Body Project and Healthy Weight programme

1. Introduction

Version followed: the 4-session Body Project script as distributed by the National Eating Disorders Association (NEDA, peer-leader edition, dated Nov 2016, which uses the term "appearance ideal"), cross-checked against the clinician-led "enhanced dissonance" version described by Stice, Butryn, Rohde, Shaw & Marti (2013) and the Blueprints and CEBC programme profiles. Healthy Weight verification pass: the Healthy Weight and Project Health descriptions were re-checked against trial abstracts and project pages (Evidence-Based Nursing abstract of a 3-session healthy weight trial; Stice, Shaw, Burton & Wade 2006; Stice, Rohde, Shaw & Gau 2018; Stice, Desjardins, Shaw & Rohde 2019; Oregon Research Institute project page). These confirm the programmes' aims, format and core elements. The facilitator manual and the trials' full Methods sections were not obtained, so the session-by-session content is still [uncertain].

The Body Project (also called the dissonance intervention) is a brief, scripted, group-based selective prevention programme developed by Eric Stice, Katherine Presnell, Heather Shaw, Paul Rohde and colleagues for adolescent girls and young women (roughly 14 to 24) who have body image concerns but do not meet criteria for an eating disorder. It is a prevention programme, not a treatment: people who meet eating disorder criteria are excluded and referred. [source: Blueprints; CEBC]

How change happens. Based on cognitive dissonance theory: when participants voluntarily and publicly speak, write and act against the culturally promoted appearance (thin) ideal, the mismatch between what they say and what they previously believed creates discomfort, which they resolve by endorsing the ideal less. Reduced ideal internalisation is expected to lower body dissatisfaction, which in turn reduces dieting, negative mood and eating disorder symptoms and onset. The key active ingredient is that participants, not leaders, generate the arguments against the ideal. [source: NEDA 4-session script; Stice et al. 2013 BRAT; Blueprints]

Healthy Weight programme. A companion group programme from the same team. It promotes gradual, participant-driven changes to eating and physical activity that bring energy intake and expenditure into balance, framed as healthy weight management rather than dieting. [source: Stice, Rohde, Shaw & Gau 2018 abstract; Stice et al. 2006 abstract] Versions named in the sources: (a) a 3-session healthy weight management group for girls aged 14 to 19 [source: Evidence-Based Nursing abstract]; (b) the healthy weight arm of the 2006/2008 efficacy trial (481 adolescent girls with body dissatisfaction), compared with the dissonance programme, an expressive-writing control and assessment only [source: Stice et al. 2006 abstract]; (c) "Healthy Weight 2", about 4 hours in total and group-based, for female college students with body image concerns, targeting both eating disorder symptoms and unhealthy weight gain and including nutrition education [source: iaedp review of Stice et al. 2012; PEDro record of Stice et al. 2013]; (d) Project Health, about 6 hours, which adds dissonance-induction activities about unhealthy eating, a sedentary lifestyle and excess body fat, tested with college students with weight concerns (72% female) [source: Stice et al. 2018 abstract; ORI project page; Stice et al. 2019 abstract]. Its earlier use as a comparison condition in a 2003 trial is from recall [uncertain]. Session content: Section 4.21.

2. Framework

Format. Closed group of about 5 to 10 participants (NEDA script recommends about 6 to 8), led by one or two facilitators working from a script. Standard delivery is four weekly 1-hour sessions; alternatives are two 2-hour sessions, or six 45- to 50-minute sessions when groups run over time. Needs a room with a table and whiteboard or large paper; virtual (videoconference) delivery is also used. A co-facilitator can be a former participant who hands out materials and scribes. [source: Blueprints; CEBC; NEDA script]

Delivery versions.

Clinician-led: facilitators with graduate mental health training; less-trained staff (teachers, students) should deliver only under supervision of a qualified professional. [source: Blueprints]
Peer-led: trained college peer educators. The NEDA script is written for peer leaders and tells them they are not therapists and should pass concerns to the host organisation. [source: Blueprints; NEDA script]
Original vs enhanced: since about 2011 the "enhanced" version stresses voluntary participation (reminders each session; homework described as not required), accountability (participants sign homework; sessions video-recorded) and effort (harder homework, two role-plays each). [source: Stice et al. 2013 BRAT; Blueprints]
eBody Project (internet version) and virtual peer-led groups exist; not described here in detail [uncertain].

