Body Image DisturbanceNCT05258409
Evaluating Body Acceptance Programs for Young Men
A study testing Media Advocacy (MA) and More than Muscles (MTM) in people with Body Image Disturbance and Eating Disorder Symptom, run by Auburn University at 1 site in United States.
Trial summary
While eating disorders in males are often overlooked, up to 7 million men in the United States will experience an eating disorder in their lifetime. Critically, men are less likely to seek treatment for an eating disorder compared to women. Read more about this study
- Who is it for?
- Ages 18 to 30 years, men onlyHealthy volunteers can take part
- Conditions the study is for
- Body Image Disturbance, Eating Disorder Symptom, Eating Behavior
- What is being tested?
- Media Advocacy (MA) and More than Muscles (MTM)
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 241 participants
- Where
- 1 siteUnited States
- Study dates
- 16 Aug 2022to 27 Jan 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 30 years
- Men only
- Healthy volunteers accepted
- Adult
Who may be able to join
- 18 to 30 years old
- Identify as male
- Endorse body image concerns
- Speak English and able to provide informed consent
Who cannot join
- Diagnosis of a DSM-5 eating disorder determined by SCID-5
- Significant neuropsychiatric illness (e.g., dementia, untreated severe psychiatric illness determined by SCID-unmedicated bipolar disorder, psychosis, or active suicidal ideation)
- Older than 30 years old
- Younger than 18 years old
- Non-English speaking
Trial locations and contacts
1 site in 1 country.
About this study
While eating disorders in males are often overlooked, up to 7 million men in the United States will experience an eating disorder in their lifetime. Critically, men are less likely to seek treatment for an eating disorder compared to women. Therefore, prevention programs that target male-specific eating disorder risk factors prior to the development of an eating or appearance-related disorder are crucial in reducing eating disorders in this population. Preliminary work by our group established the initial efficacy of a novel program, the Body Project: More than Muscles (MTM) compared to assessment-only control. This study will replicate and extend this research by comparing MTM to a time and attention matched control used in previous eating disorder prevention work, media advocacy (MA).
Read the detailed description
Although often overlooked, eating disorders in men are a serious and deadly public health problem, affecting up to 7 million men in the United States. Efficacious eating disorder treatments largely remain unknown, particularly for men. Over recent decades, men have faced increasing social pressures to obtain an unrealistically lean and muscular physique, which have contributed to body dissatisfaction and unhealthy eating and weight control behaviors among men, including symptoms of both eating disorders and muscle dysmorphia (body image disturbance characterized by the unhealthy pursuit of muscularity. Despite the impairment and distress associated with these conditions, males are less likely to seek treatment than females, in part due to stigma. Importantly, for those men who do seek help, existing treatments are targeted mostly towards females, rarely address male-specific risk factors, and are ineffective for over 50% of patients. Thus, well-accepted, easily replicable preventative programs that target male-specific Eating Disorder risk factors prior to disorder onset are critical to reduce the public health burden and disparities associated with eating disorders in men.
Research supports that for men, pressures from media, friends, partners, and family to pursue a lean, muscular body can lead to body-ideal internalization -- the belief that one's self-worth and value are defined by physical appearance. This can lead to dissatisfaction with muscularity and body fat, which in turn, contributes to eating disorder and muscle dysmorphia-related attitudes and behaviors. Thus, targeting internalization of the lean, muscular ideal portrayed in media culture would be important for reducing both eating disorder and muscle dysmorphia symptoms for men.
While studies have targeted body-ideal internalization in groups of women using dissonance-based interventions, until recently, no programs had been developed to address internalization of the lean, muscular body ideal for men. The investigators recently developed and evaluated the Body Project: More than Muscles (MTM) in a randomized controlled trial (RCT) to target eating disorder and muscle dysmorphia risk factors in body-dissatisfied men. Results demonstrated significantly greater decreases in body-ideal internalization, dietary restraint, drive for muscularity, bulimic symptoms (e.g., binge eating, self-induced vomiting, laxatives, fasting, and/or excessive exercise), and muscle dysmorphia symptoms for men in the MTM intervention compared to assessment-only controls, both pre- to post-intervention and at 1-month follow- up. Further, body-ideal internalization mediated intervention outcomes for bulimic and muscle dysmorphia symptoms, supporting that the intervention's effects were exerted through reducing internalization of lean, muscular ideal images portrayed in media.
