August 6, 2013 — The U.S. health care system needs more trained professionals and prevention specialists to take on the often overlooked―and sometimes deadly―issue of eating disorders.
“Eating disorders need to be higher up on the public health agenda,” said S. Bryn Austin, associate professor in the Department of Social and Behavioral Sciences at Harvard School of Public Health (HSPH) and director of fellowship research training in the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital. Her lecture, “Getting Eating Disorders Prevention on the Public Health Agenda: A Strategic Approach to Prevention Science, Pipelines and Workforce Training,” was held July 23, 2013 as part of the summer’s “Hot Topics” lecture series at HSPH.
Austin presented data showing a dearth of studies on preventive strategies and clinically proven interventions in the scientific literature on eating disorders. For instance, in a 2012 study she found that only 4% of nearly 1,000 studies in two of the leading eating disorder-related journals were prevention-oriented. “Clearly there’s a gap in the training pipeline. Too few prevention scientists are entering the field,” Austin told the audience. “Public health schools are leaders in training the nation’s top prevention scientists, but they are laggards in training in eating disorders,” Austin said. “We are going to have to change this before we can make meaningful headway in preventing eating disorders and related problems with weight, shape, and appearance that affect too many millions of youth and adults.”
A far-reaching problem
Even as obesity has tripled among children and adolescents aged 6-19 in the U.S. over the last three decades, the Centers for Disease Control and Prevention (CDC) reports that millions of adolescent girls and boys struggle to lose or maintain weight in extremely unhealthy and sometimes dangerous ways. This includes anorexia (under eating), bulimia (eating but purging with vomiting or laxatives), and binging (overeating and feeling shame).
While young adolescent girls are especially vulnerable as they struggle to look like slim girls on fashion magazine covers, they are not the only ones falling prey to eating disorders. In fact, both sexes and all ethnicities and socioeconomic groups are affected, Austin said. The lifetime risk in women of developing anorexia is 1.0%, bulimia, 1.5%, and binge eating, 3.5%. Males experience eating disorders at one-third to one-half the rate of women. A recent CDC study of high school students found 6% of girls and 3% of boys vomit or abuse laxatives each month in desperate attempts to control their weight.
Eating disorders threaten health in a variety of ways, including putting women and men at risk for obesity and weight gain; mental health problems such as depression and anxiety; sexual risk-taking; substance abuse and medication abuse, including alcohol, marijuana, steroids, diet pills, and laxatives; chronic stress that may contribute to heart disease and problems with the immune system, in addition to digestive and fertility disorders, and even death.
Training health professionals
Austin directs the four-year-old Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), based at HSPH and Boston Children’s Hospital, which aims to train the next generation of public health professionals to help youth deal with appearance, food, and weight issues. The program has worked with over 20 trainees already. Earlier this year, STRIPED published the first teaching case developed for public health classrooms to help students build skills in eating disorders prevention. The new case can be downloaded here free, and STRIPED is developing additional teaching cases to be published in the coming months. In addition, Austin noted that the Harvard Prevention Research Center has drawn national attention to the need for replicable, effective strategies to improve nutrition and physical activity and prevent obesity in children while also being careful to not worsen weight-related stigma or eating disorders risk in youth.
“There is a compelling need to reach out to youth early―even before elementary school―before body image problems start to develop,” she said.
The role of federal and state government should be explored to see if regulating sales of diet pills and laxatives to youth and regulating access to cosmetic surgery could help as prevention strategies. Setting new standards for how the fashion industry markets products to youth could be helpful. Other strategies that should be explored include adding black box warnings on frequently abused over-the-counter products saying: “This product is not effective for weight loss.”
“A cross-disciplinary approach is needed that includes the legal sector, political scientists, health economists, public health schools, and medical and mental health professionals to address the issue,” Austin said.
Does just feeling fat make you gain weight? (U.S. News & World Report article quoting Austin)