Phases (sessions). Sessions advance on a fixed schedule rather than on clinical criteria; the only "criterion" is that each participant has had a chance to complete the session's exercises, with a short make-up session for anyone who missed one.

Pre-programme: recruitment and screening. Recruit girls or young women with self-identified body image concerns; frame participation as voluntary; screen out and refer anyone who meets criteria for an eating disorder. [source: Blueprints; CEBC]
Session 1: defining the ideal and its costs. Goals: secure voluntary commitment; have the group define the appearance ideal, contrast it with a healthy ideal, trace where it comes from, and list its personal and societal costs and who profits; each participant states publicly that it is not worth pursuing. Homework: letter to a younger girl, mirror exercise, private perpetuation checklist. [source: NEDA script]
Session 2: letters, mirror, counter-attitudinal role-play. Goals: read letters aloud, share positive self-qualities, talk the leader out of pursuing the ideal in role-play. Homework: rewind response letter, top-10 list of resistance actions. [source: NEDA script]
Session 3: comebacks, personal concerns, behavioural challenges. Goals: practise quick verbal comebacks to ideal-promoting remarks, voice and challenge personal body concerns, commit to behavioural challenges and body activism. Homework: behavioural challenge, body activism, letter to younger self. [source: NEDA script]
Session 4: consolidation and closure. Goals: debrief challenges and activism, read letters to younger self, discuss what was learned, choose a self-affirmation exercise and (optionally) a group activism project. [source: NEDA script]
After the group. Participants carry out the self-affirmation exercise and report it to the team by email; may be asked to recruit friends to future groups. [source: NEDA script]

Timings in the NEDA script run roughly 50 to 60 minutes per session with each activity time-boxed (for example, 18 minutes for defining the ideal, 20 for role-play). Keep to the allotted minutes. [source: NEDA script]

Training and fidelity. Clinician training is a 4-hour workshop; a 6-hour implementation workshop is recommended for peer educators; an 8-hour train-the-trainer option exists. Training covers group leadership, talkative and quiet members, reluctance to discuss costs, maximising homework and attendance, make-up sessions and responding to eating disorder disclosures. Fidelity checklists and competence ratings are available; supervisors can review session recordings. Curriculum and materials are a free download from the developers' facilitator site. [source: Blueprints; CEBC; Stice et al. 2013 BRAT]

3. Guiding principles

Participants generate the counter-arguments. Leaders ask questions and scribe; they do not lecture about the costs of the ideal. [source: NEDA script; Stice et al. 2013]
Never discuss benefits of the ideal. If a pro-ideal point arises, turn it back to the group to counter. [source: NEDA script]
Voluntary commitment, every session. Open each session by having each participant say she is willing to take part; choice increases dissonance. [source: NEDA script; Stice et al. 2013]
Public, owned statements. Have participants speak aloud, read their own writing and put their names to homework; in the enhanced version this was strengthened by signing forms and recording sessions. [source: Stice et al. 2013] (Clinicians adapting this must still obtain proper consent for recording and set clear confidentiality rules [synthesis].)
Effort matters. More demanding exercises (more examples, longer letters, two role-plays each) are expected to produce more attitude change. [source: Stice et al. 2013]
Stick to the script. Adherence is described as critical to outcomes; do not add content or personal stories. [source: NEDA script]
Minimal self-disclosure. Validate feelings briefly instead of sharing your own body or eating history. [source: NEDA script]
Appearance ideal is not the healthy ideal. Keep the distinction explicit: the healthy ideal is about function, fitness, health and longevity and looks different on every body. [source: NEDA script]
Prevention, not treatment. Exclude and refer people with eating disorders; peer leaders pass concerns to the host organisation and point to helpline resources. [source: Blueprints; NEDA script]
Everyone speaks. Use first names, eye contact, rotate who goes first, draw out quieter members, tactfully interrupt dominant ones. [source: NEDA script]
Respond positively to every contribution. Praise each letter or comment; redirect qualified self-statements into fully positive ones. [source: NEDA script]
Make commitments specific. Push for who, what, when and where on behavioural challenges and activism. [source: NEDA script]
Protect time. Time-box each activity; use the 6-session format if needed. [source: NEDA script]
Facilitator readiness. Leaders should be secure in their own recovery, able to model healthy eating, and hand off triggering exercises to a co-leader. [source: NEDA script]
Healthy Weight: gradual, lasting change rather than dieting. Participants choose and drive small changes to eating and activity that they can keep for good, aiming to balance intake and expenditure rather than diet restrictively. The sources describe the aim as "small permanent lifestyle changes" and "participant-driven gradual lifestyle changes". [source: Evidence-Based Nursing abstract; Stice et al. 2018 abstract]