While initial results for MTM are promising, prior to disseminating this program to a wider audience, the present study will replicate and extend effects observed in the previous trial by comparing the intervention to a time- and attention-matched media advocacy (MA) active control condition used in previous eating disorder prevention programs. The present study will also explore the impact of MTM on additional risk factors for eating disorders and muscle dysmorphia in men not explicitly included in the previous RCT including unhealthy exercise, self- and other-objectification, appearance- and performance-enhancing drug (APED) use, and overall levels of depression, stress, and anxiety.
Results from the present study will provide critical support to help translate research on eating disorders and muscle dysmorphia in men into evidence-based prevention of these problems. If results support the intervention's efficacy, this could lead to the expanded delivery of the intervention into university-based or online effectiveness trials to help prevent eating disorders and reduce body dissatisfaction for men at a national level.
- Conditions
- Body Image Disturbance, Eating Disorder Symptom, Eating Behavior, Dysmorphic Features, Dysmorphic Disorder, Body, Dysmorphia
- Being tested
- Media Advocacy (MA), More than Muscles (MTM)
- Keywords
- Male, Muscularity Oriented Eating, Exercise, Eating Disorder, Body Image, Body Dissatisfaction
- Medical subject headings
- Feeding Behavior, Body Dysmorphic Disorders, Congenital Abnormalities, Feeding and Eating Disorders, Compulsive Exercise, Motor Activity
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Media Advocacy (MA)Behavioural
MA content generally centers on acknowledging and discussing the role the media has on shaping body image ideals. Session 1: In session 1, similar to MTM, the primary activities will include: (1) describing the ideal body for men in our culture, (2) discussing how the media impacts this ideal, with a particular focus on advertising. Following this, participants will (3) watch a video on how the media influences body image among men, and the consequences of internalizing these messages. Session 2: In session 2, content will continue by further discussion of the video showed in session 1, with participants sharing their reactions. Next, the group discusses the attainability of the ideal as well as discusses other forms of media (e.g., social media) and how it impacts body image.
More than Muscles (MTM)Behavioural
Also called Body Project
In session 1, the primary activities are: 1) define the "ideal" body type for men in our culture, 2) discuss the origin and perpetration of the "ideal," 3) brainstorm the costs of pursuing the "ideal," 4) participate in a verbal challenge during which participants counter the "ideal" message, and (5) are asked to complete three "homework" assignments (i.e., a letter to an adolescent boy, a behavioral challenge, and a mirror exposure assignment). In session 2, the primary activities are: 1) reviewing homework, 2) engage in role-plays to counter/discourage pursuit of the "ideal," 3) discuss ways to challenge and avoid "negative body talk" statements, 4) list ways to resist the pressure to pursue this "ideal" both individually and as a group within the larger community (i.e., body activism), 5) discuss barriers to body activism and strategies to overcome those barriers, and 6) individually select an exit exercise to continue to actively challenge the appearance ideal.
