Levels of Prevention

Level 1: Be a Good Role Model

Level 2: Primary Prevention

Level 3: Secondary Prevention

Warning on Conducting Prevention Programs

Critical Need for Prevention Programs in Schools

Tips for Parents in Preventing Eating Disorders in Their Children

Tips for Helping Prevent Eating Disorders in Males

 Levels of Prevention

Prevention means to take prior action before an illness or event occurs, in order to stop the event or illness from occurring. Prevention measures may also be taken after a disease starts, in order to stop or slow down the progression of an illness.

When one considers the devastating physical and psychological affects of eating disorders, it is critical that eating disorder prevention programs be implemented to prevent these life-threatening illnesses.

There are different levels of eating disorder prevention, including being a good role model, primary prevention, and secondary prevention.

All of us can help prevent eating disorders as described in level 1 below by being a good role model. Educators and counselors have the additional responsibility of taking prevention initiatives to levels 2 and 3 (primary and secondary prevention) by identifying eating disorders in their early stages and through presenting eating disorder prevention programs.

Level 1: Be a Good Role Model

You can role model healthy attitudes and behaviors about weight, appearance, food, eating, and exercise, and exhibit a positive self-esteem along with self-acceptance of your body.

You can be a role model for normal eating. Normal eating is eating when you are hungry and stopping when you are full. Normal eaters enjoy eating their food. They select a variety of foods to eat that appeal to them without passing judgment about how many calories are in the food, how much fat is in it, how nutritious it is, etc. The normal eater may be aware of how to eat a nutritious, balanced diet, but does not live by rigid standards that dictate what to eat and what not to eat.

You can model positive self-esteem by practicing positive self-talk, recognizing your strengths, talents, achievements and limitations, setting goals, seeing problems as opportunities, not being critical with yourself, being assertive, and trusting yourself to be capable of making good decisions.

Exhibit a positive body image by accepting your body shape and size and not obsessing over how different body parts look. Focus on health, not weighing less. Enjoy body movement or exercise, because it feels good and contributes to improved health, not because it is a way to shed extra pounds. Federal guidelines recommend getting at least 30 minutes of exercise 5 days a week for optimal health.

Good role models recognize that their language affects how people think and feel about themselves. Refrain from using language and making comments that reflect unhealthy attitudes about weight, food, and body image. For example, don’t label food as “bad/good” and say “I’ll have to exercise later to work off the meal I just ate.” When you hear others making negative comments, you can assertively counter their comments with statements reflecting healthy concepts.

 Level 2: Primary Prevention

Primary prevention involves a systematic approach to decrease individual, family, and social risk factors predisposing people to eating disorders (such as preoccupation with one’s appearance, poor self-esteem, ineffective communication styles, and dieting) while increasing those factors promoting health in mind and body (such as by promoting healthy attitudes and behaviors about food, weight, and appearance; teaching stress management skills; and learning critical thinking skills to analyze media messages). Primary prevention is proactive as its programs attempt to prevent eating disorders before they begin.

Primary prevention programs should be started in the early grades to begin reinforcing positive, healthy concepts in young children about food, weight, appearance, and exercise. These concepts can be taught to young children through reading such books as, Full Mouse, Empty Mouse and Shapesville (- See the N.A.M.E.D. Bookstore for book details). After reading these books to first and second graders, the teacher can discuss with the children the themes in the book. For older students there are eating disorder prevention curriculums available to help students develop a positive self-esteem and a healthy body-image. Eating disorder prevention programs should teach students important life skills, such as effective communication, conflict resolution, stress management techniques, and anger management skills. Additionally, eating disorder prevention programs should show students how media messages influence their thinking and encourage them to to develop their own values, attitudes, and beliefs without blindly following the concepts presented through the media.

 Level 3: Secondary Prevention

Secondary prevention refers to identifying and treating individuals soon after
the onset of their eating disorder, in order to prevent the eating disorder from
becoming worse. This requires adept doctors, dentists, educators, family members, and friends to recognize eating disorders in the early stages. The longer one has an eating disorder, the greater the chances for physical complications and the more entrenched individuals become in their ineffective thought patterns and unhealthy behaviors, so early intervention is critical.

In secondary prevention, treatment providers must discover the specific individual factors “perpetuating” a person’s eating disorder, in order to interrupt the destructive cycle of thinking and behavior patterns associated with eating disorders.