4. Intervention inventory

All Body Project steps below follow the order and content of the NEDA 4-session script, paraphrased; minute allocations are the script's. Example language is illustrative unless quoted. [source: NEDA script, unless stated]

4.1 Introductions and rationale (Session 1, about 8 min)

Purpose: Build cohesion and explain why the group exists.
Steps: (1) Leaders introduce themselves. (2) Briefly state that the programme is research-based and has helped young women feel better about their bodies. (3) Go round the circle: each participant gives her name and one unique fact about herself.
Example language (illustrative): "This group is based on research showing that when young women talk together about the pressures on how they look, they tend to feel better about their bodies. Let's start with names and one thing about you that most people here wouldn't know."
Watch for: Anyone already silent or visibly distressed; note them to draw in gently later.

4.2 Voluntary verbal commitment (start of every session, about 2 min)

Purpose: Create the sense of free choice that dissonance depends on.
Steps: (1) State clearly that participation is voluntary. (2) Ask each participant, one by one, whether she is willing to participate actively; get a spoken yes. (3) In Session 1 also set expectations (attendance, homework) and preview the session. In the enhanced version, also say homework is not required. [source: NEDA script; Stice et al. 2013]
Example language (illustrative): "Everything we do here is by choice. Going around: are you willing to take an active part today?"
Watch for: Hesitant or mumbled agreement; acknowledge it and check whether something is in the way. A participant who declines should not be pressured [synthesis].

4.3 Defining the appearance ideal, its origins and the healthy ideal (Session 1, about 18 min)

Purpose: Make the ideal explicit so the group can critique it.
Steps: (1) Ask the group to describe the "perfect woman" as promoted by society; a scribe writes the traits on the board. (2) Relabel the list as the "appearance ideal." (3) Contrast it with the healthy ideal (function, fitness, health, longevity; includes muscle and adequate body fat; looks different on every body; no fasting or laxatives). (4) Ask where the ideal comes from: media, diet, fashion and fitness industries; how it has changed over time and differs across cultures. (5) Ask how participants have felt when they, or others, received comments about weight or shape.
Example language (illustrative): "What does the 'perfect' woman look like according to ads and social media? Shout things out and I'll write them up." Then: "Where did this list come from? Who decided this is what women should look like?"
Watch for: The group listing healthy traits as if they were the ideal; separate them out. Leaders can draw on the script's media-myths fact sheet (photo editing, how rare the advertised body type is, dieting statistics) to prompt, not lecture.

4.4 Costs of the ideal and who profits (Session 1, about 18 min)

Purpose: Have participants generate arguments against the ideal; the core dissonance exercise.
Steps: (1) Ask for personal costs of pursuing the ideal (for example, low self-worth, money, exhaustion, health problems, unhealthy weight control, depression, anxiety) and list them. (2) Ask for costs to society (health care spending, lost productivity, a culture of dissatisfaction). (3) Ask who profits (diet, media, fashion and fitness industries, cosmetic surgery). (4) Ask whether, given all this, the ideal is worth pursuing. (5) Have each participant say aloud, in her own words, that it is not.
Example language (illustrative): "What does chasing this ideal actually cost a girl or woman? ... And who makes money from us feeling this way?" Then: "So is it worth it? Let's hear from each person."
Watch for: Leaders supplying the answers; wait, prompt, and let the group fill the board. Never list benefits. Signs it is working: participants elaborate on each other's points and the closing statements are personal rather than formulaic.

