The Body Project: 4-Session Eating Disorder Prevention Program
Eating disorders affect 13–15% of females over the lifespan and represent one of the most serious public health problems facing young women. Despite their high prevalence and serious health consequences, only three prevention programs have produced significant reductions in eating disorder symptoms or onset.
Only three prevention programs have produced effects in trials conducted by independent labs: The Body Project, the SPARX program, and the Sticking Up for Yourself program. Of these, The Body Project has produced the strongest effects in terms of magnitude and duration.
In The Body Project, young women voluntarily critique the thin-ideal in group-based verbal, written, and behavioral exercises. This produces cognitive dissonance, an internal discomfort arising from arguing against a position one holds, which leads participants to reduce their subscription to the thin-ideal. This, in turn, reduces key eating disorder risk factors including body dissatisfaction, negative affect, and unhealthy dieting behaviors.
Task-shifting trial: A recent trial found that when college women delivered The Body Project to their peers, outcomes were 58% greater than when clinicians delivered it, suggesting that peer delivery capitalizes on social influence processes.
A recent large randomized trial (Ghaderi et al., 2020) found that The Body Project produced a 77% reduction in future onset of eating disorders over a 2-year follow-up, the strongest prevention effect ever reported for any eating disorder prevention program.
Why The Body Project stands apart
The Body Project is the only eating disorder prevention program that has:
- Produced significant reductions in future onset of eating disorders in multiple randomized trials conducted by independent research groups
- Shown superior effects relative to alternative active interventions (not just waitlist or brochure controls)
- Demonstrated effectiveness when delivered by undergraduate peer leaders, not just clinicians or researchers
- Been validated across diverse racial and ethnic groups with no significant moderation by race/ethnicity
- Been implemented at scale, reaching over 8 million participants in 140+ countries
A version adapted for males has also been developed and tested, demonstrating the framework's applicability beyond its original target population.
Project Health: Obesity & Eating Disorder Prevention Program
Project Health is a 6-session dissonance-based program that combines the core The Body Project framework with additional content targeting healthy weight behaviors. It was designed to prevent both eating disorders and unhealthy weight gain in the same intervention.
The program uses the same dissonance-induction approach as The Body Project, participants voluntarily argue against both the thin-ideal and obesity-promoting behaviors, while also incorporating behavioral exercises around healthy eating and physical activity that are grounded in self-determination theory.
Randomized controlled trials have found that Project Health reduces eating disorder risk factors and symptoms while also producing reductions in BMI among participants at elevated risk for weight gain. The program is particularly well-suited for settings where both eating disorder and obesity prevention are institutional priorities.
A recent study (Stice et al., 2022) examined the effects of implementing Project Health in single-sex groups with food response inhibition and attention training, finding promising results for integrated prevention.
Project Health materials, including the 6-session facilitator script and participant exercises, are available for free download in the Documents section of this website.
Download Project Health MaterialsPriorities: A Prevention Program Targeting Overvaluation of Weight/Shape
Appearance overvaluation refers to the tendency for individuals, particularly young women, to primarily base their self-worth on body size, appearance, and weight. While physical health and mindful self-care can be positive goals, many girls and women grow up surrounded by pressures that overemphasize appearance. This overemphasis can distract from other vital sources of self-esteem, such as intellect, creativity, social connectedness, compassion, and personal accomplishments.
Research suggests that when individuals derive most of their self-esteem from weight and shape, they are at higher risk for unhealthy body image concerns, disordered eating, negative mood, and relationship difficulties. Indeed, a large prospective study found that appearance overvaluation increased risk for the future onset of all four major types of eating disorders (Stice, Desjardins, Rohde, & Shaw, 2021).
Priorities builds on the idea that challenging appearance overvaluation, and increasing the degree to which self-worth is based on other factors, can yield significant benefits for young people's psychological well-being. By helping participants identify and nurture alternative sources of self-worth, the program aims to reduce body image concerns, prevent eating disorders, bolster self-esteem, and promote mental and emotional health.
Key Elements of the Intervention
- Group discussion: Through structured conversations, participants collectively discuss the negative impact of basing self-worth on weight/shape and the benefits of basing self-worth on other factors.
- Role-plays & behavioral challenges: Participants practice short, targeted responses to weight/shape overvaluation statements and engage in hands-on activities that help them break out of habitual, appearance-focused thinking.
- Homework assignments & letter-writing: Participants track their progress and deeper reflections through weekly exercises, such as writing letters to a younger girl or to themselves and generating lists of non-appearance strengths to diversify their sense of worth.
Body Project Treatment: 8-Session Eating Disorder Treatment Program
Body Project Treatment (BPT) is an 8-session group treatment program for individuals already experiencing clinically significant eating disorder symptoms. It extends the dissonance-based framework from prevention into treatment, maintaining the same core mechanism, cognitive dissonance induction through voluntary counter-attitudinal advocacy, while adding clinical content appropriate for individuals with active eating disorder symptoms.
The program is delivered by trained therapists in a group format, with each session building on the previous. Participants engage in verbal, written, and behavioral exercises that progressively challenge their investment in the thin-ideal and related eating disorder cognitions.
Randomized Controlled Trial Evidence
A pilot study (Stice et al., 2015) comparing BPT (then called "Counter Attitudinal Therapy") to a usual care control found large reductions in eating disorder symptoms at post-treatment and 2-month follow-up, providing initial proof-of-concept for the treatment approach.
A second RCT (Stice et al., 2019b) compared Body Project Treatment to an alternative treatment matched on therapy dose and modality, finding that BPT produced larger reductions in eating disorder symptoms, demonstrating superiority over an active control condition.
A third study (Stice et al., 2019c) provided the first evidence that BPT reduced hypothesized intervention targets as assessed by survey measures, structured diagnostic interviews, and fMRI neuroimaging, suggesting that the intervention works through its proposed mechanism of reducing reward-region response to thin models.
An Italian adaptation of BPT has also been developed and validated, with materials available in Italian translation for international clinical settings.
Note for clinicians: Body Project Treatment is a clinical program requiring therapist training. If you are interested in implementing BPT in your clinical setting, please contact the Stice Lab to discuss training and supervision options.