating disorders. Prevention trials indicate that interventions that reduce pressure to be thin, thin-ideal internalization, body dissatisfaction, and negative affect significantly reduce eating disorder symptoms. Further, there is evidence that selective prevention programs that target young women at elevated risk for eating pathology by virtue of thin-ideal internalization, body dissatisfaction, and negative affect produce significant larger intervention effects than do universal programs offered to unselected populations. Thus, research on risk factors and prodromal stages of eating pathology has assisted in the design of efficacious prevention programs and the identification of high-risk individuals to target with these interventions; additional research in this area may lead to even more effective prevention programs.

    View details for DOI 10.1111/j.1469-7610.2010.02212.x

    View details for Web of Science ID 000275519500009

    View details for PubMedID 20074299

  • Are dietary restraint scales valid measures of dietary restriction? Additional objective behavioral and biological data suggest not APPETITE Stice, E., Sysko, R., Roberto, C. A., Allison, S. 2010; 54 (2): 331?39

    Abstract

    Prospective studies find that individuals with elevated dietary restraint scores are at increased risk for bulimic symptom onset, yet experiments find that assignment to energy-deficit diet interventions reduce bulimic symptoms. One explanation for the conflicting findings is that the dietary restraint scales used in the former studies do not actually identify individuals who are restraining their caloric intake. Thus, we tested whether dietary restraint scales showed inverse relations to objectively measured caloric intake in three studies. Four dietary restraint scales did not correlate with doubly labeled water estimates of caloric intake over a 2-week period (M, r=.01). One scale showed a significant inverse correlation with objectively measured caloric intake during a regular meal ordered from an ecologically valid menu (M, r=-.30), but a significant positive relation that was qualified by a significant quadratic effect, to objectively measured caloric intake during multiple eating episodes in the lab (M, r=.32). In balance, results suggest that dietary restraint scales are not valid measures of dietary restriction, replicating findings from prior studies that examined objective measures of caloric intake.

    View details for DOI 10.1016/j.appet.2009.12.009

    View details for Web of Science ID 000276005100013

    View details for PubMedID 20006662

    View details for PubMedCentralID PMC2830309

  • Genetic Variation in Dopaminergic Reward in Humans FRONTIERS IN EATING AND WEIGHT REGULATION Stice, E., Dagher, A., Langhans, W., Geary, N. 2010; 63: 176?85

    Abstract

    Dopamine-based reward circuitry appears to play a role in encoding reward from eating and incentive sensitization, whereby cues associated with food reward acquire motivational value. Data suggest that low levels of dopamine D2 receptors and attenuated responsivity of dopamine-target regions (e.g. the striatum) to food and food cues are associated with elevated weight. There is mixed evidence that genotypes that appear to be associated with reduced signaling of dopamine circuitry, including DRD2, DRD4 and DAT, are correlated with obesity. In addition, there is emerging fMRI evidence that reduced responsivity in brain regions implicated in food reward increase risk for future weight gain among individuals who appear to be at genetic risk for attenuated dopamine signaling by virtue of DRD2 and DRD4 genotypes. However, it is vital for these relations to be replicated in larger, independent prospective studies and to use positron emission tomography to better characterize parameters of dopamine signaling, including dopamine receptor density, basal dopamine levels, and phasic dopamine release. Improved understanding of the role of dopamine-based reward circuitry and genotypes that influence the functioning of this circuitry may inform the design of more effective preventive and treatment interventions for obesity.

    View details for Web of Science ID 000273355700015

    View details for PubMedID 19955785

  • Major and Minor Depression in Female Adolescents: Onset, Course, Symptom Presentation, and Demographic Associations JOURNAL OF CLINICAL PSYCHOLOGY Rohde, P., Beevers, C. G., Stice, E., O'Neil, K. 2009; 65 (12): 1339?49

    Abstract

    We examined the epidemiology and phenomenology of major depressive disorder (MDD) and minor depression among a community sample of 496 female adolescents. Diagnostic interviews were conducted annually for 7 years, allowing us to examine onset, course, and symptom presentation among participants 12 through 20 years old. Approximately 1 of 6 girls experienced MDD. MDD episodes had a mean duration of 5.3 months (SD=4.2). One-year prevalence for MDD peaked at age 16 (5.3%). White racial status and younger age were associated with greater worthlessness and suicidality during an MDD episode. One of 5 girls met criteria for minor depression. Adolescents from racial/ethnic minority groups were at especially high risk for minor depression. Adolescence is a high-risk period for depression in young women, although its prevalence and phenomenology vary as a function of age and race/ethnicity.