4.5 Letter to a younger girl (homework after Session 1; debrief Session 2, about 20 min)

Purpose: Written counter-attitudinal advocacy, then public reading.
Steps: (1) Assign a roughly two-page letter to a younger girl explaining the costs of pursuing the appearance ideal. (2) In Session 2, each participant reads hers aloud; the leader responds positively and highlights strong arguments. (3) A participant unwilling to read can summarise or read an excerpt.
Example language (illustrative): "Would you read us your letter? ... What a powerful point about how much time dieting stole from you."
Watch for: Undone letters (have her summarise what she would write, and still ask for it next time [synthesis]); letters that drift into weight-loss tips (gently redirect).

4.6 Mirror exercise (homework after Session 1; debrief Session 2, about 12 min)

Purpose: Practise noticing positive qualities, including physical ones.
Steps: (1) Assign: stand in front of a mirror and list at least 10 positive qualities, some of them physical. (2) In Session 2, each participant shares at least three, including at least two physical. (3) Redirect qualified statements ("I guess my hair is OK") into fully positive ones. (4) Discuss why complimenting ourselves feels hard and how confidence differs from arrogance.
Example language (illustrative): "Try that again without the 'I guess': 'I like my hair.'"
Watch for: Only non-physical qualities; avoidance of the mirror entirely (explore the barrier, encourage a smaller version [synthesis]).

4.7 Appearance-ideal perpetuation checklist (homework after Session 1)

Purpose: Private self-monitoring of everyday behaviours that keep the ideal going.
Steps: Hand out the checklist; participants mark yes or no for behaviours they engage in. It is private and not read aloud.
Example language (illustrative): "This one is just for you; notice how often small habits feed the ideal."
Watch for: Shame reactions; frame as noticing, not judging [synthesis]. (Checklist items not reproduced.)

4.8 Counter-attitudinal role-play: talking the leader out of the ideal (Session 2, about 20 min; enhanced version: two per participant)

Purpose: Verbal advocacy against the ideal under mild pressure; produces the strongest dissonance.
Steps: (1) Leaders first model the exercise. (2) A leader plays a character fixated on the ideal or using unhealthy weight control (sample themes: skipping meals before an event, extreme exercise, diet pills or laxatives, believing thinness brings dates or acceptance, restriction framed as willpower). (3) Each participant has about two minutes to dissuade the character. (4) The leader echoes any pro-ideal comments participants have made, stresses the unrealistic benefits, drops hints about costs for the participant to pick up, and does not give in through several exchanges; with resilient participants the leader can be playful and exaggerate. (5) Debrief: how did it feel; why does arguing against the ideal help? The script's leader instruction is "Don't give in."
Example language (illustrative, leader in role): "But if I skip breakfast for a week before the pool party I'll finally look good in my swimsuit, and everyone will notice."
Watch for: Participants agreeing with the character, or giving diet advice; step out of role and invite the group to counter. Working: participants argue with growing conviction and use costs from Session 1.

4.9 Rewind response letter (homework after Session 2; debrief Session 3, about 10 min)

Purpose: Rehearse a response to a real past source of appearance pressure.
Steps: (1) Assign a letter to someone who once commented on or pressured the participant about her body, explaining its impact and how she would respond now. (2) In Session 3, participants read letters aloud; collect forms. The letter is not sent.
Example language (illustrative): "Write back to someone whose comment stuck with you, with the response you wish you'd had."
Watch for: Letters about a family member or abuse that open strong emotion; validate briefly and check in afterwards [synthesis].

4.10 Top-10 list of ways to resist the ideal (homework after Session 2; debrief Session 3, about 15 min)

Purpose: Generate societal-level actions against the ideal; leads into body activism.
Steps: (1) Assign a list of ten things young women can do to resist the ideal (for example, letters to editors or companies, positive notes in public bathrooms, blog or social media posts). (2) In Session 3 each participant shares three items. (3) Each commits to two concrete body-activism acts for the week (see 4.14), specifying who, when, where and how.
Example language (illustrative): "Pick two from your list you'll actually do this week. When exactly, and where?"
Watch for: Vague commitments ("be more positive"); press for a specific act.

4.11 Quick comebacks role-play (Session 3, about 10 min)

Purpose: Build fast, everyday responses that shut down ideal-promoting talk.
Steps: (1) Briefly discuss subtle ways the ideal is reinforced (praising weight loss, commenting on others' food or size, diet trends, celebrity body talk). (2) Leaders or participants voice ideal-promoting remarks. (3) Each participant answers two remarks, one or two sentences each, going twice round the circle. (4) Interrupt gently if a response runs long and ask for a shorter version. The script's sample reply is "There is nothing wrong with the size I currently wear."
Example language (illustrative): Remark: "You look amazing, have you lost weight?" Comeback: "I feel good, thanks, and my weight isn't the interesting thing about me."
Watch for: Lectures instead of comebacks; comebacks that shame the speaker's body. Working: quick, confident, varied replies.

