Belinda M Pratt|Susan Woolfenden
Interventions for preventing eating disorders in children and adolescents
Children's Hospital at Westmead|Liverpool Hospital
eating disorders represent extremely difficult condition treat patients consume enormous amount mental health energy resources young female dieting identified risk factors reliably linked development eating disorders several prevention eating disorder prevention programs developed trialed children adolescents purpose systematic review evaluate effectiveness eating disorder prevention programs children adolescents general population determined risk1 determine eating disorder prevention programs effective promoting healthy eating attitudes behaviours children adolescents 2 determine eating disorder prevention programs effective promoting psychological factors protect children adolescents developing eating disorders 3 determine eating disorder prevention programs effective promoting satisfactory physical health children adolescents 4 determine eating disorder prevention programs longterm sustainable positive impact mental physical health children adolescents 5 determine safety eating disorder prevention programs terms possible harmful consequences mental physical health children adolescentsrelevant trials identified searching cochrane controlled trial register cctr relevant biomedical social science databases terms necessary detect prevention programs participant groups used strategy locate randomised controlled trials used sources information bibliographies systematic nonsystematic reviews reference lists articles identified search strategy order identify unpublished studies experts field contacted letter andor electronic mailrandomised controlled trials rct major focus eating disorder prevention programs children adolescents known dsmiv diagnosis eating disorder eligible inclusion review trials must include control group least one objective outcome measure eg bmi standardised psychological measure used intervention control group pre postinterventiona total 1379 titles identified search date 13 studies located reported use randomised controlled trial methodology critically appraised two independent reviewers five 5 studies excluded data reported useable form useable data could obtained trial authors one dissertation could obtained one study true notreatment usual treatment control group one study use pretest outcome measure eight 8 studies met selection criteria outlined aboveonly one eight pooled comparisons two studies using similar outcome measures similar intervention types demonstrated statistically significant effect particular type eating disorder prevention program children adolescents combined data two eating disorder prevention programs based media literacy advocacy approach indicate reduction internalisation acceptance societal ideals relating appearance 3 6month followup kusel unpublished neumarksztainer2000 smd 028 051 005 95 ci however insufficient evidence conclude approach also demonstrated significant impact awareness societal standards relating appearance insufficient evidence support effect four programs designed address eating attitudes behaviours adolescent issues body weight eating disorder symptoms associated eating disorder psychopathology general psychological physical wellbeing general sample classified high risk eating disorder buddebergf 1998 killen 19931996 santonastaso 1999 zanetti 1999 given one program used psychoeducation approach prevent bulimia nervosa jerome unpublished one program adopted focus selfesteem odea 2000 effect approaches could evaluated via metaanalyses relation potential harmful effects sufficient evidence suggest harm resulted prevention programs included reviewthe one significant pooled effect current review allow firm conclusions made impact prevention programs eating disorders children adolescents although none pooled comparisons indicated evidence harm clinical perspective development refinement prevention programs complicated lack knowledge risk factors associated eating disorders need strike balance delivering preventive interventions eating disorders considering potential cause harm research perspective idea thresholds identifying young people risk developing eating disorders raised denial concern denial illness represents issue complicating early identification relation eating disorder symptomatology longerterm effects intervention approaches need monitored across development order demonstrate decline incidence eating disorders associated risk factors