| Study group | Role | What they receive |
|---|---|---|
| Media Advocacy (MA) | Active comparator | Participants assigned to this condition take place in a time and attention-matched active control where they discuss the role of media in promoting the body ideal. Receives: Behavioral: Media Advocacy (MA) |
| Body Project: More than Muscles (MTM) | Experimental | Participants assigned to this condition take part in a two-session intervention based on dissonance theory which encourages them to challenge the body ideal. Receives: Behavioral: More than Muscles (MTM) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Eating Pathology Symptom Inventory (EPSI)
The EPSI is a 45-item measure scored on a 5-point rating scale with scores ranging from 0 to 4 on individual questions. The EPSI measures eating pathology across eight dimensions with higher scores indicating greater eating pathology.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Eating Disorder Examination Questionnaire (EDE-Q)
The EDE-Q is a 28-item measure scored on a 7-point rating scale with scores ranging from 0 to 168 (scores higher than 4 on individual questions are indicative of clinical levels). The EDE-Q is a transdiagnostic measure of Eating Disorder symptoms with high scores indicating elevated eating pathology.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Muscularity Oriented Eating Test (MOET)
The MOET is a 15-item measure scored on a 5-point rating scale with scores ranging from 0 to 60. Higher scores on the MOET indicate greater muscularity-related disordered eating.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Muscle Dysmorphic Disorder Inventory (MDDI)
The MDDI is a 13-item measure for muscle dysmorphia symptoms, which is a common feature of Eating Disorders in men. Items are scored 0 (never) to 4 (always) with higher scores indicating greater muscle dysmorphic symptoms. Scores on this measure range 0 to 52.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Eating Pathology Symptom Inventory-Clinician Rated Version (EPSI-CRV
The EPSI-CRV is a semi-structured interview that assesses dimensional constructs of psychopathology associated with Diagnostic and Statistical Manual-5 Eating Disorders. The interview will take approximately 40 minutes to complete.
Measured: Change from baseline to 6-month follow-up related to dimensional changes in Eating Disorder-related psychopathology
Secondary outcomes (10)
Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ)
The SATAQ is a 30-item measure of westernized beauty standards represented in media. Items are rated 1 (definitely disagree) to 5 (definitely agree) with scores ranging from 30 to 150. Higher scores indicate greater endorsement of beauty ideals portrayed in the media.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Drive for Muscularity Scale (DMS)
The DMS is a 15-item measure of self-perceived muscularity. The measure utilizes a 6 point scale, (1) indicating always, and (6) denoting never. Lower scores indicate higher drive for muscularity. Scores range from 16 to 90 on the DMS.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Male Body Attitudes Scale (MBAS)
The MBAS is a 29-item dimensional assessment of men's body attitudes. Items are scored from 1 (never) to 6 (always) with higher scores reflecting elevated negative body attitudes. Scores from this measure range from 29 to 174.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Self-Objectification Questionnaire (SOQ)
The SOQ is a 20-item measure of how individuals appraise attributes in reference to themselves and their partner. Half of the questions relate to personal attributes the other half relate to a potential partners. The measure requires participants to rank the ten questions related to their personal attributes from 0 (least impact) to 9 (highest impact) and repeat the procedure for a potential partner
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Obligatory Exercise Questionnaire (OEQ)
The OEQ is a 20-item measure of maladaptive exercise, a common feature in Eating Disorders. Responses are captured using a 4-point scale, 1 (never) to 4 (always), with higher scores indicating increased dysregulation relating to exercise. Scores range from 20 to 80 for this measure.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Appearance and Performance Enhancing Drug Use (APED; questions were derived from the Adolescents Training and Learning to Avoid Steroids [ATLAS] study)
APED use was measured using 8-items derived from the ATLAS study. Participants are asked to respond from 1 (strongly agree) to 7 (strongly disagree) on the first 5 questions. Higher scores indicate elevated risk for future steroid use. The final 3-items request participants indicate if they have used anabolic steroids in the past 3 months (yes or no); if they have used supplements to alter their physical appearance (yes or no); if they answered yes to using supplements to alter their physical appearance, they were asked to endorse what specific substance was used (e.g., protein powder, creatine, testosterone booster, and fat burners).
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Depression, Anxiety, Stress Scale (DASS-21)
The DASS-21 is a 21-item measure that examines symptoms related to stress, anxiety, and depression. Participants are asked for respond on a scale from 0 (doesn't apply to me at all) to 3 (applies to me very much, or most of the time). Higher scores on the three sub-scales indicate elevated symptoms associated with depression, anxiety, or stress. Total scores range from 0 to 63. Each sub-scale is scored from 0 to 21.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Difficulties in Emotion Regulation Scale (DERS) short form
The DERS-16 is a validated brief version of the original DERS (36-item measure). The brief version of the DERS, is a 16-item measure for dimensions of emotion dysregulation. Participants indicate how often each statement applies to them on a scale from 1 (almost never) to 5 (almost always). Scores for the measure range from 16 to 80, with higher scores indicating greater emotion regulation difficulty.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Acceptance and Action Questionnaire 2 (AAQ-II)
The AAQ-II is a 7-item measure of experiential avoidance and psychological flexibility. Participants use a 7-point scale ranging from 1 (never true) to 7 (always true) in response to each statement. Scores range from 7 to 49, with higher scores indicating greater psychological inflexibility and avoidance of emotional experiences.
