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The majority of research on prevention programs focuses on questionnaire\u2010based efficacy or the reduction of eating disorder symptoms while neglecting the health\u2010economic perspective. By contrast, the present study focuses on both an efficacy analysis considering diagnostic criteria (DSM\u20105) and on evaluating the cost\u2010benefit of a universal prevention program for eating disorders (\u201cMaiStep\u201d).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A three\u2010arm randomized controlled trial with baseline, posttreatment and 12\u2010month follow\u2010up was conducted with 1,654 adolescents (<jats:italic>M<\/jats:italic>\u00a0=\u200913.35, <jats:italic>SD<\/jats:italic>\u00a0=\u20090.76), comprising two intervention groups (MaiStep delivered by psychologists or teachers, IG\u2010T) and an active control group (ACG). The primary outcome was DSM\u20105 eating disorder diagnosis measured with the SIAB\u2010S. Furthermore, the costs of the prevention program and the savings in health care costs were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A significant difference in eating disorder diagnosis was found between the IG\u2010T and the ACG for posttreatment (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>(1=\u20097.352, <jats:italic>p<\/jats:italic>\u00a0=\u2009.007), Relative Risk (RR)\u00a0=\u00a0.53 and 12\u2010month follow\u2010up (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> (1=\u20095.203, <jats:italic>p<\/jats:italic>\u00a0=\u2009.023), RR\u00a0=\u00a0.61. MaiStep proved to be cost\u2010effective (<jats:italic>t<\/jats:italic><jats:sub>cbr<\/jats:sub>\u00a0= 6.75), saving about 560,000 \u20ac (standardized per 1,000 students\u00a0= 601,388.19 \u20ac).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Universal prevention can both reduce incidence rates of eating disorders and be cost\u2010beneficial for health care systems. Future research should analyze prevention programs regarding efficacy and cost\u2010benefit to enable comparability and derive guidelines for political decision\u2010makers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p>MaiStep is registered at the German Clinical Trials Register (DRKS00005050).<\/jats:p><\/jats:sec>","DOI":"10.1002\/eat.23599","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T06:21:38Z","timestamp":1631168498000},"page":"1855-1864","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prevention of eating disorders\u2014Efficacy and cost\u2010benefit of a school\u2010based program (\u201c<scp>MaiStep<\/scp>\u201d) in a randomized controlled trial (RCT)"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4242-3389","authenticated-orcid":false,"given":"Vanessa","family":"Wolter","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy University Medical Center of the Johannes Gutenberg University Mainz  Mainz Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2659-6266","authenticated-orcid":false,"given":"Florian","family":"Hammerle","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy University Medical Center of the Johannes Gutenberg University Mainz  Mainz Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5203-6510","authenticated-orcid":false,"given":"Arne","family":"Buerger","sequence":"additional","affiliation":[{"name":"German Centre of Prevention Research in Mental Health University of Wuerzburg  Wuerzburg Germany"},{"name":"Center of Mental Health, Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, University Hospital of Wuerzburg  Wuerzburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1168-2011","authenticated-orcid":false,"given":"Verena","family":"Ernst","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy University Medical Center of the Johannes Gutenberg University Mainz  Mainz Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-016-0264-x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/10640266.2017.1297107"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0034004"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.15f10150"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.74"},{"issue":"06","key":"e_1_2_8_7_1","first-page":"248","article-title":"Die barbie\u2010matrix: Wirksamkeit des Programms PriMa zur Prim\u00e4rpr\u00e4vention von Magersucht bei M\u00e4dchen ab der 6. 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