4.12 Reasons for signing up: naming and challenging personal body concerns (Session 3, about 10 min)

Purpose: Apply the group's critique to each participant's own concerns.
Steps: (1) Ask each participant why she joined and what body concerns she has, sharing only what she is comfortable with. (2) If someone hesitates, note that nearly everyone has some body concern and invite her to share hers. (3) Have the group help challenge the specific fears and thoughts raised. (4) Close by noting that challenging these concerns is likely to help several members. In the enhanced version this is framed as discussing personal body image concerns before choosing a behavioural challenge. [source: NEDA script; Stice et al. 2013]
Example language (illustrative): "What would you say to her about that worry? Anyone?"
Watch for: Disclosures suggesting a current eating disorder, self-harm or abuse; follow the screening and referral steps in Section 5.

4.13 Behavioural challenge (assigned Session 3, about 10 min; debrief Session 4, about 10 min)

Purpose: Behavioural dissonance and exposure to avoided body-related situations.
Steps: (1) Each participant names two things she avoids because of body concerns but would otherwise do (for example, wearing shorts, going to the pool, eating in front of others). (2) She commits to doing both within the week, with day, place and details. (3) In Session 4 each describes what happened. (4) If she did not try, explore barriers, agree an easier first step and encourage continued work on the concern.
Example language (illustrative): "What's one thing you've been skipping because of how you feel about your body? When this week could you do it?"
Watch for: Choices that are unsafe or involve exercise or food rules (steer toward approach behaviours, not compensatory ones [synthesis]); reports of intense anxiety afterwards. Working: participants report the feared outcome did not happen or was bearable.

4.14 Body activism (assigned Session 3; debrief Session 4, about 10 min)

Purpose: Public action against the ideal outside the group, extending dissonance into real behaviour.
Steps: (1) From the top-10 list, each participant commits to two acts this week (who, when, where, how). (2) In Session 4 each reports what she did and whether she would continue.
Example language (illustrative): "Tell us what you did and how people reacted."
Watch for: Acts that expose the participant to bullying online; help pick lower-risk options [synthesis].

4.15 Letter to younger self (homework after Session 3; debrief Session 4, about 10 min)

Purpose: Consolidate learning by advising her younger self how to avoid body image concerns.
Steps: (1) Assign a letter of about three pages. (2) In Session 4 participants read aloud; leader responds positively. The enhanced version uses an exit letter to a younger adolescent girl about avoiding body image concerns. [source: NEDA script; Stice et al. 2013]
Example language (illustrative): "What do you wish someone had told you at eleven?"
Watch for: Grief or regret surfacing; validate briefly.

4.16 Benefits and closure discussion (Session 4, about 10 min)

Purpose: Participants articulate what they gained, a further public commitment.
Steps: Ask what they have learned about body acceptance, which activities mattered most and how they will handle future pressure. The enhanced version explicitly includes planning for future pressures to be thin. [source: NEDA script; Stice et al. 2013]
Example language (illustrative): "When the pressure shows up again next month, what will you do?"
Watch for: Leader summarising instead of participants.

4.17 Self-affirmation exercise (Session 4, about 10 min, plus closure about 8 min)

Purpose: Carry body acceptance beyond the group.
Steps: (1) Present options: talk with a friend or relative about something you each like about yourselves; keep a journal of what your body lets you do; make a pact with a friend to stop negative body talk and remind each other; replace a self-criticism with something positive about that body part; say thank you to compliments instead of deflecting. (2) Each chooses one and commits aloud. (3) She later emails the team to report it.
Example language (illustrative): "Which of these will you do in the next week, and with whom?"
Watch for: Unrealistic picks; aim for something she will actually do.

4.18 Group body activism and recruitment (end of Session 4)

Purpose: Collective action and programme sustainability.
Steps: Optionally plan one group project (for example, a signed letter to a company that promotes the ideal) with a volunteer coordinator and collected contact details; if the organisation continues the programme, ask participants to invite three friends to a future group.
Example language (illustrative): "Who would like to coordinate a group letter?"
Watch for: Pressure on unwilling participants; keep it optional.