    View details for DOI 10.1002/jclp.20629

    View details for Web of Science ID 000271921500009

    View details for PubMedID 19827116

    View details for PubMedCentralID PMC4217533

  • An Effectiveness Trial of a Dissonance-Based Eating Disorder Prevention Program for High-Risk Adolescent Girls JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Rohde, P., Gau, J., Shaw, H. 2009; 77 (5): 825?34

    Abstract

    Efficacy trials indicate that an eating disorder prevention program involving dissonance-inducing activities that decrease thin-ideal internalization reduces risk for current and future eating pathology, yet it is unclear whether this program produces effects under real-world conditions. The present effectiveness trial tested whether this program produced effects when school staff recruit participants and deliver the intervention. Adolescent girls with body image concerns (N = 306; M age = 15.7, SD = 1.1) randomized to the dissonance intervention 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, and eating disorder symptoms persisting through 1-year follow-up. Effects were slightly smaller than those observed in a prior efficacy trial, suggesting that this program is effective under real-world conditions, but that facilitator selection, training, and supervision could be improved.

    View details for DOI 10.1037/a0016132

    View details for Web of Science ID 000270564400003

    View details for PubMedID 19803563

    View details for PubMedCentralID PMC2760014

  • Relation of obesity to consummatory and anticipatory food reward Stice, E., Spoor, S., Ng, J., Zald, D. H. PERGAMON-ELSEVIER SCIENCE LTD. 2009: 551?60

    Abstract

    This report reviews findings from studies that have investigated whether abnormalities in reward from food intake and anticipated food intake increase risk for obesity. Self-report and behavioral data suggest that obese relative to lean individuals show elevated anticipatory and consummatory food reward. Brain imaging studies suggest that obese relative to lean individuals show greater activation of the gustatory cortex (insula/frontal operculum) and oral somatosensory regions (parietal operculum and Rolandic operculum) in response to anticipated intake and consumption of palatable foods. Yet, data also suggest that obese relative to lean individuals show less activation in the dorsal striatum in response to consumption of palatable foods and reduced striatal D2 dopamine receptor density. Emerging prospective data also suggest that abnormal activation in these brain regions increases risk for future weight gain and that genotypes associated with lowered dopamine signaling amplify these predictive effects. Results imply that individuals who show greater activation in the gustatory cortex and somatosensory regions in response to anticipation and consumption of food, but who show weaker activation in the striatum during food intake, may be at risk for overeating, particularly those at genetic risk for lowered dopamine receptor signaling.

    View details for DOI 10.1016/j.physbeh.2009.03.020

    View details for Web of Science ID 000267729700007

    View details for PubMedID 19328819

    View details for PubMedCentralID PMC2734415

  • A Meta-Analytic Review of Depression Prevention Programs for Children and Adolescents: Factors That Predict Magnitude of Intervention Effects JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Shaw, H., Bohon, C., Marti, C. N., Rohde, P. 2009; 77 (3): 486-503

    Abstract

    In this meta-analytic review, the authors summarized the effects of depression prevention programs for youth as well as investigated participant, intervention, provider, and research design features associated with larger effects. They identified 47 trials that evaluated 32 prevention programs, producing 60 intervention effect sizes. The average effect for depressive symptoms from pre-to-posttreatment (r = .15) and pretreatment to-follow-up (r = .11) were small, but 13 (41%) prevention programs produced significant reductions in depressive symptoms and 4 (13%) produced significant reductions in risk for future depressive disorder onset relative to control groups. Larger effects emerged for programs targeting high-risk individuals, samples with more females, samples with older adolescents, programs with a shorter duration and with homework assignments, and programs delivered by professional interventionists. Intervention content (e.g., a focus on problem-solving training or reducing negative cognitions) and design features (e.g., use of random assignment and structured interviews) were unrelated to effect sizes. Results suggest that depression prevention efforts produce a higher yield if they incorporate factors associated with larger intervention effects (e.g., selective programs with a shorter duration that include homework).

