Prevention

Why is Eating Disorder Prevention Important?

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Shame, stigma, socioeconomic inequality, racism, and other prejudices impede all phases in the identification and treatment of eating disorders (EDs). Even when someone is able to access a skilled treatment, recovery tends to be long, complex, and difficult. Most importantly, given the high prevalence of EDs, there will never be enough well-trained, experienced clinicians to meet the needs of everyone who needs and deserves help. Prevention is a necessity. 

What is Prevention?   

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Prevention is a planned attempt to change the factors that promote and initiate problems like eating disorders. In this regard, prevention scientists now focus on:

1. Reducing “risk factors” (e.g., body dissatisfaction; basing one’s self-esteem on weight and shape) 
2. Strengthening “protective or resilience factors” (e.g., self-compassion; appreciation for the body’s functionality) 
3. Identifying and helping people who are “at risk”, for example, children of a parent who has or has had an eating disorder; adolescents who have been sexually abused; and people who identify as LGBTQIA+. 

Types of Prevention

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Prevention programs are policies, systems, and interventions developed in order to prevent eating disorder onset in a population. Prevention programs vary based on the size and nature of the group for whom the programming is intended. The Mental Health Intervention Spectrum, developed by the National Academy of Sciences (Committee on the Prevention of Mental Disorders, 2009), classifies different types of prevention programs according to their goals, methods and audiences:¹

Universal prevention programs are aimed at all people in a large to very large population (e.g., all adolescents in New York City or all students entering a major university). Typically, the aim is to prevent the development of EDs in large groups, with varying degrees of risk, by changing public policy, institutions, and normative cultural attitudes and practices, including educational curricula for students and for professionals (e.g., physicians, nurses, dietitians, psychologists). In addition to specific programs (such as the Body Project; see below) for small groups, which can be upscaled to populations of different sizes, universal prevention draws from research findings in the field to advocate for changes in laws, public policies, industry practices, and cultural norms.

Selective prevention programs are designed to prevent EDs in individuals who do not yet have symptoms but are at risk for an ED due to biological, psychological, or sociocultural factors (e.g., girls ages 10 to 13 who are facing puberty, experience sociocultural pressure for thinness, and have a parent who has had an ED). Selective prevention usually involves a multisession, interactive curriculum.

Indicated/targeted prevention focuses on individuals who are at high or very high risk because they already have mild to moderate ED symptoms (e.g., preoccupation with weight/shape, high levels of body dissatisfaction, and/or periodic binge eating).      

Does Eating Disorder Prevention Work?

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Prevention “works” when well-designed research indicates that a set of changes or a program reduces risk factors, increases protective factors, and over a long period of time significantly reduces the incidence (percentage of new cases in a population) of EDs. Research up to this point (mid-2024) tells us that, based on data from carefully developed programs, we can confidently conclude:^2,3,4,5

• ED prevention does not cause harm.
• ED prevention can significantly reduce risk-factor attitudes and behaviors over periods up to 3 years.
• Several prevention programs for older adolescents and young adults have shown the ability, over several years, to prevent the development of disordered eating and EDs.  
• Although universal ED prevention programs have had some success, in general,  selective and indicated/targeted prevention programs have shown more robust and lasting positive effects. 
• Much more research is needed concerning ED prevention. Specifically, we lack information about prevention programs that work with children and young adolescents, with males, people from a variety of ethnic groups, and people in high-risk groups such as adolescent girls with diabetes and people identifying as LGBTQIA+.
• We also need much more program development and research into applying well-established prevention science approaches to EDs. In particular, we need to work in a coordinated way, not only with groups of youth or young adults in schools, but also with influential adults in their lives (e.g., teachers, coaches, clergy, scout leaders) and with important community organizations and institutions such as local media, public health, and youth organizations (e.g., the YMCA, 4-H).

What Makes a Successful Prevention Program?

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Researchers have identified certain elements of prevention programs which can indicate whether they will be successful. Prevention programs with more of these elements have a greater chance of being successful in the long run. These program elements, which Michael Levine calls the “7 Cs,” include:

• Consciousness-raising: Promotes engaged, active learning about the sociocultural, personal, and interpersonal risk factors for disordered eating and EDs.
• Competencies: Helps build skills in critical thinking, public speaking, research, art, and leadership.
• Connections: Fosters connections between participants and between participants and leaders/mentors. 
• Choices and Confidence: Provides participants with opportunities for personal and group agency in making choices and building confidence.
• Change: Promotes not only personal and interpersonal change but also, through activism and advocacy, meaningful changes in the environments (e.g., posters up at school, university programs, public policies affecting social media) that affect participants.
• Courage: Helps participants understand that important changes can trigger anxiety, doubt, and failure—and therefore takes courage.

The Body Project

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Backed by two decades of research, the Body Project is a group-based intervention that provides a forum for girls and women to confront unrealistic beauty ideals and develop healthy body image through verbal, written, and behavioral exercises. Research shows when girls/women talk about the beauty or appearance ideals glorified in our society and then practice publicly challenging pressures to conform to these unhealthy standards, it creates cognitive dissonance or mental discomfort between their actions and internalized values. This motivates people to reconcile their actions and beliefs, which eventually improves how they feel about their bodies and reduces the risk of developing EDs. 

The Body Project was developed by researchers at the University of Texas at Austin, Stanford University, Oregon Research Institute, and Trinity University (Texas).^5,6,7 Using train-the-trainer and peer educator models, the Body Project and adaptations have been delivered to several million girls and young women throughout the USA and in countries as diverse as Malaysia and Mexico. Learn more about the Body Project.