Measured: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Intervention Acceptability
Participants will respond to a 13-item measure of intervention acceptability for the MTM condition and MA condition. The first 10-items are scored on a 5 point scale, 1 indicating strongly disagree and 5 indicating strongly agree (higher score indicating higher acceptability). The last 3-items request participants provide written feedback about the intervention they participated in: which part of the program was most helpful? Which activity was the least helpful? Do you have any suggestions for improving the program? The last 3-items are not scored or included in the overall treatment acceptability score.
Measured: Immediately post-intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Feb 2022
- Study start16 Aug 2022
- Primary completion27 Jan 2025
- Study completion27 Jan 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (25)Papers the sponsor has linked to this study.
- Other trials for Body Image DisturbanceStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will briefly be screened for eligibility criteria by phone. Eligible participants will be assessed using two structured clinical interviews (SCID-5 \& EPSI-CRV) and complete a set of self-report measures at baseline. Following assessment participants will be randomized into one of two groups. One group will receive a dissonance-based intervention known as the More than Muscles (MTM), while other participants will engage in a Media Advocacy (MA) active control. Participants will complete the same set of self-report measures from baseline, after their final group, at 1-month follow-up and at 6-month follow-up. During the 6-month follow-up participants will also be reassessed using the same structured clinical interviews at baseline.
- Masking
- Double blind
- Who is masked
- Investigator, Outcomes assessor
- Enrolment
- 241 participants (actual)
Sponsor and investigators
- Lead sponsor
- Auburn University
- Sponsor type
- University, hospital or other
- Collaborators
- Arlene and Michael Rosen Foundation
- Responsible party
- Principal investigator, Tiffany Brown, Auburn University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05258409
- Sponsor's protocol ID
- 201229
- Status last verified
- May 2025
- First submitted
- 17 Feb 2022
- Last updated
- 18 May 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Principal Investigator will comply with data storage and sharing guidelines associated with her institutions best practices. Participant information will be deidentified in cases of sharing to maintain anonymity.
Publications
Strother E, Lemberg R, Stanford SC, Turberville D. Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eat Disord. 2012;20(5):346-55. doi: 10.1080/10640266.2012.715512.
PubMed 22985232Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 1;61(3):348-58. doi: 10.1016/j.biopsych.2006.03.040. Epub 2006 Jul 3.
PubMed 16815322Keel PK. Eating Disorders. Upper Saddle River: Prentice Hall; 2005
Rodgers RF, Ganchou C, Franko DL, Chabrol H. Drive for muscularity and disordered eating among French adolescent boys: a sociocultural model. Body Image. 2012 Jun;9(3):318-23. doi: 10.1016/j.bodyim.2012.03.002. Epub 2012 Apr 10.
PubMed 22494958Tylka TL. Refinement of the tripartite influence model for men: dual body image pathways to body change behaviors. Body Image. 2011 Jun;8(3):199-207. doi: 10.1016/j.bodyim.2011.04.008. Epub 2011 Jun 12.
PubMed 21664886Litt D, Dodge T. A longitudinal investigation of the Drive for Muscularity Scale: predicting use of performance enhancing substances and weightlifting among males. Body Image. 2008 Dec;5(4):346-51. doi: 10.1016/j.bodyim.2008.04.002. Epub 2008 Jul 21.
PubMed 18644753Leit RA, Gray JJ, Pope HG Jr. The media's representation of the ideal male body: a cause for muscle dysmorphia? Int J Eat Disord. 2002 Apr;31(3):334-8. doi: 10.1002/eat.10019.