    View details for DOI 10.1037/a0015168

    View details for PubMedID 19485590

  • Screening for Depression Prevention: Identifying Adolescent Girls at High Risk for Future Depression JOURNAL OF ABNORMAL PSYCHOLOGY Seeley, J. R., Stice, E., Rohde, P. 2009; 118 (1): 161?70

    Abstract

    This study investigated a broad array of putative risk factors for the onset of major depression and examined their screening properties in a longitudinal study of 479 adolescent girls. Results indicated that the most potent predictors of major depression onset included subthreshold depressive symptoms, poor school and family functioning, low parental support, bulimic symptoms, and delinquency. Classification tree analysis revealed interactions between 4 of these predictors, suggesting qualitatively different pathways to major depression. Girls with the combination of elevated depressive symptoms and poor school functioning represented the highest risk group, with a 40% incidence of major depression during the ensuing 4-year period. Results suggest that selected and indicated prevention programs should target these high-risk populations and seek to reduce these risk factors.

    View details for DOI 10.1037/a0014741

    View details for Web of Science ID 000263369700015

    View details for PubMedID 19222322

    View details for PubMedCentralID PMC2849672

  • Preventing Eating Disorders CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Shaw, H., Stice, E., Becker, C. 2009; 18 (1): 199-+

    Abstract

    This article reviews eating disorder (ED) prevention programs, highlighting features that define successful programs and particularly promising interventions, and how they might be further refined. The field of ED prevention has advanced considerably both theoretically and methodologically compared with the earlier ED prevention programs, which were largely psychoeducational and met with limited success. Recent meta-analytic findings show that more than half (51%) of ED prevention interventions reduced ED risk factors and more than a quarter (29%) reduced current or future eating pathology (EP). A couple of brief programs have been shown to reduce the risk for future onset of EP and obesity. Selected interactive, multisession programs offered to participants older than 15 years, delivered by professional interventionists and including body acceptance or dissonance-induction content, produced larger effects. Understanding and applying these results can help inform the design of more effective prevention programs in the future.

    View details for DOI 10.1016/j.chc.2008.07.012

    View details for Web of Science ID 000261975400016

    View details for PubMedID 19014867

    View details for PubMedCentralID PMC2938770

  • Subtyping Women With Bulimia Nervosa Along Dietary and Negative Affect Dimensions: Further Evidence of Reliability and Validity JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Bohon, C., Marti, C. N., Fischer, K. 2008; 76 (6): 1022-1033

    Abstract

    Studies have found that individuals with bulimia nervosa can be classified into dietary and dietary-negative affect subtypes and that the latter exhibit greater eating pathology, psychiatric comorbidity, and functional impairment; a more protracted clinical course; and a worse treatment response. In this report, the authors describe 2 prospective studies that found that young women with threshold (n = 48) and subthreshold (n = 83) bulimic pathology can be classified into dietary and dietary-negative affect subtypes; that two subtyping approaches produced similar results (mean kappa = .94); that the subtyping distinction showed 4-week test-retest reliability (kappa = .61); and that the dietary-negative affect subtype showed greater eating pathology, emotional distress, functional impairment, treatment seeking, and lower likelihood of recovery over 6-month and 3-year follow-ups than the dietary subtype. The dieting-negative affect subtyping distinction evidenced greater test-retest reliability and concurrent and predictive validity than did the purging-nonpurging subtyping distinction. The additional evidence for the reliability and validity of this subtyping scheme, particularly the prognostic utility, suggests it is worth additional inquiry.

    View details for DOI 10.1037/a0013887

    View details for Web of Science ID 000261113000011

    View details for PubMedID 19045970

    View details for PubMedCentralID PMC2849665

  • Relation of Reward From Food Intake and Anticipated Food Intake to Obesity: A Functional Magnetic Resonance Imaging Study JOURNAL OF ABNORMAL PSYCHOLOGY Stice, E., Spoor, S., Bohon, C., Veldhuizen, M. G., Small, D. M. 2008; 117 (4): 924-935

