Abstract
The Prevention of Eating Disorders is the second of a series of studies in eating disorders (see previous review). It is a similarly multi-authored text. While the majority of chapters address primary prevention, there is some attention given to secondary prevention.
Striegel-Moore and Steiner-Adair set the scene challenging the specific disease model and its limitations when applied to primary prevention. They argue for more research evaluating the potency of risk factors. They point to the similarities between minimal intervention and primary prevention and the continuum from primary, to secondary, to tertiary prevention strategies. They comment that ‘we may feel more comfortable educating young girls about the perils of dieting than we are about trying to achieve social change necessary to reduce physical and sexual victimisation perpetuated against young girls, yet perhaps the latter would be more effective than the former in reducing the incidence of eating disorders…’. Levine and Smolak explore ways in which the mass media might be transformed from ‘monolithic obstacle to collaborator in primary prevention’. It is of note that curriculum based interventions have produced only modest increases in knowledge, and very little or no changes in attitudes or behaviours that increase the risk of eating disorders. They finish with an interesting, and encouraging, contrast with the lessons learned from programs for the prevention of cigarette smoking. Programs in primary prevention described in the next chapters include the McKnight Foundation (Shisslak and colleagues) prospective study of risk factors for the development of eating disorders, the several phases of the Norwegian school-based prevention model (Gresko and Rosenvinge), school-based programs in the UK (Stewart) and US (Smolak and colleague) and an innovative program in a dance school with rather more promising results (Piran). This is a good place to read the detail of these programs, which is often not in the published reports. However, readers may be frustrated in that the controlled studies either had disappointing results, or results that have been or will be published elsewhere.
The book ends with two contrasting chapters by Schoemaker and by Noordenbos, on secondary preventative strategies. Schoemaker describes the difficulties: namely, lack of empirical knowledge about aetiology and early course of eating disorders, the difficulty of conducting prospective studies in order to investigate this further because of the low incidence of eating disorders among the population as a whole, and problems with participant denial, non-attendance and refusal to participate in follow-up interviews. Noordenbos is, however, more positive, while acknowledging the factors involved with delay into treatment such as patient delay, doctors' lack of identification and the negative attitude of some practitioners towards eating disorders, and the lack of knowledge about treatment once the eating disorder has been identified. Practical ways for doctors to more easily identify eating disorders and for improved physician knowledge in this area are described with examples from the Dutch experience.
As a place to start this is a good book, and it introduces most of the current controversies and themes in this area. The book would have benefited from a closing chapter (in addition to the opening overview by Striegel-Moore and Steiner-Adair) that critically reviewed the programs presented in the book, addressed issues of efficacy and effectiveness of primary and secondary prevention, and the further development of empirical research such that relevant outcomes are sought and appropriate ‘high risk’ groups are targeted to maximise gains. Most specialists in the area of eating disorders, and those interested in the general area of mental health prevention would find this book useful and of interest.