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Background This study tested whether the dissonance-based Body Project eating disorder prevention program reduced onset of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) over long-term follow-up. Methods Data were combined from three prevention trials that targeted young women at high-risk for eating disorders (N = 1092; M age = 19.3). Participants were randomized to Body Project groups led by peer educators or expressive writing/educational controls and completed masked diagnostic interviews over 2- to 4-year follow-ups. Logistic regressions tested whether onset of each eating disorder over follow-up differed between Body Project and control participants. Results Peer-led Body Project groups produced a 46% reduction in onset of subthreshold/threshold BN and a 62% reduction in onset of PD relative to controls over follow-up. Rates of onset of subthreshold/threshold AN and BED did not significantly differ between peer-led Body Project participants and control participants. Conclusions Results support the dissemination of the peer-led Body Project for reducing future onset of BN and PD. This study and recent research suggest that thin-ideal internalization, the risk factor for eating disorders targeted in the Body Project, may be more relevant for predicting onset of BN and PD compared to AN and BED. Findings support the development of a version of the Body Project aimed to reduce risk factors that have predicted future onset of all four types of eating disorders (e.g. overvaluation of weight/shape, fear of weight gain), which may more effectively prevent all eating disorder types.

BACKGROUND Most individuals with eating disorders (EDs) do not receive treatment. Leveraging digital tools such as chatbots may be a promising method to mobilize mental health care utilization following ED screening. OBJECTIVE This study examined rates and predictors of uptake of a chatbot aimed to promote mental health services use among adults who screened positive for clinical/subclinical EDs on an online ED screen. METHODS Following screening, eligible individuals (≥18 years, screened positive for a clinical/subclinical ED, not in treatment) were shown the study opportunity. Participants who enrolled were instructed to initiate an SMS conversation with the chatbot. Chi-square tests and logistic regressions explored differences in demographics, ED symptoms, suicidality, and probable ED diagnoses between those who enrolled and engaged with the chatbot versus those who did not. RESULTS Of 6,747 respondents shown the study opportunity, 205 (3.0%) enrolled, of whom 185 (90.2%) subsequently used the chatbot. Chatbot uptake was more common among individuals aged ≥25 versus young adults and less common among individuals engaging in regular dietary restriction. No other differences across demographics or ED presentations were observed. CONCLUSIONS Overall chatbot uptake was low, reflecting a need for additional strategies to promote help-seeking behaviors. However, chatbot uptake was high among those that enrolled and equal across most demographics or ED symptoms. Differences by age and dietary restriction in chatbot uptake indicate a need to better engage those who are younger or report restriction.

BACKGROUND Eating disorders (EDs) are complex mental illnesses with debilitating, pervasive psychological and physiological consequences when left untreated. Unfortunately, patients may face barriers to receiving treatment, such as stereotypes surrounding EDs, denial of illness severity, lack of motivation for treatment, and lack of knowledge about treatment resources. Barriers such as these result in a large treatment gap: only 20% of those with EDs will ever receive treatment. Digital tools like chatbots show potential to disseminate mental health–related interventions to large populations while offering a user-friendly, cost-effective, accessible, and anonymous means of tackling patient concerns. OBJECTIVE This study developed and evaluated the usability of a chatbot designed for pairing with online ED screening. The tool aimed to promote mental health service utilization by improving motivation for treatment and self-efficacy among individuals with EDs. METHODS A chatbot prototype, Alex, was designed using decision trees and theoretically informed components: psychoeducation, motivational interviewing, personalized recommendations, and repeated administration. Usability testing was conducted over 4 iterative cycles, with user feedback informing refinements to the next iteration. Postintervention, participants (N=21) completed the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), and a semistructured interview. This process aimed to create an optimized chatbot by the final cycle for use in a randomized trial. RESULTS Interview feedback detailed chatbot aspects participants enjoyed and aspects necessitating improvement. Feedback converged on four themes: user experience, chatbot qualities, chatbot content, and ease of use. Following refinements, users described Alex as humanlike, supportive, and encouraging. Content was perceived as novel and personally relevant. USE scores across domains were generally above average (~5 out of 7), and SUS scores indicated “good” to “excellent” usability across cycles, with the final iteration receiving the highest average SUS score. CONCLUSIONS Overall, participants responded well in interactions with Alex, including the initial version. Refinements between cycles further improved user experiences. This study provides preliminary evidence of the feasibility and acceptance of a chatbot designed to promote motivation for and use of services among individuals with EDs. Alex is the first chatbot designed for pairing with an ED or other mental health–related online screen, with the goal of ultimately increasing service utilization.