    Abstract

    The authors tested the hypothesis that obese individuals experience greater reward from food consumption (consummatory food reward) and anticipated consumption (anticipatory food reward) than lean individuals using functional magnetic resonance imaging (fMRI) with 33 adolescent girls (mean age = 15.7, SD = 0.9). Obese relative to lean adolescent girls showed greater activation bilaterally in the gustatory cortex (anterior and mid insula, frontal operculum) and in somatosensory regions (parietal operculum and Rolandic operculum) in response to anticipated intake of chocolate milkshake (vs. a tasteless solution) and to actual consumption of milkshake (vs. a tasteless solution); these brain regions encode the sensory and hedonic aspects of food. However, obese relative to lean adolescent girls also showed decreased activation in the caudate nucleus in response to consumption of milkshake versus a tasteless solution, potentially because they have reduced dopamine receptor availability. Results suggest that individuals who show greater activation in the gustatory cortex and somatosensory regions in response to anticipation and consumption of food, but who show weaker activation in the striatum during food intake, may be at risk for overeating and consequent weight gain.

    View details for DOI 10.1037/a0013600

    View details for Web of Science ID 000260974500017

    View details for PubMedID 19025237

    View details for PubMedCentralID PMC2681092

  • Fasting Increases Risk for Onset of Binge Eating and Bulimic Pathology: A 5-Year Prospective Study JOURNAL OF ABNORMAL PSYCHOLOGY Stice, E., Davis, K., Miller, N. P., Marti, C. 2008; 117 (4): 941?46

    Abstract

    Although adolescent girls with elevated dietary restraint scores are at increased risk for future binge eating and bulimic pathology, they do not eat less than those with lower restraint scores. The fact that only a small proportion of individuals with elevated dietary restraint scores develop bulimic pathology suggests that some extreme but rare form of dietary restriction may increase risk for this disturbance. The authors tested the hypothesis that fasting (going without eating for 24 hr for weight control) would be a more potent predictor of binge eating and bulimic pathology onset than dietary restraint scores using data from 496 adolescent girls followed over 5 years. Results confirmed that only 23% of participants with elevated dietary restraint scores reported fasting. Furthermore, fasting generally showed stronger and more consistent predictive relations to future onset of recurrent binge eating and threshold/subthreshold bulimia nervosa over 1- to 5-year follow-up relative to dietary restraint, though the former effects were only significantly stronger than the latter for some comparisons. Results provide preliminary support for the hypothesis that fasting is a stronger risk factor for bulimic pathology than is self-reported dieting.

    View details for DOI 10.1037/a0013644

    View details for Web of Science ID 000260974500019

    View details for PubMedID 19025239

    View details for PubMedCentralID PMC2850570

  • Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Rohde, P., Seeley, J. R., Gau, J. M. 2008; 76 (4): 595?606

    Abstract

    In this depression prevention trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater reductions in depressive symptoms than did supportive-expressive, bibliotherapy, and assessment-only participants at posttest, though only the difference compared with assessment controls was significant at 6-month follow-up. CB participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions. Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls at certain follow-up assessments but produced no effects for social adjustment and substance use. CB, supportive-expressive, and bibliotherapy participants showed a significantly lower risk for major depression onset over the 6-month follow-up than did assessment-only controls. The evidence that this brief CB intervention reduced risk for future depression onset and outperformed alternative interventions for certain ecologically important outcomes suggests that this intervention may have clinical utility.

    View details for DOI 10.1037/a0012645

    View details for Web of Science ID 000258008000006

    View details for PubMedID 18665688

    View details for PubMedCentralID PMC2553682

  • Are dietary restraint scales valid measures of moderate- to long-term dietary restriction? Objective biological and behavioral data suggest not PSYCHOLOGICAL ASSESSMENT Stice, E., Cooper, J. A., Schoeller, D. A., Tappe, K., Lowe, M. R. 2007; 19 (4): 449?58

    Abstract

    Prospective studies indicate that elevated scores on dietary restraint scales predict bulimic symptom onset, but experiments indicate that assignment to dietary restriction interventions reduces bulimic symptoms. One possible explanation for the inconsistent findings is that the dietary restraint scales used in the former studies are not valid measures of dietary restriction. The authors previously found that dietary restraint scales were not inversely correlated with objective measures of short-term caloric intake (E. Stice, M. Fisher, & M. R. Lowe, 2004). In this follow-up report, 3 studies indicated that the Three-Factor Eating Questionnaire dietary restraint scale was not correlated with doubly labeled water estimated energy intake over 2-week periods or with observationally measured caloric intake over 3 months. Results from this study and others suggest that dietary restraint scales may not be valid measures of moderate- to long-term dietary restriction and imply the need to reinterpret findings from studies that have used dietary restraint scales.