PubMed 11920996Cafri G, Thompson JK, Ricciardelli L, McCabe M, Smolak L, Yesalis C. Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors. Clin Psychol Rev. 2005 Feb;25(2):215-39. doi: 10.1016/j.cpr.2004.09.003. Epub 2004 Dec 30.
PubMed 15642647Pope HG Jr, Gruber AJ, Choi P, Olivardia R, Phillips KA. Muscle dysmorphia. An underrecognized form of body dysmorphic disorder. Psychosomatics. 1997 Nov-Dec;38(6):548-57. doi: 10.1016/S0033-3182(97)71400-2.
PubMed 9427852Olivardia R, Pope HG Jr, Hudson JI. Muscle dysmorphia in male weightlifters: a case-control study. Am J Psychiatry. 2000 Aug;157(8):1291-6. doi: 10.1176/appi.ajp.157.8.1291.
PubMed 10910793Bramon-Bosch E, Troop NA, Treasure JL. Eating disorders in males: a comparison with female patients. European Eating Disorders Review. 2000;8(4):321-328.
Griffiths S, Hay P, Mitchison D, Mond JM, McLean SA, Rodgers B, Massey R, Paxton SJ. Sex differences in the relationships between body dissatisfaction, quality of life and psychological distress. Aust N Z J Public Health. 2016 Dec;40(6):518-522. doi: 10.1111/1753-6405.12538. Epub 2016 Jul 3.
PubMed 27372301Griffiths S, Mond JM, Li Z, Gunatilake S, Murray SB, Sheffield J, Touyz S. Self-stigma of seeking treatment and being male predict an increased likelihood of having an undiagnosed eating disorder. Int J Eat Disord. 2015 Sep;48(6):775-8. doi: 10.1002/eat.22413. Epub 2015 Jun 6.
PubMed 26052695Striegel-Moore RH, Leslie D, Petrill SA, Garvin V, Rosenheck RA. One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. Int J Eat Disord. 2000 May;27(4):381-9. doi: 10.1002/(sici)1098-108x(200005)27:43.0.co;2-u.
PubMed 10744844Brown TA, Keel PK. Current and emerging directions in the treatment of eating disorders. Subst Abuse. 2012;6:33-61. doi: 10.4137/SART.S7864. Epub 2012 Mar 29.
PubMed 22879753
Study at a glance
From the registry record, last updated by the sponsor on 18 May 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluating Body Acceptance Programs for Young Men
- ClinicalTrials.gov ID
- NCT05258409
- Acronym / sponsor ID
- 201229
- Conditions
- Body Image Disturbance, Eating Disorder Symptom, Eating Behavior, Dysmorphic Features, Dysmorphic Disorder, Body, Dysmorphia
- Keywords
- Male, Muscularity Oriented Eating, Exercise, Eating Disorder, Body Image, Body Dissatisfaction
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 241 participants (actual)
- Lead sponsor
- Auburn UniversityUniversity, hospital or other
- Collaborators
- Arlene and Michael Rosen Foundation
- Study start
- 16 Aug 2022 (actual)
- Primary completion
- 27 Jan 2025 (actual)
- Study completion
- 27 Jan 2025 (actual)
- First posted
- 28 Feb 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
While eating disorders in males are often overlooked, up to 7 million men in the United States will experience an eating disorder in their lifetime. Critically, men are less likely to seek treatment for an eating disorder compared to women. Therefore, prevention programs that target male-specific eating disorder risk factors prior to the development of an eating or appearance-related disorder are crucial in reducing eating disorders in this population. Preliminary work by our group established the initial efficacy of a novel program, the Body Project: More than Muscles (MTM) compared to assessment-only control. This study will replicate and extend this research by comparing MTM to a time and attention matched control used in previous eating disorder prevention work, media advocacy (MA).
