WASHINGTON -- Many colleges and universities across the country have set up eating disorder prevention programs to address the well-known fact that female college students are a high-risk group for developing eating disorders. But as the authors of a study in the May issue of Health Psychology (published by the American Psychological Association APA) point out, "the simple fact that eating disorder prevention programs exist does not mean that the problem is being adequately addressed." To the contrary, the authors found evidence that the typical college eating disorder prevention program could be making the problem worse.
In what is the first empirical evaluation of a college eating disorder prevention program, researchers from Stanford University and the University of Santa Clara examined the effectiveness of the program at Stanford. A total of 788 freshman females participated in a study in which half were invited to participate in a eating disorder prevention program and half were not. Participants filled out questionnaires three months before the program and four weeks and 12 weeks after the program.
The eating disorder prevention program at Stanford (which the researchers found to be fairly typical of college programs) consisted of a 90-minute discussion attended by 10-20 participants at a time. It was led by pairs of Stanford students with different histories of disordered eating (one was a recovered anorexia patient, the other a bulimia patient who was not fully recovered). In one part of their presentation, the presenters offered information about eating disorders, such as prevalence, symptoms, how they are treated, the better prognosis for treatment if they are detected early and where to get help on campus. In the second part, the presenters told their personal stories about developing, recognizing and then getting treatment for their eating disorders.
The purpose of the program, the researchers note, is to do both primary and secondary prevention. That is, by giving students this information about eating disorders it is hoped that students who don't have an eating disorder would not develop one (primary prevention) and that students who do have an eating disorder would be motivated to seek help early in the course of the disorder (secondary prevention).
In terms of primary prevention, the Stanford program was a failure; it did not prevent eating disordered behavior in students who attended it. "In fact," the authors note, "exploratory analyses showed that students who attended the program reported slightly more symptoms of eating disorders than did students who did not attend the prevention program."
Did it at least motivate those at high risk of eating disorders to seek help? Only three high-risk participants reported seeking help, which was not enough, the authors say, to make any sort of comparison worthwhile. "To consider the intervention a success in terms of secondary prevention," the authors say, "we would have to have seen many more high-risk participants seek help."
The authors speculate that programs of this type may fail because they are attempting to accomplish both primary and secondary prevention. The educational messages for primary prevention (emphasizing such things as the health dangers of eating disorders and the difficulty treating them) are very different from the messages that would be used for secondary prevention, such as reducing stigma and emphasizing treatability. It may have been, the authors say, that the Stanford program overemphasized the secondary prevention component, inadvertently giving some of the students the impression that anorexia and bulimia are fairly common, even normal.
While both types of prevention programs are needed for a college population, the authors suggest it might be more effective to offer them separately -- rather than simultaneously -- to appropriately defined student populations. In the meantime, the authors point out that since this is the only intervention for preventing eating disorders that has been evaluated to date, "as far as we know, effective prevention programs for eating disorders still do not exist."
Article: "Are Two Interventions Worse Than None? Joint Primary and Secondary Prevention of Eating Disorders in College Females," by Traci Mann, Ph.D., Susan Nolen-Hoeksema, Ph.D., and Karen Huang, Ph.D., Stanford University; Debora Burgard, Ph.D., University of Santa Clara; Alexi Wright, Ph.D., and Kaaren Hanson, Ph.D., Stanford University, in Health Psychology, Vol. 16, No. 3.
(Full text available from the APA Public Affairs Office.)
(Traci Mann, Ph.D., can be reached at (310) 794-0631 or firstname.lastname@example.org)
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