Doctors have a primary responsibility in diagnosing an eating disorder. They need to notice the signs and symptoms of eating disorders apart from any lab results, which often show no problems until one’s condition is seriously compromised.

Educators can play an important part in secondary prevention. Teachers can report to school counselors or nurses those students who they suspect may have an eating disorder. School counselors and nurses should know the signs of eating disorders and be able to do a basic assessment of a student to determine if they think the student has an eating disorder. School counselors and nurses need to be able to provide information on eating disorders, offer initial support and counseling, be prepared to refer students to eating disorder therapists in the community, and know how to approach parents on the issue (for students under 18).

As the general public becomes more informed about eating disorders, people will be able to recognize eating disorders in others, encourage them to seek treatment, and provide support to them.

 Warning on Conducting Prevention Programs

Eating disorder prevention programs need to be carefully developed and monitored to ensure they achieve the intended results. Some prevention programs in the past have been ineffective, even detrimental to participants. For example, having a speaker with an eating disorder speak to a group about her eating disorder has done more to glamorize and encourage eating disorders than to prevent them. Also, describing eating disorder behaviors, such as different ways to purge, does more to give teenagers ideas on what to “try to do,” not “not do.”

Effective eating disorder prevention programs have less to do with offering a description of what eating disorders are, and more to do with helping people develop a positive self-esteem and positive body image, learning effective communication and stress management skills, developing critical thinking skills to prevent one from blindly following media and cultural messages, and learning healthy, positive attitudes and behaviors related to food, exercise, weight, and appearance.

Critical Need for Prevention Programs in Schools

Despite eating disorders being a serious problem, especially among teenagers and young adults, prevention programs for eating disorders are essentially non-existent in school curriculum. Carolyn Costin (1999, p. 275) reported that a study found that 86% of those with eating disorders reported an onset of their illness before age 20. This points to the critical need for eating disorder prevention programs in schools.

There may be several reasons why school administrators are either reluctant to implement eating disorder prevention programs or simply do not see it as a problem. These reasons, include:
1. Educators do not want to teach on eating disorder prevention, because
they have very little or no understanding into the complexity and
dynamics of eating disorders.
2. Eating disorders are silent, private, personal experiences, not visible to the
casual observer.
3. With society’s unhealthy preoccupation with weight, dieting, and
appearance, eating disorders are not taken seriously.
4. The belief that there is too many other things to teach, so a curriculum on
eating disorder prevention does not warrant the time.

The alarming rate of eating disorders and obsessions with weight, fat, dieting, and appearance, warrants attention just like any other major issue affecting students, such as HIV infection, and drug and alcohol abuse.

 Tips for Parents in Preventing Eating Disorders in Their Children

1. Role model healthy attitudes and behaviors about food, weight, body image, and
   exercise. This first requires examining, and then modifying your own unhealthy
   attitudes and behaviors. Remember, children learn by what you say and do. If
   you criticize your body, you influence them to be critical with their bodies. If you
   restrict certain foods, you imply that those foods are bad. If you talk about
   dieting and diet frequently, they will learn to value themselves on their
   appearance.
2. Don’t place moral judgment on food. For example, a dieter says, “I was good
   today” meaning he did not eat any food not on his diet plan.
3. Take the time to listen when children express themselves and encourage them to
   express their feelings, thoughts, and problems.
4. Help children realize their self-worth comes from a God who loves them and
   created them, not from something that is earned or achieved. Love them
   unconditionally. Help children understand their self-worth is not based on
   appearance or their discipline in dieting.
5. Help children realize the value of their positive internal qualities (such as
   friendliness, integrity, and thoughtfulness) in developing and sustaining their relationships.
6. Show respect to people of all sizes and shapes. Bring to children’s attention the
   positive internal qualities and talents of people of all sizes.
7. Confront others who tease children.
8. Help build children’s self-esteem. Compliment them often. Show them in word
   and action that you love, accept, value, and appreciate them.
9. Refrain from making comments, either positive or negative, about a child’s
   weight, shape, appearance, or specific body parts.
10. Discuss with children how advertisements manipulate them to feel poorly about themselves, in order to persuade them into buying the advertised products with the claim that if they buy the products, they will feel better about themselves.
11. Encourage children to critically examine the messages they receive from the media and their peers about the expectations about appearance and dieting.
12. Help children value following what their conscience tells them is right and not
    blindly following popular belief.
13. Help children accept all the characteristics of their bodies that make them
    uniquely themselves.
14. Encourage children to appreciate all that their bodies can do and to take pride
    in all of their skills, talents, and positive personality characteristics.
15. Encourage children to eat a variety of foods in moderation, to try new foods,
    and to eat in response to hunger and stop in response to satiety. Never restrict
    their food intake or put them on diets unless directed by a physician for medical
    reasons.
16. Do not always restrict certain foods or drinks from children, such as soda.
17. Don’t use food as a reward or restrict it as a punishment.
18. Teach children about the physical and psychological dangers of dieting and over
    exercising.
19. Encourage children to balance the various important dimensions in their life,
    such as school, family, friends, exercise, chores, spirituality, sleep, and eating.
20. Teach children effective communication and anger management skills as well as positive ways of coping with stress. Encourage them to be assertive and to express their feelings and thoughts. These skills will make them less likely to use food as a coping mechanism to ignore or numb feelings they find difficult expressing.
21. Help children develop an attitude that physical activity/exercise is fun and not
    work or an inconvenience.
22. Be aware of the warning signs of an eating disorder and that both girls and boys are vulnerable to eating disorders. Examples of signs to look for include, skipping meals, purging, bingeing, excessive exercising, social withdrawal, depression, and comments about one’s body weight and dieting.

