Is there hope for eating disorder prevention

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Is there hope for eating disorder prevention?

• Andrew Hill
• Institute of Health Sciences
• University of Leeds

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The prevention spectrum

• Primary Secondary Tertiary

Prevention Early recognition Intervention
Treatment
Education
Referral
Information
Aftercare
Assessment
Early identification
Outpatient treatment
Day-patient treatment
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The prevention spectrum

• Primary Secondary Tertiary

Prevention Early recognition Intervention
Treatment
Education
Referral
Information
Aftercare
Assessment
Early identification
Outpatient treatment
Day-patient treatment
a gram of prevention is worth a kilogram of cure
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The prevention spectrum

• Primary Secondary Tertiary

Prevention Early recognition Intervention
Treatment
Education
Referral
Information
Aftercare
Assessment
Early identification
Outpatient treatment
Day-patient treatment
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1 prevention - what has been tried?

• Content
• information - psychoeducation
• media literacy
• dissonance-inducing
• behavioural solutions
• Delivery
• school/college based
• whole school plus parents
• teacher-led or peer led
• work book tasks and discussion forums

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1 prevention - what works?

• Meta-analysis (Stice et al, 2007)
• 51 programmes, 68 trials, 81 effect sizes
• 51 at least 1 risk factor
• 29 in eating pathology
• More effective programmes were
• selective interactive
• multi-session offered solely to females
• to participants 15 without psychoeducation

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Other issues

• what should programmes include?
• eating disorder specific or global mental health?
• body image, thin culture, fat talk
• vs. coping with stress, ve self-esteem

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Incidence of mental health problems

• organic factors environ. stress exploitation
• coping skills self-esteem social support
• Prevention by
• weakening the numerator, and/or
• strengthening the denominator

Albee, 1983
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The cult of thinness
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Incidence of mental health problems

• organic factors environ. stress exploitation
• coping skills self-esteem social support
• Prevention by
• weakening the numerator, and/or
• strengthening the denominator

irresistible internal/external forces
to understand, buffer, resist
Albee, 1983
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Specific and non-specific risk
Connors, 1996
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Other issues

• what should programmes include?
• eating disorder specific or global mental health?
• differences in impact?
• greatest change is increased knowledge
• greatest benefit in those at higher risk

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The prevention spectrum

• Primary Secondary Tertiary

Prevention Early recognition Intervention
Treatment
Education
Referral
Information
Aftercare
Assessment
Early identification
Outpatient treatment
Day-patient treatment
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Secondary prevention initiatives

• National Eating Disorders Screening Program (US)
• started in 1996
• college campuses
• aims to
• raise awareness
• connect at-risk students with resources

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Secondary prevention

• Benefits
• potentially resource efficient
• reach beyond school/college
• Limitations
• treatment resource intensive
• IT dependent
• uptake unclear

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Integrating ED obesity prevention?

• shared risk
• adolescent dieting e.g. Neumark-Sztainer et al
  (2006)
• media inactivity, body dissatisfaction
• weight-related teasing
• health at every size movement
• ve body image, active lifestyle, better eating
  habits, life skills, social support

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Early obesity management and EDs?

• clinical (Epstein)
• 4 incidence in 10 years
• no change in ED measures in 2 yrs
• school (Austin et al, 2005)
• Planet Health obesity prevention
• diet pills, purging (11-14 yos)
• review (Butryn Wadden, 2005)
• minimal risk, psychological improvement

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ED prevention - unanswered issues

• what age to start?
• primary school, high school, college?
• who should deliver?
• specialist, school/college staff, peer-led?
• criteria for success?
• dieting, body image, ED symptoms, service use?
• why is there so little coordinated evaluated 1
  or 2 prevention in the UK?