Feasibility and Acceptability of the BE REAL Let's Eat Curriculum in Middle Schoolers

Be Real's 'Let's Eat' Middle School Curriculum: A Feasibility and Acceptability Pilot Study

The purpose of this study is to evaluate the feasibility and acceptability of 'Let's Eat' and its capacity to change eating behavior and body appearance/functionality considerations in adolescents aged 11-14 years. This pilot study aims to ascertain whether the 'Let's Eat' curriculum a.) is considered acceptable by adolescents and their teachers, b.) is feasible for delivery as part of the middle school health curriculum, c.) preliminary efficacy of the curriculum to increase intuitive eating, eating competence, body acceptance, and well-being, d.) met the nutrition knowledge goals of select federal and state nutrition curriculum standards.

Study Overview

• Status: Completed
• Conditions: Eating Disorders in Children
• Intervention / Treatment: Behavioral: Let's Eat Nutrition Curriculum

Detailed Description

Rationale: There is widespread, harmful 'diet culture' messages which state that one needs to have the ideal body to be happy, healthy, and desirable and the way you achieve that is through a restrictive dieting. It has been well-studied that these messages apply pressure on adolescents to conform to unrealistic ideals which have been associated with body dissatisfaction, disordered eating, and lower well-being. Of salience to the present study, school is an important environment that can promote 'diet culture' messages, and specifically in health or physical activity or gym classes. For instance, in one study, researchers interviewed 150 adolescents who received medical treatment for anorexia nervosa and found that health education was attributed as a trigger to the eating disorder in 14% of the sample and their eating disorder was more likely to start younger with health education. Moreover, 2018 Health Textbooks have been found to teach students to count calories, log food, promote "good" versus "bad" foods all of which have been associated with disordered eating and eating disorders.

Furthermore, middle school is a sensitive period for developing one's eating behavior as they are experiencing changing social environments (i.e., elementary to middle school), increased autonomy and perceived independence, and cognitive and affective changes stimulated by puberty, which further sensitize individuals to learning new behaviors. To expand on adolescent changes with puberty, the changes in some students' physical bodies add another area in which 'diet culture' can influence adolescents' eating behaviors. The adolescent's eating behaviors can also vary by gender identity and cultural practices of eating. For example, in a qualitative study involving boys and girls discussing their food habits, both genders discussed anti-fat attitudes; however, girls described more societal pressures to be thin as a motivation for food restriction than boys. Another example is the differences in food choices and preferences based on cultural diets, such as the typical dishes prepared by parents from different ethnic backgrounds. In summary, adolescence is an important period to intervene, and given the known presence of diet culture in many of the current school programs, the Be Real 'Let's Eat' Curriculum is a novel approach to eating that does not include 'diet culture' messaging and is culturally sensitive to diverse youth experiences.

Let's Eat program:

BE REAL's Let's Eat is an evidence-informed schools-based curriculum that was developed in a multinational collaboration of established researchers with expertise in adolescent body image, disorder eating, nutrition and health education, and public health professionals. Let's Eat teaches "tuned-in eating," a holistic eating practice informed by intuitive and mindful eating, and how to apply it within the state and federal guidelines for nutrition education. The main goals of "tuned-in eating" are for adolescents to learn about physiological and emotional signals and experiences related to eating and learn how to make food choices based on their body's needs and preferences. Students are also exposed to the importance of eating for pleasure or enjoyment and of the social or community aspects of eating. This is a gender-neutral, inclusive curriculum that also addresses the role of culture with food and addresses the other messaging around food such as 'diet culture.' The program is a 3 lesson, teacher-led program delivered to 6th & 8th graders [See Attachments for an outline of the program].

This is the first trial of this multi-component eating and nutrition curriculum that may prevent against eating disorders and improve nutrition in adolescents.

Aim/objectives:

The purpose of this study is to evaluate the feasibility and acceptability of 'Let's Eat' and its capacity to change eating behavior and body appearance/functionality considerations in adolescents aged 11-14 years. This pilot study aims to ascertain whether the 'Let's Eat' curriculum a.) is considered acceptable by adolescents and their teachers, b.) is feasible for delivery as part of the middle school health curriculum, c.) preliminary efficacy of the curriculum to increase intuitive eating, eating competence, body acceptance, and well-being, d.) met the nutrition knowledge goals of select federal and state nutrition curriculum standards.