Biological, genetic, and environmental factors make weight loss very difficult. Acceptance-based behavioral treatment (ABT) supplements standard behavioral treatments (BT) for obesity by teaching skills to accept the discomfort inherent to weight control behaviors and prioritize long-term, values-based goals. Grit, the ability to persevere in goal pursuit, overlaps conceptually with ABT principles and may predict outcomes in ABT. During a randomized controlled trial comparing three weight loss interventions (BT, BT with an emphasis on physical activity [BT+PA], ABT with an emphasis on physical activity [ABT+PA]), this study examined if grit predicted weight loss, intervention engagement (session attendance and dietary self-monitoring), and perceived intervention effectiveness, and whether intervention condition moderated these relationships. Participants (N=309) with overweight/obesity enrolled in an 18-month weight loss intervention completed the Short Grit Scale at baseline. Weight and PA were measured at baseline, during the intervention (12 and 18 months), and at follow-up (24 and 36 months). Session attendance and dietary self-monitoring were assessed throughout the intervention, and perceived intervention effectiveness at end-of-intervention. The relation of grit to several outcomes depended on condition. In ABT+PA, but not BT or BT+PA, lower grit related to higher weight loss at 12 and 24 months, session attendance, and perceived intervention effectiveness. Grit was not related to PA or dietary self-monitoring in any condition. ABT’s focus on building skills to facilitate long-term goal pursuit may be unique and beneficial to those with lower grit. Those with higher grit may already possess ABT-consistent skills and benefit less from ABT. Research on trait-level characteristics like grit in relation to weight must be cautious not to reinforce weight bias; rather, this work suggests that an evidence-based intervention (ABT) may be well-suited to those with lower grit levels seeking weight loss.

Biological, genetic, and environmental factors make weight loss very difficult. Acceptance-based behavioral treatment (ABT) supplements standard behavioral treatments (BT) for obesity by teaching skills to accept the discomfort inherent to weight control behaviors and prioritize long-term, values-based goals. Grit, the ability to persevere in goal pursuit, overlaps conceptually with ABT principles and may predict outcomes in ABT. During a randomized controlled trial comparing three weight loss interventions (BT, BT with an emphasis on physical activity [BT+PA], ABT with an emphasis on physical activity [ABT+PA]), this study examined if grit predicted weight loss, intervention engagement (session attendance and dietary self-monitoring), and perceived intervention effectiveness, and whether intervention condition moderated these relationships. Participants (N=309) with overweight/obesity enrolled in an 18-month weight loss intervention completed the Short Grit Scale at baseline. Weight and PA were measured at baseline, during the intervention (12 and 18 months), and at follow-up (24 and 36 months). Session attendance and dietary self-monitoring were assessed throughout the intervention, and perceived intervention effectiveness at end-of-intervention. The relation of grit to several outcomes depended on condition. In ABT+PA, but not BT or BT+PA, lower grit related to higher weight loss at 12 and 24 months, session attendance, and perceived intervention effectiveness. Grit was not related to PA or dietary self-monitoring in any condition. ABT’s focus on building skills to facilitate long-term goal pursuit may be unique and beneficial to those with lower grit. Those with higher grit may already possess ABT-consistent skills and benefit less from ABT. Research on trait-level characteristics like grit in relation to weight must be cautious not to reinforce weight bias; rather, this work suggests that an evidence-based intervention (ABT) may be well-suited to those with lower grit levels seeking weight loss.