Detailed description
Although often overlooked, eating disorders in men are a serious and deadly public health problem, affecting up to 7 million men in the United States. Efficacious eating disorder treatments largely remain unknown, particularly for men. Over recent decades, men have faced increasing social pressures to obtain an unrealistically lean and muscular physique, which have contributed to body dissatisfaction and unhealthy eating and weight control behaviors among men, including symptoms of both eating disorders and muscle dysmorphia (body image disturbance characterized by the unhealthy pursuit of muscularity. Despite the impairment and distress associated with these conditions, males are less likely to seek treatment than females, in part due to stigma. Importantly, for those men who do seek help, existing treatments are targeted mostly towards females, rarely address male-specific risk factors, and are ineffective for over 50% of patients. Thus, well-accepted, easily replicable preventative programs that target male-specific Eating Disorder risk factors prior to disorder onset are critical to reduce the public health burden and disparities associated with eating disorders in men.
Research supports that for men, pressures from media, friends, partners, and family to pursue a lean, muscular body can lead to body-ideal internalization -- the belief that one's self-worth and value are defined by physical appearance. This can lead to dissatisfaction with muscularity and body fat, which in turn, contributes to eating disorder and muscle dysmorphia-related attitudes and behaviors. Thus, targeting internalization of the lean, muscular ideal portrayed in media culture would be important for reducing both eating disorder and muscle dysmorphia symptoms for men.
While studies have targeted body-ideal internalization in groups of women using dissonance-based interventions, until recently, no programs had been developed to address internalization of the lean, muscular body ideal for men. The investigators recently developed and evaluated the Body Project: More than Muscles (MTM) in a randomized controlled trial (RCT) to target eating disorder and muscle dysmorphia risk factors in body-dissatisfied men. Results demonstrated significantly greater decreases in body-ideal internalization, dietary restraint, drive for muscularity, bulimic symptoms (e.g., binge eating, self-induced vomiting, laxatives, fasting, and/or excessive exercise), and muscle dysmorphia symptoms for men in the MTM intervention compared to assessment-only controls, both pre- to post-intervention and at 1-month follow- up. Further, body-ideal internalization mediated intervention outcomes for bulimic and muscle dysmorphia symptoms, supporting that the intervention's effects were exerted through reducing internalization of lean, muscular ideal images portrayed in media.
While initial results for MTM are promising, prior to disseminating this program to a wider audience, the present study will replicate and extend effects observed in the previous trial by comparing the intervention to a time- and attention-matched media advocacy (MA) active control condition used in previous eating disorder prevention programs. The present study will also explore the impact of MTM on additional risk factors for eating disorders and muscle dysmorphia in men not explicitly included in the previous RCT including unhealthy exercise, self- and other-objectification, appearance- and performance-enhancing drug (APED) use, and overall levels of depression, stress, and anxiety.
Results from the present study will provide critical support to help translate research on eating disorders and muscle dysmorphia in men into evidence-based prevention of these problems. If results support the intervention's efficacy, this could lead to the expanded delivery of the intervention into university-based or online effectiveness trials to help prevent eating disorders and reduce body dissatisfaction for men at a national level.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (investigator, outcomes assessor)
- Number of arms
- 2
- Model description
- Participants will briefly be screened for eligibility criteria by phone. Eligible participants will be assessed using two structured clinical interviews (SCID-5 \& EPSI-CRV) and complete a set of self-report measures at baseline. Following assessment participants will be randomized into one of two groups. One group will receive a dissonance-based intervention known as the More than Muscles (MTM), while other participants will engage in a Media Advocacy (MA) active control. Participants will complete the same set of self-report measures from baseline, after their final group, at 1-month follow-up and at 6-month follow-up. During the 6-month follow-up participants will also be reassessed using the same structured clinical interviews at baseline.
