Purpose No effective curriculum to prevent eating disorders is currently available. Our purpose was to identify necessary components for a team-centered curriculum to prevent female high school athletes' disordered eating behaviors and body-shaping drug use, and prospectively evaluate the curriculum and relate its proximal and primary outcomes to curriculum design.
Methods Initial cross-sectional survey of 2090 female middle and high school (HS) students (mean [± SD] age, 14.6 ± 1.4 years). Prospective randomized intervention trial participants were 928 (457 intervention, 471 control) female HS athletes (mean [± SD] age, 15.4 ± 1.2 years). Factor analysis (FA) to identify constructs from survey items; discriminant function analysis (DFA) to determine those constructs' ability to correctly classify students with a higher risk of future disordered eating. Use constructs with greatest contribution to that distinction to design a curriculum and assess its outcomes with a prospective randomized, controlled intervention trial.
Results Ten robust and meaningful factors were identified, which by DFA could correctly classify higher and lower risk students (Wilks' Lambda 0.748, p≤0.001), with constructs' relative contributions ranked by DFA coefficients. The identified priorities were combined with sports nutrition and strength training to construct a curriculum, formatted to be eight 45-minute team-based, peer-facilitated sessions incorporated into a team's usual activities. When prospectively assessed, the program significantly altered targeted components (controlling mood [p≤0.005], refusal skills [p=0.05], belief in the media [p≤0.005] and perceptions of peers' behaviors [p≤0.001]) and reduced ongoing and new use of diet pills and body-shaping substances (amphetamines, anabolic steroids and sport supplements) (p≤0.05 for each).
Conclusion The program's positive outcomes illustrate the utility of a structured process targeting the antecedents of disordered eating, rather than those specific behaviors, to define curriculum content. The derived program, which is scripted, peer-led and sport team-centered, effectively promoted healthy lifestyles and deterred disordered eating and body-shaping drug use.