Living With Food: The Science Supporting Eating Disorder Treatment

One of the questions we are often asked is “how do you prevent an eating disorder?” or “is it even possible to prevent an eating disorder?” While there are no true answers to these questions, we know that many of the things that we think might help in fact have shown not to be effective. There is significant evidence questioning this issue. Parents are legitimately concerned about what their kids are being taught in school about eating disorders and obesity. Many still advocate for this psycho-education to be provided. Others, however, point out that some individuals with eating disorders will pinpoint this education as a mechanism that fueled their eating disorder behaviors and thoughts.

A recent study of eating disorder education in the schools showed that didactic prevention programs demonstrated little to no impact on the future development of an eating disorder. As with the science of eating disorder treatment, there is a need for evidence-based eating disorder education and prevention. One-time lectures about the evils of eating disorders are unlikely to produce the change we would like to see.

There have been recent discussions among eating disorder professionals on how to best educate high school students on eating disorders and their dangers. A recent study in Ireland exposed adolescents to a computerized eating disorder prevention program in which psycho-education was provided to students in the areas of food, mood, body image, self-esteem, media literacy, and personal stories. The program was provided in hopes that it would reduce disordered eating in males and females between the ages of 13 and 17. The researchers found that the program helped educate students on eating disorder behaviors and reduced disordered eating. Unfortunately, this study is not yet published. We look forward to reading more on this prevention program and encourage continued research on this necessary area of study.

Stice, E. & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130, 206-227. 

Contributions by Sarah Emerman 

Why are eating disorders primarily diagnosed in women over men? From one angle is answer is obvious, many more women than men present for eating disorder treatment. The National Institute of Mental Health suggests that 5 – 15 percent of individuals diagnosed with anorexia or bulimia will be male. Of clients diagnosed with binge eating disorder, 35 percent will be male. But does this really mean that eating disorders are more common in women? Nobody really knows. There are multiple reasons for this confusion:

1. The DSM IV – In the diagnostic manual, the criteria for anorexia is gender biased so that it is relatively certain that more women than men will carry this diagnosis. The DSM specifically references the absence or delay of menses as one of the criteria for the identification of anorexia in presenting clients. This may therefore decrease the likelihood that a male will meet the criteria for a diagnosis. Similarly, the criteria for bulimia nervosa speaks of compensatory behaviors such as laxative usage, diuretics, and enemas that are generally marketed more directly towards women. The diagnostic criteria do not include the abuse of muscle building agents, thermogenics, or other agents typically used by men obsessed with body size and shape.
2. Social factors – The image of a person with an eating disorder in our common culture is most commonly portrayed by the thin young woman with anorexia. For men with anorexia, this likely increases both the shame and stigma associated with the disease and makes them less likely to present for treatment. This stereotype also affects patients with bulimia, which is more commonly diagnosed than anorexia. Because of this misconception, individuals with bulimia may feel their eating disorder is invisible, and may therefore be less likely to present for treatment.
3. Environmentally supporting factors – Men have a multitude of “acceptable” body types in our culture. This ideal ranges from hyper-thin male models, to Brad Pitt, to hyper-muscular Hulk Hogans.  In general, women must adhere only to the thin female ideal. Therefore the social support for eating disorders in women may be significantly higher than for men.