The Healthy Body Image Intervention and Reduction in Eating Disorder Symptomatology and Muscle Building Supplement Use in High School Students: A Study of Mediating Factors

Kethe Marie Engen Svantorp-Tveiten; Andreas Ivarsson; Monica Klungland Torstveit; Christine Sundgot-Borgen; Therese Fostervold Mathisen; Solfrid Bratland-Sanda; Jan Harald Rosenvinge; Oddgeir Friborg; Gunn Pettersen; Jorunn Sundgot-Borgen

doi:10.3389/fpsyg.2022.803654

The Healthy Body Image Intervention and Reduction in Eating Disorder Symptomatology and Muscle Building Supplement Use in High School Students: A Study of Mediating Factors

Front Psychol. 2022 Jun 28:13:803654. doi: 10.3389/fpsyg.2022.803654. eCollection 2022.

Affiliations

¹ Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
² Center of Research on Welfare, Health and Sport, Halmstad University, Halmstad, Sweden.
³ Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.
⁴ Faculty of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway.
⁵ Department of Sports, Physical Education and Outdoor Studies, University of South-Eastern Norway, Kongsberg, Norway.
⁶ Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.
⁷ Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.

Abstract

Background: Mediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image (HBI) intervention's effect on eating disorder (ED) symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use.

Methods: This study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development including 30 schools in Norway. A total of 1,713 (37% boys) participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators.

Results: In girls, the reduction in ED symptomatology was mediated by positive changes in protective factors (self-esteem and body image flexibility) and reductions in risk factor scores (perceived media pressure and thin appearance internalization). Comparable changes in protective and risk factors among boys played no mediating role.

Conclusion: Interventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys.

Keywords: adolescence; body image (MeSH); eating disorder (ED); mental health; muscle building supplements; prevention.