    View details for DOI 10.1037/1040-3590.19.4.449

    View details for Web of Science ID 000251631900008

    View details for PubMedID 18085937

  • Relations of bulilmic symptom frequency and intensity to psychosocial impairment and health care utilization: Results from a community-recruited sample INTERNATIONAL JOURNAL OF EATING DISORDERS Spoor, S. T., Stice, E., Burton, E., Bohon, C. 2007; 40 (6): 505-514

    Abstract

    To determine the frequency and intensity of bulimic symptoms related to psychosocial impairment and health care utilization.Females (N = 1231, M age = 17.7, range 13-55) from four community-recruited samples varying in bulimic pathology completed the eating disorder examination, social adjustment scale, and health survey utilization scale.Co-occurrence of binge eating and compensatory behaviors and solely compensatory behaviors >or=1 time/month were associated with elevations in psychosocial impairment. Co-occurrence of both binge eating and compensatory behaviors and solely compensatory behaviors >or=8 times/month were related to greater service utilization. Solely binge eating and duration of bulimic behaviors were unrelated to these functional outcomes. Overvaluation of body shape and weight showed significant linear relations to the functional outcomes.Results suggest that current diagnostic thresholds for bulimia nervosa may be too high when considering functional impairment and service utilization and that different cut-points need to be considered for different bulimic symptoms.

    View details for DOI 10.1002/eat.20410

    View details for PubMedID 17607700

  • A meta-analytic review of eating disorder prevention programs: Encouraging findings ANNUAL REVIEW OF CLINICAL PSYCHOLOGY Stice, E., Shaw, H., Marti, C. 2007; 3: 207?31

    Abstract

    This meta-analytic review found that 51% of eating disorder prevention programs reduced eating disorder risk factors and 29% reduced current or future eating pathology. Larger effects occurred for programs that were selected (versus universal), interactive (versus didactic), multisession (versus single session), solely offered to females (versus both sexes), offered to participants over 15 years of age (versus younger ones), and delivered by professional interventionists (versus endogenous providers). Programs with body acceptance and dissonance-induction content and without psychoeducational content and programs evaluated in trials using validated measures and a shorter follow-up period also produced larger effects. Results identify promising programs and delineate sample, format, and design features associated with larger effects, which may inform the design of more effective prevention programs in the future.

    View details for DOI 10.1146/annurev.clinpsy.3.022806.091447

    View details for Web of Science ID 000255488800010

    View details for PubMedID 17716054

  • Predicting time to recovery among depressed adolescents treated in two psychosocial group interventions JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Rohde, P., Seeley, Kaufman, N. K., Clarke, G. N., Stice, E. 2006; 74 (1): 80?88

    Abstract

    Aims were to identify the demographic, psychopathology, and psychosocial factors predicting time to major depressive disorder (MDD) recovery and moderators of treatment among 114 depressed adolescents recruited from a juvenile justice center and randomized to a cognitive behavioral treatment (CBT) condition or a life skills-tutoring control condition. Nine variables predicted time to recovery over 1-year follow-up (e.g., earlier MDD onset, attention-deficit/hyperactivity disorder, functional impairment, hopelessness, negative thoughts, low family cohesion, coping skills); suicidal ideation and parental report of problem behaviors were the best predictors. CBT resulted in faster recovery time relative to control treatment, specifically among adolescents of White ethnicity, with recurrent MDD, and with good coping skills. Results suggest that psychopathology plays a more prominent role in maintaining adolescent depression than demographic or psychosocial factors.

    View details for DOI 10.1037/0022-006X.74.1.80

    View details for Web of Science ID 000236490700008

    View details for PubMedID 16551145

    View details for PubMedCentralID PMC2248603

  • Prediction of outcome in bulimia nervosa by early change in treatment AMERICAN JOURNAL OF PSYCHIATRY Fairburn, C. G., Agras, W. S., Walsh, B. T., Wilson, G. T., Stice, E. 2004; 161 (12): 2322-2324

    Abstract

    The authors' goal was to identify predictors of treatment response in bulimia nervosa and, in particular, to attempt to replicate and extend the observation that early change predicts outcome.Predictors of response at the end of treatment and 8-month follow-up were sought from a group of 220 women treated with either cognitive behavior therapy or interpersonal psychotherapy.Early change in frequency of purging was the best predictor of response at the end of treatment and at 8-month follow-up.Early change in treatment is a robust and potent predictor of immediate and longer-term outcome in bulimia nervosa.