 Tips for Helping Prevent Eating Disorders in Males

1. Recognize males are as susceptible to eating disorders as females.
2. Know the signs of an eating disorder, such as preoccupation with fat, obsession with physique, excessive exercising, social withdrawal, depression, etc.
3. If you approach a male with an eating disorder to express your concern, be aware that he, not only is likely to deny his eating disorder, but will be unwilling to express any troubling emotions he may be experiencing. Males are likely to justify their dieting and/or excessive exercising by saying their purpose is for good health, avoiding disease, and for being fit.
4. Be aware of the risk groups for eating disorders, such as athletes (especially body builders, wrestlers, swimmers, skaters, etc.), certain professions (models, actors, and professionals who make public appearances), homosexual men, men who have been teased as children for being overweight, men who come from families who put high expectations on their sons, and men who have a family history of a genetically predisposed disease that they are trying to avoid (such as heart disease).
5. Coaches must prohibit excessive weight control or body building measures in their athletes and advocate for healthy eating and moderate exercise for health and optimum performance.
6. Be aware of how traumatic events can trigger an eating disorder. Traumatic events include, seeing horrific events in a war or accident; sexual, emotional, and physical abuse; a sexual identity conflict; and the death of a family member or friend.
7. Help males to understand how the media both reflects and manipulates cultural perceptions about men’s ideal body image, masculinity, and sexuality, and hence, what it means to be a man.
8. Help boys to develop a positive self-esteem, critical thinking and effective communication skills, and assertiveness, in order to reduce their risk of falling prey to media and peer pressures to conform to cultural norms for masculinity.
9. Don’t objectify either women or men.
10. Help boys and men embrace and expand their definition of what it means to be a man to include traditionally “non-masculine” traits, such as nurturing, caring, and patience as well as to include traditionally “non-masculine” roles, such as cooking and child care.
11. Encourage boys and men to develop all aspects of their personality and talents, and pursue life fulfilling goals.
12. Validate boy’s and men’s positive qualities and achievements.
13. Fathers must not degrade their sons who lack interest in sports and other traditionally masculine activities.
14. Help boys and men to value internal qualities (such as integrity, caring, and thoughtfulness), rather than external qualities (such as weight and muscularity). When they realize that people are attracted to them more by their internal qualities than by their external qualities, they will be more likely to value their internal traits.
15. Help boys and men to express their emotions in healthy ways.
16. Respect boy’s and men’s need to have the freedom to control things in their life. Allow them to be independent, autonomous, and make their own decisions (when appropriate, if a child) without pressure to conform to another way. When men feel a sense of control over their lives, they are less likely to resort to eating disorder behaviors as a means of exerting control.
17. Help boys and men to feel no shame in going to a therapist. Help them see therapy as an opportunity for achieving personal growth, happiness, and health.
18. Be prepared to provide men with resources to therapists who treat eating disorders in males.