Theoretical rationale: The program teaches "tuned-in" eating which is based on intuitive eating. Intuitive eating emphasizes integrating the body's physical cues to eat (i.e., hunger and fullness cues) along with the individual's energy needs, community, and/or food preference to decide on what and how much food to eat. Intuitive eating is a proposed alternative to restrictive diets and longitudinal research has demonstrated that greater intuitive eating in adolescence predicts lower depressive symptoms, disordered eating, and body dissatisfaction in young adulthood. It is theorized with the acceptance model of intuitive eating, that increasing individual's trust and reliance on internal body cues also transfers to overal increase in body satisfaction and well-being since eating serves as an essential example of a positive body functioning. Therefore, the proposed intervention may improve eating behaviors, body image, and overall well-being.

Hypotheses: It is anticipated that the curriculum will be evaluated as acceptable by students and teachers, feasibly delivered, and that there will be statistically significant changes in outcome measures among adolescents who receive the curriculum; specifically we would expect significant increases in intuitive eating, eating competence, body acceptance, nutrition knowledge, and well-being between pre and post intervention.

Overall, the study seeks to provide some evidence of proof-of-concept for the curriculum to teach state and federally designated nutrition information without an emphasis on weight and diet culture in it. Additionally, to note how the curriculum goes above in improving other related domains of well-being and body image, which can be negatively impacted by the current, weight-focused curriculum (i.e., increase the risk of disordered eating post-exposure).

• Study Type: Interventional
• Enrollment (Actual): 138
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Oregon
    • Portland, Oregon, United States, 97206
      • Kellogg Middle School
    • Portland, Oregon, United States, 97225
      • West Sylvan Middle School

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• must attend a partnering middle school in the Portland Public School district
• be between the ages of 11-14 years old
• be in either grade 6 or grade 8

Exclusion Criteria:

• not attending a partnering middle school in the Portland Public School district
• be younger than 11 years old
• be older than 14 years old
• not in the 6th or 8th grade

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Let's Eat Nutrition Curriculum; Students will receive a 3-lesson nutrition curriculum based in anti-diet culture, weight-neutral philosophies on eating flexibly in response to internal bodily cues, for pleasure, and for community.	Behavioral: Let's Eat Nutrition Curriculum; Students will receive a 3-lesson nutrition curriculum based in anti-diet culture, weight-neutral philosophies on eating flexibly in response to internal bodily cues, for pleasure, and for community.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility of Implementing the Let's Eat Curriculum	This will be examined through multiple metrics including meeting participant recruitment goals; student attrition; the amount of missing data; the ability to accurately track student pre-post data	from baseline to within a week of completing the curriculum
Acceptability of the Let's Eat Curriculum	Acceptability will be measured through survey items administered after treatment	within a week of completing the curriculum
Nutrition Knowledge - Curriculum Learning Objectives	These items will assess the students' nutrition knowledge and familiarity with the learning objectives of the Let's Eat curriculum.	within a week of completing the curriculum

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body Acceptance	This is a subscale from the FAAT Toolkit that assesses acceptance of one's body.	at baseline and within a week of completing the curriculum
Eating Competence	This construct will be measured using the Eating Competence 2.0 survey tool.	at baseline and within a week of completing the curriculum
Intuitive Eating	Three items from the Intuitive Eating Scale - 3 will be used to assess aspects of this construct.	at baseline and within a week of completing the curriculum

Collaborators and Investigators

• Sponsor: University of North Carolina, Charlotte
• Investigators: Principal Investigator: Jennifer B Webb, PhD, UNC Charlotte

Publications and helpful links

Helpful Links

• BE REAL USA Let's Eat Curriculum Overview

Study record dates

Study Major Dates

• Study Start (Actual): February 6, 2026
• Primary Completion (Actual): March 15, 2026
• Study Completion (Actual): March 15, 2026

Study Registration Dates

• First Submitted: February 22, 2026
• First Submitted That Met QC Criteria: May 22, 2026
• First Posted (Actual): May 29, 2026

Study Record Updates

• Last Update Posted (Actual): May 29, 2026
• Last Update Submitted That Met QC Criteria: May 22, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: middle school; intuitive eating; eating disorder prevention; nutrition curriculum; eating competence
• Other Study ID Numbers: IRB-25-0873

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: After obtaining the approval of the UNC Charlotte IRB and the Portland Public School district's Research and Evaluation Office, we would make available a de-identified version of the data set to interested researchers for analytic purposes.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No