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

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data extraction, lack of quality assessment, reliance on endpoint data, exclusion of obesity prevention programs, or outdated findings.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.