Taking an Integrative Approach to Preventing Eating Disorders and Obesity

Dr. Dianne Neumark-Sztainer, an epidemiologist at the University of Minnesota, suggests that taking an integrated approach to intervening to prevent obesity and eating disorders may have benefits among children and teens (Adolescent Medicine 2003; 14:159).

According to the author, most prevention interventions focus on either preventing eating disorders by addressing risk factors such as dieting and body dissatisfaction, or preventing obesity by addressing risk factors such as overeating, low levels of physical activity, and high levels of sedentary behavior. However, Dr. Neumark-Sztainer notes that more integrated programs that address the broader spectrum of weight-related disorders can be beneficial for professionals and patients alike. For example, if interventions can address risk and protective factors for both obesity and eating disorders, less time will be needed than if separate interventions are done. Costs for staff time, staff training, and intervention materials may be decreased through the implementation of an integrated approach. Conflicting messages may also be avoided.

High levels of weight-related concerns and behaviors in teens

Dr. Neumark-Sztainer’s proposal for greater collaboration among professionals in the eating disorders and obesity treatment fields would improve results has been reinforced by numerous studies. For example, in a recent study of weight-related concerns and behaviors among 4746 teens in Minnesota, her research team found a high prevalence of weight-related disorders in middle school and high school adolescents, especially girls (Pediatr Adolesc Med 2002; 156). Body dissatisfaction was reported by 46% of the girls and 26% of the boys; in addition, 70% of the girls and 42% of the boys wanted to weigh less than their current weight, even if when their weight was normal. Forty-five percent of the girls and 21% of the boys were currently dieting to lose weight.

An even more alarming statistic was that 57% of the girls had used unhealthy methods to control their weight, including skipping meals, fasting, and smoking more cigarettes. Twelve percent of the girls used extreme methods to control weight, such as self-induced vomiting, diet pills, and laxatives. A third of the boys reported using unhealthy ways to lose weight, and 5% used extreme methods to do so. When the researchers weighed and measured the students, one third of the girls and boys were overweight, with body mass indexes above the 85th percentile.

According to Dr. Neumark-Sztainer, a first step in establishing an integrated approach involves increasing communication and collaboration across the eating disorder and obesity fields, in an effort to find “a common language.” Ten suggestions are listed in the table below.

Ways to Work Toward the Prevention of Weight-Related Disorders

1. Talk with professionals who work in different fields (i.e., the obesity field if you work primarily in the eating disorder field), who have different training from yours, and who have different perspectives about eating disorder and obesity prevention.
2. Listen to others and be open to modifying your own perspective on how best to work toward the prevention of weight-related disorders.
3. Read relevant literature outside your discipline.
4. After opening up lines of communication across disciplines and perspectives, foster collaborative relationships in program development, grant preparation, and manuscript writing.
5. Conduct qualitative and quantitative research with teens, parents, and health-care providers to explored potential shared risk factors for different weight-related disorders.
6. To develop appropriate messages and interventions, address the broad spectrum of weight-related disorders. This is relevant to one on one clinical interactions and more formal group interactions.
7. When evaluating programs, assess changes in different weight-related disorders to make certain that the program has not inadvertently led to an increase in conditions that aren’t the primary targets of the intervention—for example, in programs that are targeting obesity, also consider changes in body image and dieting behaviors.
8. During secondary treatment and prevention for specific weight-related disorders (for example, obesity), consider the broader spectrum of weight-related behaviors and conditions, to avoid iatrogenic effects.
9. Work with parents of teens to help the family establish healthy eating and activity patterns and to avoid excessive preoccupation with weight.
10. In interventions, use practical examples when addressing media messages and media exposure (e.g., suggest decreasing exposure to ads within schools), increasing opportunities for physical activity, and increasing the number of healthy food choices where teens eat—home, school, and fast-food restaurants.