4.19 Make-up session (as needed, about 15 min)

Purpose: Keep absent participants on track.
Steps: Meet briefly by phone or just before the next session; cover the key missed exercise in condensed form and assign the homework. [source: NEDA script; Blueprints]
Example language (illustrative): "Let's do a short version of last week's role-play so you're ready."
Watch for: Repeated absences (see Section 5).

4.20 Homework support system (all sessions)

Purpose: Maximise completion.
Steps: Explain each assignment at session end and confirm commitment; send a reminder by text, email or phone the day before each session; keep each participant's forms in a folder held by the facilitator. Enhanced version: participants sign homework forms and assignments demand more output. [source: NEDA script; Stice et al. 2013]
Watch for: Patterns of non-completion (Section 5).

4.21 Healthy Weight programme and Project Health components

Verified only to the level of trial abstracts and project pages. No manual or full Methods section is drawn on. Elements tagged [source] are confirmed; everything else is recall [uncertain] or the author's synthesis [synthesis]. Get the developers' materials before delivering either programme.

Purpose: Reduce eating disorder risk and prevent unhealthy weight gain at the same time by helping people with body dissatisfaction or weight concerns make gradual, healthy, sustainable changes to eating and activity. Early trials enrolled adolescent girls; later trials enrolled college students of both sexes. [source: Stice et al. 2006 abstract; Stice et al. 2018 abstract; Stice et al. 2019 abstract]
Format: 3-session version: three weekly 1-hour groups of 6 to 10, led by a clinical psychologist or graduate student with a research assistant [source: Evidence-Based Nursing abstract]. Healthy Weight 2: about 4 hours in total, with a nutrition-science education segment that the authors suspected may have weakened its effects [source: iaedp review]. Project Health: about 6 hours in total, group-based [source: Stice et al. 2018 abstract; ORI project page].
Steps (confirmed elements): (1) Open by explaining that the group helps members make small, permanent lifestyle changes so they can reach and keep a healthy weight; it is not a diet [source: Evidence-Based Nursing abstract]. (2) Give basic information on healthy eating and activity; Healthy Weight 2 includes nutrition education [source: iaedp review]. (3) Each participant chooses her own small, gradual changes to eating and activity, aimed at balancing intake and expenditure; the leader does not prescribe them [source: Stice et al. 2018 abstract]. (4) Project Health only: run group discussions in which members themselves state the costs of unhealthy eating, a sedentary lifestyle and obesity and the benefits of healthy eating and exercise. Saying this publicly is meant to bring their attitudes into line with what they have said, the same dissonance mechanism as in the Body Project applied to health behaviour [source: ORI project page; Stice et al. 2018 abstract].
Steps recalled, not verified [uncertain]: self-monitoring of eating and activity between sessions; a written personal change plan or commitment, reviewed at the next session, with problem-solving around barriers.
Example language (illustrative): "Choose one small change to how you eat or move that you could keep doing for a year, not a week." Project Health style: "What does sitting most of the day cost you? Let's get everyone's ideas on the board."
Watch for: Drift towards restrictive dieting, calorie counting, weight-loss goals or weight talk, which would conflict with eating disorder prevention; in Project Health discussions, keep the focus on behaviours and away from judging body size [synthesis]. Signs it is working: participants can name specific small changes they have kept between sessions [synthesis]. No calorie, weight or exercise targets are given here, by design.

