Young Athlete Body Project - Prevention of Body Dissatisfaction and Eating Disorders Among Adolescent Athletes

This study is a school‐based cluster‐randomized controlled trial conducted amongadolescent athletes attending sports‐specialized lower and upper secondary schools inNorway.Based on statistical power analyses, approximately 1740 adolescent athletes aged 13‐17years are expected to participate in the study. The sample size calculation was based oneffect sizes observed in the pilot study of the Young Athlete Body Project (0.40 forthin‐ideal internalization and 0.23 for muscularity‐ideal internalization), asignificance level of α = 0.05, and 80% statistical power. The calculation accounted forthe clustered study design by assuming an average cluster size of 60 students per schooland an intraclass correlation coefficient (ICC) of 0.02. In addition, the sample size wasadjusted for an anticipated attrition rate of up to 25%. Based on these assumptions,between 291 and 867 participants are required per study arm. To ensure adequate power forall primary outcomes and follow‐up assessments, approximately 1740 participants will berecruited.Participating schools will be randomized to either the intervention group or controlgroup. Randomization will be conducted at the school level to minimize contaminationbetween participants within schools. Data will be analyzed according to theintention‐to‐treat principle. Intervention effects will be evaluated using linearmixed‐effects regression models with a random intercept for school to account forclustering at the school level.The intervention, Young Athlete Body Project, is delivered during school hours over afive‐week period and consists of two digital educational sessions followed by threein‐person workshops. The educational sessions focus on (1) energy availability,nutrition, biological maturation and puberty in young athletes and (2) social media, bodyideals and mental health in sport. These topics are part of the existing curriculum insports‐specialized lower and upper secondary schools and provide the foundation for thesubsequent workshop activities. Students attending schools randomized to the interventiongroup will receive the educational sessions and take part in the workshops as part oftheir school program. Participation in the research component of the study, includingcompletion of questionnaires and other study‐related assessments, is voluntary andrequires informed consent.The workshops are conducted in small sex‐specific groups of approximately tenparticipants and are led by trained instructors following a standardized interventionmanual. The workshop content is adapted from the evidence‐based Body Project and is basedon cognitive dissonance principles. Through guided discussions, role‐play activities,reflective exercises and written assignments, participants are encouraged to criticallyexamine appearance ideals, body appearance pressures and sociocultural influences relatedto body image. The workshops also focus on strengthening body acceptance, reducinginternalization of appearance ideals and developing strategies to cope withappearance‐related pressures from sport, social media and society.Data will be collected using self‐report questionnaires administered at baseline,immediately following the intervention, and at 6‐, 12‐, and 24‐month follow‐upassessments. Outcomes will be assessed using the Body Appreciation Scale‐2 (BAS‐2), theSociocultural Attitudes Towards Appearance Questionnaire‐4 (SATAQ‐4), the Eating DisorderExamination Questionnaire short form (EDE‐Q short form), and additional questionsassessing mental health and psychosocial functioning. In addition, a randomized subsampleof participants will be invited to participate in qualitative interviews to evaluatetheir experiences with and perceived benefits of the program. All participants scoring≥15 on the EDE‐Q short form, together with a sex‐matched sample of participants scoringbelow this cut‐off, will be invited to complete the Eating Disorder Examination (EDE), astructured diagnostic interview assessing eating disorder symptoms, behaviors, andrelated cognitions. These interviews will be used to strengthen the validity ofself‐reported questionnaire data and provide a more comprehensive assessment of eatingdisorder outcomes.The study will evaluate both short‐term and long‐term effects of the intervention andprovide evidence regarding the effectiveness of a school‐based body image and eatingdisorder prevention program specifically adapted for adolescent athletes.