    View details for Web of Science ID 000225503500030

    View details for PubMedID 15569910

  • Subtyping binge eating-disordered women along dieting and negative affect dimensions INTERNATIONAL JOURNAL OF EATING DISORDERS Stice, E., Agras, W. S., Telch, C. F., HALMI, K. A., Mitchell, J. E., Wilson, T. 2001; 30 (1): 11-27

    Abstract

    Because etiologic and maintenance models of binge eating center around dieting and affect regulation, this study tested whether binge eating-disordered (BED) individuals could be subtyped along dieting and negative affect dimensions and whether subtypes differed in eating pathology, social functioning, psychiatric comorbidity, and response to treatment.Three independent samples of interviewer-diagnosed BED women (N = 218) were subtyped along dieting and negative affect dimensions using cluster analysis and compared on the outcomes of interest.Cluster analyses replicated across the three independent samples and revealed a dietary subtype (63%) and a dietary-depressive subtype (37%). The latter subtype reported greater eating and weight obsessions, social maladjustment, higher lifetime rates of mood, anxiety, and personality disorders, and poorer response to treatment than did the dietary subtype.Results suggest that moderate dieting is a central feature of BED and that affective disturbances occur in only a subset of cases. However, the confluence of dieting and negative affect signals a more severe variant of the disorder marked by elevated psychopathology, impaired social functioning, and a poorer treatment response.

    View details for Web of Science ID 000169077300002

    View details for PubMedID 11439405

  • How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors AMERICAN JOURNAL OF PSYCHIATRY Kraemer, H. C., Stice, E., Kazdin, A., Offord, D., Kupfer, D. 2001; 158 (6): 848-856

    Abstract

    The authors developed a methodological basis for investigating how risk factors work together. Better methods are needed for understanding the etiology of disorders, such as psychiatric syndromes, that presumably are the result of complex causal chains.Approaches from psychology, epidemiology, clinical trials, and basic sciences were synthesized.The authors define conceptually and operationally five different clinically important ways in which two risk factors may work together to influence an outcome: as proxy, overlapping, and independent risk factors and as mediators and moderators.Classifying putative risk factors into these qualitatively different types can help identify high-risk individuals in need of preventive interventions and can help inform the content of such interventions. These methods may also help bridge the gaps between theory, the basic and clinical sciences, and clinical and policy applications and thus aid the search for early diagnoses and for highly effective preventive and treatment interventions.

    View details for Web of Science ID 000169175200003

    View details for PubMedID 11384888

  • Negative affect moderates the relation between dieting and binge eating INTERNATIONAL JOURNAL OF EATING DISORDERS Stice, E., Akutagawa, D., Gaggar, A., Agras, W. S. 2000; 27 (2): 218-229

    Abstract

    Although laboratory experiments suggest that negative affect inductions potentiate the relation between dieting and disinhibited eating, little research has tested whether this finding generalizes to binge eating in the natural environment. Thus, we assessed whether negative affect moderated the relation between dieting and binge eating in a passive-observational study.This aim was addressed with longitudinal data from a community sample of adolescents (N = 631).For females, dieting and negative affect predicted binge eating in cross-sectional and prospective analyses, but negative affect potentiated the relation between dieting and binge eating only in the cross-sectional analyses. Similar, but attenuated results were found for males.Findings converge with those from laboratory studies in suggesting that negative affect moderates the relation between dieting and binge eating, but also imply that dieting and negative affect constitute independent risk factors for binge eating. The lack of prospective effects may suggest that the interactive relations have a short time lag or are difficult to detect prospectively.