Abnormal fetal tongue size is a phenotypic feature of various syndromes including Beckwith-Wiedemann, Pierre-Robin, oromandibular limb hypoplasia, chromosomal aberrations, etc. Current data regarding normal fetal tongue size are limited. Hence, micro/macroglossia are subjectively determined. The aim of the study was to construct a contemporary fetal tongue nomogram and to assess its clinical contribution.A prospective cross-sectional study was performed in well dated, low risk, singleton pregnancies. Fetal tongues were measured by 5 trained sonographers. Highest quality images were selected. Intra- and interobserver variability was assessed. Tongue length, width, area, and circumference 1st to 99th centiles were calculated for each gestational week. Based on the normal tongue size charts, we created a Tongue Centile Calculator.Over 18 months, 664 tongue measurements were performed. A cubic polynomial regression model best described the correlation between tongue size and gestational age. The correlation coefficient (rWe present novel fetal tongue size charts from 13 to 40 weeks of gestation. Clinical application of these nomograms may be beneficial in the prenatal diagnosis of syndromes or malformations associated with abnormal fetal tongue size.

Background Eating disorders (EDs) are complex mental illnesses with debilitating, pervasive psychological and physiological consequences when left untreated. Unfortunately, patients may face barriers to receiving treatment, such as stereotypes surrounding EDs, denial of illness severity, lack of motivation for treatment, and lack of knowledge about treatment resources. Barriers such as these result in a large treatment gap: only 20% of those with EDs will ever receive treatment. Digital tools like chatbots show potential to disseminate mental health–related interventions to large populations while offering a user-friendly, cost-effective, accessible, and anonymous means of tackling patient concerns. Objective This study developed and evaluated the usability of a chatbot designed for pairing with online ED screening. The tool aimed to promote mental health service utilization by improving motivation for treatment and self-efficacy among individuals with EDs. Methods A chatbot prototype, Alex, was designed using decision trees and theoretically informed components: psychoeducation, motivational interviewing, personalized recommendations, and repeated administration. Usability testing was conducted over 4 iterative cycles, with user feedback informing refinements to the next iteration. Postintervention, participants (N=21) completed the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), and a semistructured interview. This process aimed to create an optimized chatbot by the final cycle for use in a randomized trial. Results Interview feedback detailed chatbot aspects participants enjoyed and aspects necessitating improvement. Feedback converged on four themes: user experience, chatbot qualities, chatbot content, and ease of use. Following refinements, users described Alex as humanlike, supportive, and encouraging. Content was perceived as novel and personally relevant. USE scores across domains were generally above average (~5 out of 7), and SUS scores indicated “good” to “excellent” usability across cycles, with the final iteration receiving the highest average SUS score. Conclusions Overall, participants responded well in interactions with Alex, including the initial version. Refinements between cycles further improved user experiences. This study provides preliminary evidence of the feasibility and acceptance of a chatbot designed to promote motivation for and use of services among individuals with EDs. Alex is the first chatbot designed for pairing with an ED or other mental health–related online screen, with the goal of ultimately increasing service utilization. Acknowledgments This research was supported by K08 MH120341 from the National Institute of Mental Health. Availability of Data, Materials, and Code The data will be made available by reasonable request to the corresponding author. Authors’ Contributions EEFC conceptualized and designed the study. OL and BD conducted the investigation process. BD and JS assisted with data curation and conducted formal thematic analyses. JS conducted formal statistical analyses. JS wrote the original manuscript, with contribution from BD. EEFC, CBT, DEW, and SSS designed the data collection instruments, and coordinated and supervised data collection, in addition to reviewing and editing the manuscript with LS, LMF, LAF, and LD. Conflicts of Interest None declared.