Evidence-based interventions for eating disorders have been established, but they are not being implemented in routine clinical care, resulting in a devastating gap between those who are and are not receiving treatment (Beidas and Kendall, 2010, Drake et al., 2001, Proctor et al., 2009 and Shafran et al., 2009). Translating interventions into disseminable mediums that are readily deliverable, rely less on specialists, and can be tailored for varied levels of risk and symptom profiles is a priority. Internet-based interventions overcome translational barriers and enable rapid dissemination (Kazdin and Blase, 2011 and Paxton, 2013). Online interventions have been successfully used to reduce eating disorder risk factors or for the treatment or prevention of eating disorders (Bauer and Moessner, 2013, Bauer et al., 2009, Carrard et al., 2011, Carrard et al., 2010, Jacobi et al., 2012, Lindenberg et al., 2011, Ljotsson et al., 2007, Paxton et al., 2007, Pretorius et al., 2009, Sánchez-Ortiz et al., 2010, Stice et al., 2012 and Taylor et al., 2006). These interventions have been tested in comparison to face-to-face treatments as well as educational materials or wait-list control conditions, and have demonstrated reductions in eating risk factors, eating disorder onset, eating disorder symptoms, or relapse (Bauer & Moessner, 2013). Internet-based interventions are often associated with high user acceptability given their accessible and anonymous format (Abascal et al., 2004, Lenhart et al., 2010, Luce et al., 2005, Moessner and Bauer, 2012 and Shaw et al., 2009); however, anonymous online platforms can also be met with user dropout given the reduced accountability than face-to-face treatments or met with reduced engagement if technological innovations/enhancements are not released at the same speed as that of our rapidly-changing technological landscape (Paxton, 2013). Moreover, overcoming access-to-care barriers through the use of internet-based platforms requires strong, collaborative partnerships and ongoing attention to uptake and sustainability to ensure successful implementation (Paxton, 2013).
Student Bodies is an internet-based preventive intervention that aims to reduce eating disorder risk factors in order to prevent eating disorders in college-age women at risk for onset ( Beintner et al., 2012 and Taylor et al., 2006). The largest evaluation of Student Bodies demonstrated significant differences between intervention conditions in reducing the eating disorder risk factor weight/shape concerns, and although no main effects were shown for reducing eating disorder onset, differential effects were found for eating disorder prevention among two subsets of users. Specifically, the subset of users in the intervention condition who were overweight had significantly fewer eating disorder cases at two-year follow-up than the control condition (i.e., 0% onset versus 10.8% onset), and at one site, those engaging in compensatory behaviors at baseline in the intervention condition had significantly fewer eating disorder cases at two-year follow-up than the control condition (i.e., 14.4% versus 30%, respectively; Taylor et al., 2006). Though no trial evaluating Student Bodies has demonstrated main effects for eating disorder prevention, the success of the intervention across multiple trials in reducing eating disorder risk factors makes it ripe for implementation across college campuses for students at high eating disorder risk ( Beintner et al., 2012). Scaling the intervention for widespread use may depend on maximizing cost effectiveness. The two highest costs associated with the intervention are running the program on a HIPAA-protected server and delivering the program using a guided self-help format through the use of a guided discussion group. Though the former is imperative for participant privacy, the clinical utility of the latter has yet to be determined.