    View details for Web of Science ID 000085402800010

    View details for PubMedID 10657895

  • Dissonance prevention program decreases thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment INTERNATIONAL JOURNAL OF EATING DISORDERS Stice, E., Mazotti, L., Weibel, D., Agras, W. S. 2000; 27 (2): 206-217

    Abstract

    Because psychoeducational primary prevention programs for eating disorders have met with little success, this preliminary experiment tested a dissonance-based targeted preventive intervention.Female undergraduates (N = 30) with elevated body image concerns were assigned to a three-session intervention, wherein they voluntarily argued against the thin ideal, or a delayed-intervention control condition. Participants completed a baseline, termination, and a 1-month follow-up survey.The intervention resulted in a subsequent decrease in thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptomatology, with most changes remaining at the 1-month follow-up.These preliminary results suggest that this dissonance-based targeted prevention intervention reduces bulimic pathology and known risk factors for eating disturbances, and provide experimental support for the claim that thin-ideal internalization contributes to body dissatisfaction, dieting, negative affect, and bulimic symptoms.

    View details for Web of Science ID 000085402800009

    View details for PubMedID 10657894

  • Natural history of disordered eating attitudes and behaviors over a 6-year period INTERNATIONAL JOURNAL OF EATING DISORDERS Rizvi, S. L., Stice, E., Agras, W. S. 1999; 26 (4): 406-413

    Abstract

    This study investigated the course of eating attitudes and eating-disordered behaviors in a community sample of adult women.Participants (N = 166; mean age = 32.8 years) completed the Eating Disorder Inventory (EDI), the Three-Factor Eating Questionnaire (TFEQ), and a questionnaire assessing bulimic behaviors at two time points, 6 years apart.Correlations for rank ordering of scores on these measures were all significant, indicating high rank stability over time. Although rates of specific bulimic behaviors decreased over time, mean scores on eating disorder attitude scales tended to increase.Findings challenge the commonly held belief that disturbed eating attitudes decline with age.

    View details for Web of Science ID 000083570000006

    View details for PubMedID 10550781

  • Risk factors for the emergence of childhood eating disturbances: A five-year prospective study INTERNATIONAL JOURNAL OF EATING DISORDERS Stice, E., Agras, W. S., Hammer, L. D. 1999; 25 (4): 375-387

    Abstract

    Research suggests that eating problems are often present by preadolescence, yet little is known about the age of emergence of these early eating disturbances or risk factors for these behaviors. Thus, we investigated the timing of onset of disturbed eating during childhood and the predictors of these behaviors.These aims were addressed by following a sample of children and their parents (N = 216) for the first 5 years of the children's lives.Data suggested that the risk for emergence of inhibited eating, secretive eating, overeating, and vomiting increased annually through age 5. Maternal body dissatisfaction, internalization of the thin-ideal, dieting, bulimic symptoms, and maternal and paternal body mass prospectively predicted the emergence of childhood eating disturbances. Infant feeding behavior and body mass during the first month of life also predicted the emergence of these behaviors.Results suggest that eating disturbances emerge during childhood and may be a function of certain parental and child characteristics.

    View details for Web of Science ID 000079497800002

    View details for PubMedID 10202648

  • Age of onset for binge eating and purging during late adolescence: A 4-year survival analysis JOURNAL OF ABNORMAL PSYCHOLOGY Stice, E., Killen, J. D., Hayward, C., Taylor, C. B. 1998; 107 (4): 671-675

    Abstract

    This prospective study examined age of onset for binge eating and purging among girls during late adolescence and tested whether dieting and negative affectivity predicted these outcomes. Of initially asymptomatic adolescents, 5% reported onset of objective binge eating, 4% reported onset of subjective binge eating, and 4% reported onset of purging. Peak risk for onset of binge eating occurred at age 16, whereas peak risk for onset of purging occurred at age 18. Adolescents more often reported onset of a single symptom rather than multiple symptoms, and symptoms were episodic. Dieting and negative affectivity predicted onset of binge eating and purging. Findings suggest that late adolescence is a high-risk period for onset of bulimic behaviors and identify modifiable risk factors for these outcomes.

    View details for Web of Science ID 000076987000013

    View details for PubMedID 9830254

  • Prospective differential prediction of adolescent alcohol use and problem use: Examining the mechanisms of effect 103rd Annual Meeting of the American-Psychological-Association Stice, E., Barrera, M., Chassin, L. AMER PSYCHOLOGICAL ASSOC. 1998: 616?28

    Abstract

    This prospective study tested the assertion that psychopathology would predict both adolescent alcohol use and problem use, whereas socialization factors would predict only use, and explored mechanisms by which predictors led to problem use in a community sample of families (N = 216). Externalizing symptoms, parental alcoholism, peer influences, and parental support were indirectly related to negative consequences through their effects on use level. Externalizing symptoms, internalizing symptoms, peer influences, and parental approval of use directly predicted consequences, controlling for the indirect effects through use level. Internalizing pathology potentiated the relation between consumption and consequences, whereas parental support and control mitigated this relation. Collectively, findings provided mixed support for the assertion that psychopathology would predict both use and problem use, whereas socialization factors would predict only use.

