Prevention of Eating Disorders: A Review of Outcome Evaluation Research
Piran, Niva, The Israel Journal of Psychiatry and Related Sciences
Abstract: Prevention programs for eating disorders have been targeted both at primary prevention, through minimizing risk and enhancing protective factors, and secondary prevention, through the early identification of individuals displaying sub-clinical forms of eating disorders. Primary prevention programs with elementary school children have been found to change knowledge effectively, change attitudes in about half of students, and result in maintained behavioral change in about one-fifth of the students. Interactive primary prevention programs in elementary schools that intervened with students' social environment, such as peers and teachers, in addition to equipping students with resilience skills, seemed to be more effective. Secondary prevention at the university level revealed, in follow-up studies of about three months, the maintenance of attitudinal change in about two-thirds of the sample, and the maintenance of behavioral change in about two-fifths of the participants. In addition to including cognitive, critical and general resilience skills, these programs also engaged participants actively and invited their critical reflections. Apart from the implementation of "packaged" prevention programs, preventative interventions should be applied by all health, mental health and education professionals in their daily contact with children and their significant others.
Eating Disorders as a Social Issue Requiring Prevention Interventions
Eating disorders are prevalent and associated with significant morbidity. In many Westernized countries, the prevalence of anorexia nervosa among adolescents and young women is 0.2-0.5% and about 1-2%, respectively (1). However, clinical eating disorders are part of a larger spectrum of disordered eating behaviors that produce significant morbidity while not meeting the full anorexia or bulimia nervosa clinical criteria. It is estimated that 8-15% of adolescent women display significant levels of subclinical symptomatology (2, 3). Further, at any point in time, about 40-45% of adolescent women are trying to lose weight through various means motivated by "normative" (4) body dissatisfaction (5). Among girls, body dissatisfaction and eating disorders increase during and following puberty (6), together with challenges to the experience of self, self esteem and mood, as well as other behaviors indicating disrupted connection with the body, such as smoking to curb appetite and weight gain, plastic surgeries, self harm behaviors, and sexual activity without negotiating for protection and without the experience of desire (7-9). While less research is available to date regarding boys, reports are suggesting that an increasing number of boys display preoccupation with becoming more muscular and losing fat (10). While the female to male ratio of clinical eating disorders is about 9:1, the ratio of binge eating disorder seems to be less extreme, abouti.5:1 (10). At any point in time, about 15%-20% of adolescent men are trying to lose weight (5). Body weight and shape preoccupation, and associated eating disorders, can therefore be considered a significant health issue for youth.
The cost of the eating disorder spectrum to society and to affected individuals is significant. In terms of the impact on individuals, body dissatisfaction and disordered eating patterns have been found to be associated with challenges to self esteem and to predict, in prospective studies, future depression and eating disorders (11). The more severe end of the spectrum of disordered eating behaviors found in about 15% of adolescent women has been found to be associated with significant physical, psychological and social problems (3). Clinical eating disorders impact all aspects of afflicted individuals' lives, and those of their families and friends. Treatment for eating disorders is difficult and expensive, and recovery in many centers is reported to be achieved in about half of patients (12). The mortality rate for anorexia nervosa is 12 times higher than it is for young women in the general population (13). …