Comparative efficacy and acceptability of interventions for universal, selective and indicated prevention of eating disorders: study protocol for a systematic review and network meta-analysis

Sandra Schlegl¹, Felicitas Hirler², Andreas Gerich², Mikkel Højlund³, Eric Stice⁴, Tracey Wade⁵, Denise Wilfley⁶, James Downs⁷, Ulrich Voderholzer^{2

8

9}, Jasmine Perry⁴, Verena Haas¹⁰, Marco Solmi^{10

11

12

13}, Christoph Correll^{10

14

15}

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Muenchen, Germany. sandra.schlegl@med.uni-muenchen.de.
² Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Muenchen, Germany.
³ Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.
⁴ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
⁵ Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia.
⁶ Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
⁷ Independent Researcher and Expert by Experience, Cardiff, Wales, UK.
⁸ Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany.
⁹ Schoen Clinic Roseneck, Prien am Chiemsee, Germany.
¹⁰ Department of Child and Adolescent Psychiatry, corporate member of Freie, Charité Universitätsmedizin Berlin, Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
¹¹ SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
¹² Regional Centre for the Treatment of Eating Disorders and On Track, The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
¹³ Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON, Canada.
¹⁴ Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA.
¹⁵ Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.

PMID: 40281541
PMCID: PMC12032746
DOI: 10.1186/s40337-025-01244-8

Comparative efficacy and acceptability of interventions for universal, selective and indicated prevention of eating disorders: study protocol for a systematic review and network meta-analysis

Sandra Schlegl et al. J Eat Disord. 2025.

. 2025 Apr 25;13(1):72.

doi: 10.1186/s40337-025-01244-8.

Authors

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Muenchen, Germany. sandra.schlegl@med.uni-muenchen.de.
² Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Muenchen, Germany.
³ Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.
⁴ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
⁵ Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia.
⁶ Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
⁷ Independent Researcher and Expert by Experience, Cardiff, Wales, UK.
⁸ Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany.
⁹ Schoen Clinic Roseneck, Prien am Chiemsee, Germany.
¹⁰ Department of Child and Adolescent Psychiatry, corporate member of Freie, Charité Universitätsmedizin Berlin, Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
¹¹ SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
¹² Regional Centre for the Treatment of Eating Disorders and On Track, The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
¹³ Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON, Canada.
¹⁴ Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA.
¹⁵ Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.

PMID: 40281541
PMCID: PMC12032746
DOI: 10.1186/s40337-025-01244-8

Abstract

Background: Eating disorders (EDs) are severe psychiatric conditions, with prevalence rates ranging from 5.5 to 17.9% in women and 0.6 to 2.4% in men. EDs carry a high risk of chronicity and mortality, highlighting the need for effective prevention strategies. Primary prevention can target the entire population (universal), high-risk groups (selective), or individuals with early signs (indicated). Despite substantial research, prior reviews often show limitations, such as single-author data extraction, lack of quality assessment, reliance on endpoint data, exclusion of obesity prevention programs, or outdated findings. No review has yet evaluated the comparative effectiveness of multiple interventions across risk groups. This article outlines a systematic review and network meta-analysis (NMA) protocol to assess the comparative effectiveness of various ED preventive interventions across different prevention types and populations.

Methods: Eligible studies will include (cluster) randomized controlled trials (RCTs) involving children, adolescents, and adults across a range of settings. Databases to be searched include MEDLINE, Embase, PsycINFO, and CENTRAL. All prevention types (universal, selective, indicated) will be included. Interventions will encompass psychological, educational, physical, and nutritional approaches aimed at preventing EDs, disordered eating, or negative body image and/or reducing risk factors. Coprimary outcomes will be ED diagnostic symptoms, overall ED pathology, ED onset, and intervention all-cause discontinuation (acceptability). A frequentist NMA framework will be used for data synthesis, with sensitivity and subgroup analyses to identify effect modifiers.

Discussion: This first NMA on ED prevention aims to provide valuable insights for clinicians, researchers, policymakers and the public by identifying the most effective interventions and highlighting research gaps. The findings will inform intervention selection for specific populations and guide future prevention strategies to reduce the burden of EDs on affected individuals, their communities, and wider society.

Clinical trial registration number: CRD42024498102.

Keywords: Anorexia nervosa; Binge-eating disorder; Bulimia nervosa; Eating disorders; Indicated; Network meta-analysis; Prevention; Selective; Systematic review; Universal.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This review does not require ethical approval as it will draw data from studies in which consent to participate has already been obtained. Consent for publication: Not applicable. Competing interests: There are potential conflicts of interests regarding ES and TW who each developed some of the prevention programs to be evaluated. CC has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Adock Ingram, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Takeda, Teva, Tolmar, Vertex, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, Denovo, Lundbeck, Relmada, Reviva, Rovi, Supernus, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Mindpax, and Quantic. MH received honoraria/has been a consultant for Lundbeck and Otsuka. MS received honoraria/has been a consultant for Angelini, AbbVie, Boehringer Ingelheim, Lundbeck, Otsuka. All other authors declare that they have no known conflicts of interest.

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Comparative efficacy and acceptability of interventions for universal, selective and indicated prevention of eating disorders: study protocol for a systematic review and network meta-analysis

Affiliations

Comparative efficacy and acceptability of interventions for universal, selective and indicated prevention of eating disorders: study protocol for a systematic review and network meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

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