Critical Evaluation of School-Based Eating Disorder Prevention Programs

...

It is widely agreed upon that it is easier to prevent eating-disorders rather than treat them. In order to be most effective, prevention programs have therefore been naturally influenced by those perspectives with strong prevention components (Romano, 2015). Examples of some of the theories that prevention science is based upon include: psychoeducation (Anderson et al., 1986), the developmental model (Ivey, Ivey, & Zalaquett, 2009), social learning theory (Bandura, 1986), the theory of planned behaviour (Ajzen, 1991), positive psychology and positive human functioning (Lopez et al., 2006), and Caplan’s (1964) prevention model.

In a recent research review, Gail McVey and her associates evaluated the intervention effects of a comprehensive universal eating disorder prevention program, involving male and female middle school students (McVey, Tweed, & Blackmore, 2007). Although conclusions about the results of this particular study are limited by the age range of participants (participants were young adolescents between Grades 6 and 7 in middle school), and by the sample population of the study (participants consisted of students who all attended the same school); it was found that the prevention program Healthy School-Healthy Kids was effective at reducing disordered eating over time, decreasing the internalization of media ideals, and increasing body satisfaction in high-risk young adolescents (McVey et al., 2007).

In another study, Simon Wilksch attempted to investigate the effectiveness of prevention programs in decreasing disordered eating in both high- and low-risk adolescent participants. Wilksch found that adolescents who were more media literate showed lower mean levels of depression, anxiety, eating pathology, psychosis, and insomnia compared to adolescents with less media literacy (e.g., Ehring & Watkins, 2008; Watkins, 2008; Wilksch, 2010). Wilksch also found in his research that the media literacy program Media Smart was more beneficial, and the effects of the program lasted longer for participants with a higher risk of developing an eating disorder compared to those participants with a lower risk of developing an eating disorder (Wilksch, 2010). Although these results are encouraging for the literature of prevention, there were several limitations to this study. The first was that on the 2.5-year follow-up, 45.9% of participants were unavailable to provide the necessary research data concerning their eating behaviours; and the second, was the lack of a control group, which makes it difficult to draw accurate conclusions concerning the true effectiveness and exact cause of change in participants eating behaviours.

Although these studies indicate that prevention programs are effective at reducing eating disorders in adolescents, they fail to outline the mechanisms involved that make these types of programs effective.

In this following study, Eric Stice and his fellow researchers conducted a meta-analytic review to assess the efficacy of prevention programs in reducing current and projected eating pathology. The independent variables that were used in this study to measure the effectiveness of the programs included: body mass, thin-ideal internalization, body dissatisfaction, dieting, negative affect, and eating pathology. Stice and his colleagues found that a number of potential moderators tended to produce larger intervention effects within the reviewed programs. These intervention effects were influenced by the risk status of participants (high- versus low-risk), participant gender (exclusive female programs versus mixed), participant age (whether the participant was older than 15 years of age), session format (interactive versus didactic), the number of sessions (multisession versus single session), the interventionist (trained versus untrained), program content, the length of follow-up periods (shorter versus longer follow-up periods), and the use of validated measures in trials (Stice, Shaw, & Marti, 2007).

Although these studies indicate that school-based eating disorder prevention programs have been effective at reducing eating pathology in at-risk adolescents, there are concerns that the ongoing sessions and professional training of teachers and/or interventionists make these types of programs too lengthy and time consuming. One intervention that has been suggested to address this particular issue is an Internet-delivered eating disorder prevention program. In a 2004 study, Jennifer Brown and her colleagues investigated the effectiveness of an Internet-delivered prevention program in reducing disordered eating and improving active health knowledge in adolescents. Researchers found that students and parents who used the program showed increases in health knowledge and improvements in eating behaviours compared to those students who did not use the program (Brown, Winzelberg, Abascal, & Taylor, 2004). In comparison, internet-based programs have both some advantages and limitations compared to a school-based eating disorder prevention approach. The first advantage of an internet-based program is the wider population that this type of approach is able to reach compared to a school-based program. The second advantage is that an internet-based program can more readily include and educate parents about the dangers of eating disorders, and teach them about how they can help prevent them from occurring. However, an advantage of the school-based approach compared to the internet-based approach is the presence of a professional interventionist that may be able to more effectively educate students about the dangers eating disorders and the importance of healthy eating behaviours, although more research is needed to determine these assertions.

Discussion

In conclusion, this study has found that school-based prevention programs have been effective at reducing disordered eating and improving health knowledge in adolescents. This was found to be particularly evident in adolescents who are at a high risk of developing an eating disorder. Gender and age were also found to be important variables. As mentioned above, it is much easier to prevent eating disorders rather than treat them, and the implications of this study suggest that prevention programs are effectively protecting adolescents from developing eating disorders. However, a limitation of this study was the inability to adequately compare school-based prevention programs against internet-based prevention programs. Further research is needed not only to determine which approach is the most effective, but also whether these approaches can be integrated to create a more effective and universal method for the prevention of eating disorders in adolescence.

References