| Arm | Type | Receives |
|---|---|---|
| Media Advocacy (MA) | Active comparator | Behavioral: Media Advocacy (MA)Participants assigned to this condition take place in a time and attention-matched active control where they discuss the role of media in promoting the body ideal. |
| Body Project: More than Muscles (MTM) | Experimental | Behavioral: More than Muscles (MTM)Participants assigned to this condition take part in a two-session intervention based on dissonance theory which encourages them to challenge the body ideal. |
Who may qualify
- Ages
- 18 to 30 years
- Sex
- Male only
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- 18 to 30 years old
- Identify as male
- Endorse body image concerns
- Speak English and able to provide informed consent
Key exclusion criteria (5 listed)
- Diagnosis of a DSM-5 eating disorder determined by SCID-5
- Significant neuropsychiatric illness (e.g., dementia, untreated severe psychiatric illness determined by SCID-unmedicated bipolar disorder, psychosis, or active suicidal ideation)
- Older than 30 years old
- Younger than 18 years old
- Non-English speaking
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Media Advocacy (MA)MA content generally centers on acknowledging and discussing the role the media has on shaping body image ideals. Session 1: In session 1, similar to MTM, the primary activities will include: (1) describing the ideal body for men in our culture, (2) discussing how the media impacts this ideal, with a particular focus on advertising. Following this, participants will (3) watch a video on how the media influences body image among men, and the consequences of internalizing these messages. Session 2: In session 2, content will continue by further discussion of the video showed in session 1, with participants sharing their reactions. Next, the group discusses the attainability of the ideal as well as discusses other forms of media (e.g., social media) and how it impacts body image. | Behavioural | Media Advocacy (MA) |
| More than Muscles (MTM)Also: Body ProjectIn session 1, the primary activities are: 1) define the "ideal" body type for men in our culture, 2) discuss the origin and perpetration of the "ideal," 3) brainstorm the costs of pursuing the "ideal," 4) participate in a verbal challenge during which participants counter the "ideal" message, and (5) are asked to complete three "homework" assignments (i.e., a letter to an adolescent boy, a behavioral challenge, and a mirror exposure assignment). In session 2, the primary activities are: 1) reviewing homework, 2) engage in role-plays to counter/discourage pursuit of the "ideal," 3) discuss ways to challenge and avoid "negative body talk" statements, 4) list ways to resist the pressure to pursue this "ideal" both individually and as a group within the larger community (i.e., body activism), 5) discuss barriers to body activism and strategies to overcome those barriers, and 6) individually select an exit exercise to continue to actively challenge the appearance ideal. | Behavioural | Body Project: More than Muscles (MTM) |
Primary outcome
Eating Pathology Symptom Inventory (EPSI)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
The EPSI is a 45-item measure scored on a 5-point rating scale with scores ranging from 0 to 4 on individual questions. The EPSI measures eating pathology across eight dimensions with higher scores indicating greater eating pathology.
Eating Disorder Examination Questionnaire (EDE-Q)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
The EDE-Q is a 28-item measure scored on a 7-point rating scale with scores ranging from 0 to 168 (scores higher than 4 on individual questions are indicative of clinical levels). The EDE-Q is a transdiagnostic measure of Eating Disorder symptoms with high scores indicating elevated eating pathology.
Muscularity Oriented Eating Test (MOET)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
The MOET is a 15-item measure scored on a 5-point rating scale with scores ranging from 0 to 60. Higher scores on the MOET indicate greater muscularity-related disordered eating.
Muscle Dysmorphic Disorder Inventory (MDDI)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
The MDDI is a 13-item measure for muscle dysmorphia symptoms, which is a common feature of Eating Disorders in men. Items are scored 0 (never) to 4 (always) with higher scores indicating greater muscle dysmorphic symptoms. Scores on this measure range 0 to 52.
Eating Pathology Symptom Inventory-Clinician Rated Version (EPSI-CRV
Time frame: Change from baseline to 6-month follow-up related to dimensional changes in Eating Disorder-related psychopathology
The EPSI-CRV is a semi-structured interview that assesses dimensional constructs of psychopathology associated with Diagnostic and Statistical Manual-5 Eating Disorders. The interview will take approximately 40 minutes to complete.
10 secondary outcomes
Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Drive for Muscularity Scale (DMS)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Male Body Attitudes Scale (MBAS)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Self-Objectification Questionnaire (SOQ)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Obligatory Exercise Questionnaire (OEQ)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Appearance and Performance Enhancing Drug Use (APED; questions were derived from the Adolescents Training and Learning to Avoid Steroids [ATLAS] study)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Depression, Anxiety, Stress Scale (DASS-21)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Difficulties in Emotion Regulation Scale (DERS) short form
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Acceptance and Action Questionnaire 2 (AAQ-II)
Time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up
Intervention Acceptability
Time frame: Immediately post-intervention
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 May 2025.
