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EATING DISORDER PREVENTION

Anorexia and bulimia are part of a continuum of disordered eating that includes compulsive eating, chronic 'normalized' dieting, weight preoccupation and body dissatisfaction. Before puberty the number of boys and girls who develop anorexia are almost equal. During adolescence anorexia increases dramatically in girls in response to the changes in the bodies and in their lives. Bulimia, which usually does not occur before adolescence, is also predominant in girls. About 10 to 15% of people with eating disorders are male. Of these 4 to 6% have anorexia, 10 to 13% have bulimia and 79 to 83% are compulsive eaters. Muscle dysmorphia or ‘reverse anorexia’ where the individual thinks he cannot get big enough or muscular enough is much more prevalent in men, as is the use of steroids.

Prevention is about Healthy Development

Prevention of the health risks that girls and boys are vulnerable to (or what is often called primary prevention) takes place ‘before the fact.’ It is not about substance abuse, depression or eating disorders and body image disturbances per se. It addresses the reasons that coping mechanisms develop, and it is about helping children and adolescents build resilience to deal with these stressors before their coping mechanisms become entrenched. Prevention is about promoting and sustaining healthy development—including healthy coping strategies, positive self-esteem, recognizing and expressing and validating a range of feelings, being able to express opinions and ideas, creating healthy relationships, building a strong sense-of-self and celebrating diversity in body size and shape.

Prevention Is both Universal and Selective

Universal programs address topics such as the influence of the media, peer pressure, healthy eating, active living and self-esteem to all girls and boys in specific age groups. In some situations, boys and girls can be together to learn from and about each other and receive information that can benefit both.

Selective prevention efforts should specifically target those girls and boys who are at a greater risk for developing eating disorders and body image disturbances. These prevention programs such as JUST FOR GIRLS and JUST FOR BOYS should take place in same-sex groups or classes. This is because girls and boys develop at different rates and their issues and learning styles can be different. Both need the safety of same-sex groups to talk about the issues that are of concern to them.

EATING DISORDERS PREVENTION involves K.I.S.S.

Knowledge – Girls and boys need knowledge and information about their bodies and about their development and personal issues and concerns. When we provide them with Knowledge, we need to make sure that instead of just talking at them we include a dialogue with them. We need to give them time to think about the information and process it. We also need to provide them with the opportunity to come back and clarify what they don’t understand. Programs that increase knowledge and awareness widen people’s views of themselves and their environment in a manner that may later be psychologically protective. However, they do not immediately translate into changed attitudes, beliefs and behaviors.

Interaction/Action is the second step of prevention. We can provide opportunities through experiential activities such as movement, drawing, role play, problem solving, cooperative learning and small group discussion depending on the setting. Written activities such as handouts are a good way to raise awareness, stimulate discussion, give girls and boys quiet times to think about themselves and provide a lead-in to specific activities. We need to ensure Interaction/Action takes place in the context of girls’ and boys’ lives and provides them with a context for their behaviors. You can’t teach girls or boys to accept their bodies (especially if they are fat) without addressing the media and the pressures on them to conform to a specific body ideal.

Skills help girls and boys deal with the stressors in their lives in a healthy way. For example, giving boys information about feelings provides Knowledge. Talking about anger and role playing situations where girls are angry engages them in Interaction/Action. However, if you want to teach girls and boys how to recognize, express and manage their anger you need Skills with which to do this. You then have to provide them with lots of opportunities to practice and reinforce those skills.

Support is important if we are going to teach girls and boys new behaviors and encourage them to adopt ways of being female and male that are different from what they are told by the media and society. Giving support means validating them and encouraging them when they try out the new behavior, providing ongoing strategies and programs that support them through different stages of development and life transitions, modeling the same behaviors that we are teaching them and advocating for them when they challenge traditional ways for girls and boys to be in the world.

The Importance of Same-Sex Peer Groups in Prevention

Same-sex peer groups are a major influence in shaping the attitudes and reinforcing the behaviors of girls and boys. If you want to change behavior, challenge societal influences and teach skills the best way to do this in through gender-based peer groups where girls and boys can learn the same skills, support each other and where they all adopt the same belief system. Groups are suited for interactive and participatory activities because they are small and they provide a safe place to try out new behavior.

Peer groups provide girls and boys with a sense of belonging and an indication that they are liked and are likable. They validate them, share their needs, and widen their interests. The peer group gives girls and boys an opportunity to test their opinions, feelings and attitudes against those of other girls and boys and to decide which of their parental and societal values they will accept or reject. Groups provide a societal and gender context for girls and boys so that they understand why they feel the way they do. Groups that are facilitated by men provide boys with mentorship—something they may not get from fathers who are emotionally or physically absent.

For more information about prevention and for skills and strategies you can integrate into your individual practice, your schools and your community read Nurturing Girlpower: Integrating Eating Disorder Prevention-Intervention Skills into Your Practice.