A Change of Focus May Improve Efforts to Prevent Eating Disorders

Over the past 20 years, research into preventing eating disorders has been pioneering and ambitious, but has had little effect, according to Dr. S. Bryn Austin, Harvard School of Public Health, Boston. Dr. Austin suggests that a more effective means of preventing eating disorders may involve taking a proactive approach to changing the social environment and using cross-disciplinary collaboration to reach students (Psychol Med 2000;30:1249).

After an intensive search, Dr. Austin found only 20 empirical intervention studies in the literature, and half of these involved only girls and young women. Although eating disorders have garnered much attention from feminist researchers during the last 25 years, Dr. Austin writes, “Little of the interest in social, political, and economic factors has been carried over into the prevention end of eating disorders research.”

Changing the social environment

According to the author, past interventions may have failed due to a fundamental disjunction in the transition from theories of etiology to theories of prevention. Primary prevention strategies train patients to view media and cultural messages relating to the thin ideal with a critical eye and to foster psychological resilience to the pressure to control weight at any cost. Thus, such interventions use a therapy of adaptation, aimed at training girls and boys how to adapt to a noxious environment. “Expecting boys and girls to develop resilience to unhealthy pressures may prove to be less successful than searching out avenues to make significant changes in that social environment,” Dr. Austin writes.

Dr. Austin suggests that information about the disordered eating risk environment in schools not only reveals something about the individuals but also gives an indication of dieting patterns at a school and the amount of exposure the student population has to dieting peers. Even the curricula can be revealing. For example health, media education, physical education, sciences, social studies and other course materials can be evaluated in terms of the degree to which healthful nutrition, and exercise, body acceptance, and other related topics are promoted.

The physical and social environment of a school can also be assessed. For example, are healthful foods available in the cafeteria? Are cafeteria foods promoted as “diet foods” or promoted for their low caloric or fat content? Is the cafeteria a site for public competition over dietary restriction? Other ecological factors that could be studied include teasing about weight and body shape and general harassment.

Cross-disciplinary collaboration

Dr. Austin also suggests that the most politically and economically feasible means to advance eating disorders prevention may lie in cross-disciplinary collaboration with researchers working to prevent other public health problems, such as coronary heart disease, cancer, and obesity. Because public schools have limited resources, most are not likely to have the ability or willingness to design and/or implement new programs designed for the prevention of eating disorders.