- Background: PubMed 22985232Strother E, Lemberg R, Stanford SC, Turberville D. Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eat Disord. 2012;20(5):346-55. doi: 10.1080/10640266.2012.715512.
- Background: PubMed 16815322Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 1;61(3):348-58. doi: 10.1016/j.biopsych.2006.03.040. Epub 2006 Jul 3.
- BackgroundKeel PK. Eating Disorders. Upper Saddle River: Prentice Hall; 2005
- Background: PubMed 22494958Rodgers RF, Ganchou C, Franko DL, Chabrol H. Drive for muscularity and disordered eating among French adolescent boys: a sociocultural model. Body Image. 2012 Jun;9(3):318-23. doi: 10.1016/j.bodyim.2012.03.002. Epub 2012 Apr 10.
- Background: PubMed 21664886Tylka TL. Refinement of the tripartite influence model for men: dual body image pathways to body change behaviors. Body Image. 2011 Jun;8(3):199-207. doi: 10.1016/j.bodyim.2011.04.008. Epub 2011 Jun 12.
- Background: PubMed 18644753Litt D, Dodge T. A longitudinal investigation of the Drive for Muscularity Scale: predicting use of performance enhancing substances and weightlifting among males. Body Image. 2008 Dec;5(4):346-51. doi: 10.1016/j.bodyim.2008.04.002. Epub 2008 Jul 21.
- Background: PubMed 11920996Leit RA, Gray JJ, Pope HG Jr. The media's representation of the ideal male body: a cause for muscle dysmorphia? Int J Eat Disord. 2002 Apr;31(3):334-8. doi: 10.1002/eat.10019.
- Background: PubMed 15642647Cafri G, Thompson JK, Ricciardelli L, McCabe M, Smolak L, Yesalis C. Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors. Clin Psychol Rev. 2005 Feb;25(2):215-39. doi: 10.1016/j.cpr.2004.09.003. Epub 2004 Dec 30.
- Background: PubMed 9427852Pope HG Jr, Gruber AJ, Choi P, Olivardia R, Phillips KA. Muscle dysmorphia. An underrecognized form of body dysmorphic disorder. Psychosomatics. 1997 Nov-Dec;38(6):548-57. doi: 10.1016/S0033-3182(97)71400-2.
- Background: PubMed 10910793Olivardia R, Pope HG Jr, Hudson JI. Muscle dysmorphia in male weightlifters: a case-control study. Am J Psychiatry. 2000 Aug;157(8):1291-6. doi: 10.1176/appi.ajp.157.8.1291.
- BackgroundBramon-Bosch E, Troop NA, Treasure JL. Eating disorders in males: a comparison with female patients. European Eating Disorders Review. 2000;8(4):321-328.
- Background: PubMed 27372301Griffiths S, Hay P, Mitchison D, Mond JM, McLean SA, Rodgers B, Massey R, Paxton SJ. Sex differences in the relationships between body dissatisfaction, quality of life and psychological distress. Aust N Z J Public Health. 2016 Dec;40(6):518-522. doi: 10.1111/1753-6405.12538. Epub 2016 Jul 3.
- Lab WebsiteLink provided by the sponsor.
- Individual participant dataSharing planned: No. Principal Investigator will comply with data storage and sharing guidelines associated with her institutions best practices. Participant information will be deidentified in cases of sharing to maintain anonymity.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Media Advocacy (MA) and More than Muscles (MTM) in people with Body Image Disturbance and Eating Disorder Symptom, run by Auburn University at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 18 May 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Eating Pathology Symptom Inventory (EPSI) (time frame: change from baseline to immediately post-intervention, change from baseline to 1-month follow-up, and change from baseline to 6-month follow-up). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05258409, which also lists 25 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 May 2025; AzTrials last refreshed its copy on 27 Oct 2026.