    View details for Web of Science ID 000076987000008

    View details for PubMedID 9830249

  • Modeling of eating pathology and social reinforcement of the thin-ideal predict onset of bulimic symptoms BEHAVIOUR RESEARCH AND THERAPY Stice, E. 1998; 36 (10): 931?44

    Abstract

    Although social influences are thought to promote bulimic pathology, little research has examined the effects of multiple socialization agents, or considered both modeling and social reinforcement processes. Accordingly, these two studies tested whether social reinforcement of the thin-ideal, and modeling of abnormal eating behavior by family, peers, and the media, (i) correlated with bulimic symptoms in a sample of young adult female (N = 114) and (ii) predicted the onset of bulimic behavior in a sample of adolescent females (N = 218). Social reinforcement of the thin-ideal by family, peers, and media was correlated with bulimic symptoms; family and peer social reinforcement prospectively predicted the onset of binge eating and purging. Family and peer, but not media, modeling of abnormal eating behavior was associated with concurrent bulimic symptoms, and predicted the onset of binge eating and purging. Results suggest that both social reinforcement and modeling processes may promote bulimic pathology, but imply that the effects are limited to family and peer influences.

    View details for DOI 10.1016/S0005-7967(98)00074-6

    View details for Web of Science ID 000075280000002

    View details for PubMedID 9714944

  • Relations of restraint and negative affect to bulimic pathology: A longitudinal test of three competing models INTERNATIONAL JOURNAL OF EATING DISORDERS Stice, E. 1998; 23 (3): 243?60

    Abstract

    Although theorists have proposed that restraint and negative affect cause bulimia nervosa, it is possible that bulimic pathology promotes restraint and negative affect, or that bulimic symptoms are reciprocally related to these two factors. The present study tested these competing models.Longitudinal data from a community sample of adolescent females (N = 218) was used to test these alternative models.Prospective correlations suggested that bulimic pathology was reciprocally related to both restraint and negative affect. However, in more stringent tests controlling for the temporal stability of these factors, restraint was not related to subsequent bulimic symptoms, but bulimic pathology predicted future restraint. Negative affect and bulimic symptoms were not related over time when the stability of these factors was controlled, but they did show contemporaneous reciprocal relations.Results provide some support for the negative affect model of bulimia, but raise questions about the restraint model.

    View details for DOI 10.1002/(SICI)1098-108X(199804)23:3<243::AID-EAT2>3.0.CO;2-J

    View details for Web of Science ID 000072617400002

    View details for PubMedID 9547659

  • Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis BEHAVIOR THERAPY Stice, E., Agras, W. S. 1998; 29 (2): 257-276
  • Prospective relation of dieting behaviors to weight change in a community sample of adolescents BEHAVIOR THERAPY Stice, E. 1998; 29 (2): 277?97
  • Relation of dietary restraint to bulimic symptomatology: The effects of the criterion confounding of the restraint scale BEHAVIOUR RESEARCH AND THERAPY Stice, E., Ozer, S., Kees, M. 1997; 35 (2): 145?52

    Abstract

    Studies indicate that various measures of dietary restraint show inconsistent relations to bulimic symptomatology. The present study tested the assertion that this is because the scales differ in the extent to which they reflect the success or failure of dietary efforts. This study also tested the competing hypothesis that criterion confounding of the Restraint Scale produced the inconsistent findings. Data from 117 undergraduates indicated that both the Restraint Scale and the Dutch Restrained Eating Scale were correlated with bulimic pathology, but that the magnitude to the relations were higher for the former. These results supported the dietary success failure hypothesis, however, this difference disappeared when the two disinhibited eating items from the Restraint Scale were deleted. Thus, the inconsistent findings in prior research appear to be due to the criterion confounding of the Restraint Scale. Implications for the measurement of restraint are discussed.

    View details for DOI 10.1016/S0005-7967(96)00077-0

    View details for Web of Science ID A1997WG39300005

    View details for PubMedID 9046677

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