5. Handling problems

From the sources

Participant argues for the ideal. Do not let her build the case. Turn it to the group ("Who has a different take?"). If needed, say you are following the programme and ask her to give the activities her best try. [source: NEDA script]
Reluctance to discuss costs. A named training topic; keep asking open questions, let peers model, and accept partial contributions. [source: Blueprints] Ask a reluctant member to "give it their best shot." [source: NEDA script]
Quiet or dominant members. First names, eye contact, rotate who starts, go round the whole circle; interrupt talkative members tactfully to protect time. [source: NEDA script; Blueprints]
Homework not done. Stress its importance, send reminders the day before, keep forms in facilitator-held folders; in the session, have her summarise what she would have written. [source: NEDA script; Blueprints] (Summarising is the script's option for unwilling readers; extending it to undone homework is [synthesis].)
Won't read a letter aloud. Offer summary or excerpt. [source: NEDA script]
Qualified self-praise in the mirror debrief. Ask her to restate without hedges. [source: NEDA script]
Behavioural challenge not attempted. Explore barriers, set an easier step, encourage continued effort. [source: NEDA script]
Long-winded comebacks or overrunning activities. Interrupt kindly, time-box, switch to the 6 x 45-50 minute format. [source: NEDA script]
Missed sessions. 15-minute make-up by phone or before the next session. [source: NEDA script; Blueprints]
Disclosure of an eating disorder or serious distress. The programme is not a stand-alone treatment for eating disorders; such participants should be excluded at screening and referred. Peer leaders tell the host organisation's representative and give helpline information; responding to such disclosures is part of facilitator training. [source: Blueprints; NEDA script] Trial participants received a list of local treatment providers. [source: Stice et al. 2013]
Facilitator triggered. Hand the exercise to the co-facilitator; if unable to continue, contact the programme coordinator. Leaders should check in with themselves after sessions. [source: NEDA script]
Temptation to self-disclose. Validate briefly instead. [source: NEDA script]

Additional guidance [synthesis] (not in the sources; clinician's own judgement)

Screening in practice. Before enrolment, use a brief eating disorder screen and clinical interview; exclude current eating disorders, purging, or significant underweight, and arrange treatment. If someone is identified mid-group, meet privately, explain kindly why a different kind of help fits better, and offer a warm referral; avoid announcing it to the group.
Suicide or self-harm disclosure. Stop and meet privately after the session (or immediately if acute); carry out a standard risk assessment, follow your service's safety-planning and safeguarding procedures, involve parents or guardians for minors as policy requires.
Group contagion of diet tips. If a participant shares weight-control methods (including in the role-play), stop and redirect immediately: "We're not going to share how-tos here." Do not let the role-play character describe methods in detail.
Participants in larger bodies or with weight-related teasing histories. Keep the healthy-ideal discussion free of weight targets; challenge weight-stigmatising remarks as part of comebacks; avoid implying any body size is the goal.
Mandated attendance (school or clinic). The model depends on choice: offer a genuine opt-out or alternative activity; keep the opening commitment real rather than ritual.
Confidentiality and recording. The enhanced trials recorded sessions and did not promise confidentiality; in routine practice, agree group confidentiality rules and obtain explicit consent for any recording; tell minors the limits (safety concerns).
Cynicism or "we already know the media is fake." Agree, then move to effort: "Then you'll be great at talking me out of it", and get into the role-play quickly; dissonance comes from doing, not knowing.
Ruptures (participant feels shamed or singled out). Name it, apologise for your part, re-establish choice ("You can pass on this one"), and check in privately afterwards.
Overwhelm during mirror, letter or behavioural challenge. Shrink the task (fewer items, shorter letter, smaller first step); use grading as in exposure work; ensure the challenge is an approach behaviour she consents to and can stop.
Mixed-gender, male or gender-diverse groups; other cultures. The certified trials were with girls and young women; adapt the definition exercise to the ideal the group actually faces (for example, muscularity, skin tone, specific cultural ideals) and note that evidence for such adaptations is thinner [uncertain].
Virtual groups. Ask for cameras on where possible, use the chat for quieter members, agree what to do if someone leaves abruptly (follow-up call), and confirm a private space for each participant.
Healthy Weight and Project Health delivery. Keep all goals behavioural, self-chosen and gradual; do not set calorie, weight or exercise targets. In dissonance discussions about unhealthy eating and inactivity, stop any shaming of body size or weight and redirect to behaviours. If a participant's monitoring or food rules become rigid or obsessive, screen her for an eating disorder and refer. Obtain the developers' materials before using either programme. [synthesis]

Sources

Sources:

Not reachable: the developers' facilitator site (bodyprojectsupport.org; permission not granted), the ClinicalTrials.gov records (NCT00042185, NCT01680224; page shell only), PubMed Central (browser check) and Europe PMC, and ResearchGate. Full texts of the Healthy Weight trials, including Stice and colleagues' "Using participant feedback to improve two selective eating disorder and obesity prevention programs", were therefore not read.